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Arch Phys Med Rehabil. 2013 Oct;94(10):1990-6. doi: 10.1016/j.apmr.2013.03.027. Epub 2013 Apr 18.

Comparison of muscle and skin perfusion over the ischial tuberosities in response to wheelchair tilt-in-space and recline angles in people with spinal cord injury.

Author information

1
Rehabilitation Research Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL. Electronic address: yjan@illinois.edu.

Abstract

OBJECTIVE:

To compare the efficacy of wheelchair tilt-in-space and recline on enhancing muscle and skin perfusion over the ischial tuberosities in people with spinal cord injury (SCI).

DESIGN:

Repeated-measures and before-after trial design.

SETTING:

University research laboratory.

PARTICIPANTS:

Power wheelchair users with SCI (N=20).

INTERVENTIONS:

Six combinations of wheelchair tilt-in-space and recline angles were presented to participants in a random order. The testing protocol consisted of a baseline 5 minutes sitting with no tilt/recline and 5 minutes positioned in a tilted and reclined position at each of 6 conditions, including: (1) 15° tilt-in-space and 100° recline, (2) 25° tilt-in-space and 100° recline, (3) 35° tilt-in-space and 100° recline, (4) 15° tilt-in-space and 120° recline, (5) 25° tilt-in-space and 120° recline, and (6) 35° tilt-in-space and 120° recline.

MAIN OUTCOME MEASURES:

Muscle and skin perfusion were assessed by near-infrared spectroscopy and laser Doppler flowmetry, respectively.

RESULTS:

Muscle perfusion was significantly increased at 25° and 35° tilt-in-space when combined with 120° recline, and skin perfusion was significantly increased at 3 tilt-in-space angles (15°, 25°, 35°) when combined with 120° recline and at 35° tilt-in-space when combined with 100° recline (P<.05). Even in the positions of increased muscle perfusion and skin perfusion (25° and 35° of tilt-in-space combined with 120° of recline), the amount of muscle perfusion change was significantly lower than the amount of skin perfusion change (P<.05).

CONCLUSIONS:

Our results indicate that a larger angle of tilt-in-space and recline is needed to improve muscle perfusion compared with skin perfusion. A position of 25° tilt-in-space combined with 120° recline is effective in enhancing muscle and skin perfusion of weight-bearing soft tissues at the ischial tuberosities.

KEYWORDS:

DTI; LDF; Laser-Doppler flowmetry; NIRS; NPUAP; National Pressure Ulcer Advisory Panel; Rehabilitation; SCI; Spectroscopy, near-infrared; Sto(2); Wheelchairs; deep tissue injury; laser Doppler flowmetry; near-infrared spectroscopy; saturation of tissue oxygen; spinal cord injury

PMID:
23602880
PMCID:
PMC3787984
DOI:
10.1016/j.apmr.2013.03.027
[Indexed for MEDLINE]
Free PMC Article
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