Decoupled pelvis rotation in sitting: a passive motion technique that regulates buttock load associated with pressure ulcer development

Abstract

Wheelchair-users who cannot reposition themselves often suffer from pressure ulcers which are places of tissue breakdown in the buttock region under the sacrum and ischial tuberosities. Periodic pressure relief is needed to recover the buttock tissue from continuous deformation and impairment of tissue perfusion. Because pelvis alignment directly affects body posture and buttock load, a passive motion technique was developed that adjusts pelvis orientation independent from the trunk and seat support. This study investigates the effects of the so-called decoupled pelvis rotation (DPR) on the loads at the buttock-seat interface and evaluates whether this technique is applicable to regulate buttock load in sitting. Eighteen healthy male subjects participated in this study. Experiments were performed with a computer-aided adjustable simulator chair, instrumented with a concept of DPR. Measurements involved quasi-static actuated pelvis movements in the sagittal and frontal plane. Pelvis orientation, buttock interface pressures, seat reaction forces and centre of pressure were simultaneously measured. As a result of the induced passive pelvis movements, the pelvis rotated 19+/-2 degrees and 9+/-2 degrees in the sagittal and frontal plane, respectively. Significant relations were found between pelvis rotation and most quantities of buttock load. Findings suggest that DPR is an effective technique to regulate buttock load in able-bodied individuals. For clinical application, this technique is still to be evaluated on individuals who cannot functionally reposition themselves. Impairments to the neuromuscular function influence postural response from chair adjustments which makes clinical investigation necessary.