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. 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

Yih-Kuen Jan  1 , Barbara A Crane, Fuyuan Liao, Jeffrey A Woods, William J Ennis
Affiliations

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

Yih-Kuen Jan et al. Arch Phys Med Rehabil. 2013 Oct.

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.

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Figures

Fig 1
Fig 1
An example of skin and muscle perfusion in response to 15° tilt-in-space combined with 100° recline and 35° tilt-in-space combined with 120° recline. The 5 min upright sitting was used to induce soft tissue ischemia and the 5 min tilted and reclined period was used to improve muscle and skin perfusion. Muscle and skin perfusion was simultaneously measured at the right and left ischial tuberosities, respectively. (a) Skin perfusion response to 15° tilt-in-space combined with 100° recline. (b) Skin perfusion response to 35° tilt-in-space combined with 120° recline. (c) Muscle perfusion (StO2) response to 15° tilt-in-space combined with 100° recline. (d) Muscle perfusion response to 35° tilt-in-space combined with 120° recline.
Fig 2
Fig 2
Comparison of normalized muscle perfusion in response to wheelchair tilt-in-space (T: 15°, 25°, 35°) in combination with recline (R: 100°, 120°). During tilted and reclined positions, 2 testing positions showed a significant increase in muscle perfusion compared with the upright seated position (P<.05), and the remaining 4 conditions did not show a significant increase in skin perfusion. Data shown as mean ± SE. Abbreviation: BPU, blood perfusion unit.
Fig 3
Fig 3
Comparison of normalized skin perfusion in response to wheelchair tilt-in-space (T: 15°, 25°, 35°) in combination with recline (R: 100°, 120°). During tilted and reclined positions, 4 testing positions showed a significant increase in skin perfusion compared with the upright seated position (P<.05), whereas positions at 15° tilt-in-space combined with 100° recline and 25° tilt-in-space combined with 100° recline did not show a significant increase in skin perfusion. Data shown as mean ± SE. Abbreviation: BPU, blood perfusion unit.
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