Effect of durations of wheelchair tilt-in-space and recline on skin perfusion over the ischial tuberosity in people with spinal cord injury

Objective: To compare the efficacy of various durations of wheelchair tilt-in-space and recline on enhancing skin perfusion over the ischial tuberosity in people with spinal cord injury (SCI). Design: Repeated-measures, intervention and outcomes measure design. Setting: University research laboratory. Participants: Power wheelchair users with SCI (N=9). Interventions: Three protocols of various durations (3min, 1min, and 0min) of wheelchair tilt-in-space and recline were randomly assigned to the participants. Each protocol consisted of a baseline 15-minute sitting, a duration of 0- to 3-minute reclined and tilted, a second 15-minute sitting, and a 5-minute recovery. The position at the baseline and the second sitting was no tilt/recline of the participant and at the reclined and tilted and recovery was at 35° tilt-in-space and 120° recline. Main Outcome Measures: Skin perfusion response to tilt and recline was assessed by laser Doppler and was normalized to mean skin perfusion at the baseline sitting. Results: The results showed that mean skin perfusion during recovery at the 3-minute duration was significantly higher than that at the 1-minute duration (P<.017) and mean skin perfusion was not significantly different between the 1-minute and 0-minute durations (not significant). Skin perfusion during the second sitting was significantly higher at the 3-minute duration than at the 1-minute and 0-minute durations (P<.017). Conclusions: Our findings suggest that performing the 3-minute duration of wheelchair tilt-in-space and recline is more effective than the 1-minute duration in enhancing skin perfusion of weight-bearing soft tissues.