Seating and wheelchairs
Amsters D, Nitz J. The consequences of increasing age and duration of injury upon the wheelchair posture of men with tetraplegia.
Int J Rehabil Res. 2006 Dec;29(4):347-9.
Apatsidis DP. Solomonidis SE. Michael SM. Pressure distribution at the seating interface of custom-molded wheelchair seats: effect of various materials. Archives of Physical Medicine and Rehabilitation. 2002 Aug; 83(8): 1151-6.
OBJECTIVE: To identify which of 4 materials has the most favorable pressure distribution when used in custom-molded seats (CMSs) to assist clinicians in providing appropriate seating for wheelchair-bound individuals who are prone to develop pressure ulcers. DESIGN: Repeated-interface pressure measurements for all materials, followed by statistical analysis. SETTING: The general community and referral centers. PARTICIPANTS: Seven subjects, 5 with cerebral palsy, 1 with Schilder's disease, and 1 with postmeningitis effects. All subjects were seated in a CMS and had spinal deformities. INTERVENTIONS: Viscoelastic polyurethane foams (Pudgee, Sunmate) and gels (Floam trade mark, Jay) were used as inserts in the CMSs. Evazote foam was used as a control material. MAIN OUTCOME MEASURES: Pressure readings were taken at the seat interface with pneumatic pressure sensors and the Talley Pressure Monitor. Peak pressure readings, mean pressure ratio, and peak pressure ratio for the different materials were compared. RESULTS: Foams, Sunmate in particular, produced lower peak-interface pressures and also showed better pressure distribution than did gels. CONCLUSION: Foams are the preferred insert material with CMSs when increased tissue breakdown risk is present.
Arthanat S. Strobel W. Wheelchair ergonomics: implications for vocational participation. Journal of Vocational Rehabilitation. 2006; 24(2): 97-109. (81 ref)
Technological advancements and research in wheeled mobility devices continue along many paths. For people with mobility impairments, use of wheelchairs is imperative to vocational functioning and wellbeing. At the same time, a high prevalence of secondary complications attributed to long-term wheelchair usage is clearly indicated in literature. This article reviews research in wheelchair seating, propulsion, and transportation as three domains of wheeled mobility that embody wheelchair ergonomics in work settings. In doing so, some important biomechanical and ergonomic guidelines are drawn from research findings. The information is expected to provide useful directions to people using wheelchairs, co-workers, clinicians, and technology developers in addressing ergonomic issues with wheeled mobility.
Berner TF, Overview of manual wheelchairs and what to consider when making seating and positioning selections OT Practice. 2007 Oct 22; 12(19):
Wheelchair seating and positioning plays an important part in assisting clients with engagement in desired activities and outcomes. An occupational therapy practitioner who does not work closely with seating and positioning technology may not appreciate the options that allow a client to participate in desired occupations. This article reviews the funding parameters for manual wheelchairs and provides an overview of the different types of wheelchair construction and related positioning options. It allows the occupational therapy practitioner to identify which manual wheelchair mobility system will allow full participation in daily life activities and occupations. Note: The Centers for Medicare & Medicaid Services (CMS, 2006b) provides Medicare information related to durable medical equipment (DME). As you review the information related to Medicare, note that the Medicare program has divided the country into four regions for purposes of DME payment. The author practices in Medicare Region B, and her Medicare DME references are specific to that region. It is important to review the specific Medicare region policies related to DME
Bogie, K., Wang, X., Fei, B., & Sun, J. (2008). New technique for real-time interface pressure analysis: getting more out of large image data sets. Journal of Rehabilitation Research and Development 45(4), 523-535.
Call E, Edsberg LE. A new initiative aiming to improve our understanding of shear force.
J Wound Care. 2007 May;16(5):209.
Cantu CO. Wheelchair positioning: foundation in wheelchair selection.
Exceptional Parent. 2004 May; 34(5): 33-5.
Each year new designs and products emerge from wheelchair manufacturers promoting the latest in ideal positioning, comfort, and mobility. Inundated with this barrage of information, parents, caregivers, and practitioners often experience an overwhelming sense of frustration and confusion, instead of clarity and direction, when selecting a wheelchair for their child. Information regarding principles of basic wheelchair positioning maintains focus on physical needs, and emphasizes purpose of occupational (activity) engagement during the selection process.
Chaves ES, Cooper RA, Collins DM, Karmarkar A, Cooper R. Review of the use of physical restraints and lap belts with wheelchair users. Assist Technol. 2007 Summer;19(2):94-107
Chung, J., Evans, J., Lee, C., Lee, J., Rabbani, Y., Roxborough, L., et al. (2008). Effectiveness of adaptive seating on sitting posture and postural control in children with cerebral palsy. Pediatr Phys Ther, 20(4), 303-317.
Clark, M. (2009). Guidelines for seating in pressure ulcer prevention and management. Nurs Times, 105(16), 40-41.
Clark J. Michael S. Morrow M. Wheelchair postural support for young people with progressive neuromuscular disorders. International Journal of Therapy and Rehabilitation. 2004 Aug; 11(8): 365-73.
This study aimed to measure the effects of postural support within the wheelchair on posture, respiration and upper limb function for young people with progressive neuromuscular disorders. A prospective two-period randomized crossover study was used. Participants were 19 people (aged 6-21 years) with a diagnosis of Duchenne muscular dystrophy or Friedreich's ataxia, who required the use of a wheelchair. Participants were assessed for wheelchair seating with a standardized in-depth protocol The new wheelchair seating was then fitted. Sitting posture, respiration and upper limb function when sitting in a standard wheelchair and also when sitting in the adaptive seating were measured.
In the adaptive seating there was a significant improvement in many of the postural measures. No such improvement was found in respiratory function. Participants were able to complete one of the six upper limb function tests more quickly in the adaptive seating.
Adaptive seating within the wheelchair can instantaneously improve sitting posture for this client group. There is, however, potential for the person's position to be over-corrected with inappropriately configured seating. There are no immediate differences in respiratory function and only small differences in upper limb function between the two chairs with the protocol of this study
Coggrave, M. J., & Rose, L. S. (2003). A specialist seating assessment clinic: changing pressure relief practice. Spinal Cord, 41(12), 692-695.
STUDY DESIGN: Description of a clinical service, evaluation of pressure relief practices. OBJECTIVES: To describe a specialist seating assessment clinic and a change in clinical practice arising from its work. SETTING: National Spinal Injuries Centre, Stoke Mandeville Hospital, UK. METHODS: Retrospective review of the ischial transcutaneous oxygen measurements of 50 newly injured and chronic spinal cord-injured (SCI) individuals seen in a specialist seating assessment clinic. Tissue oxygenation was measured in the sitting position (loaded) and during pressure relief (unloaded). RESULTS: Mean duration of pressure relief required to raise tissue oxygen to unloaded levels was 1 min 51 s (range 42 s-3 min 30 s). CONCLUSION: These results confirmed the clinical perception that brief pressure lifts of 15-30 s are ineffective in raising transcutaneous oxygen tension (TcPO(2)) to the unloaded level for most individuals. Sustaining the traditional pressure relief by lifting up from the seat for the necessary extended duration is neither practical nor desirable for the majority of clients. It was found that alternative methods of pressure relief were more easily sustainable and very efficient.
Cohen, L. J., Fitzgerald, S. G., Lane, S., Boninger, M. L., Minkel, J., & McCue, M. (2009). Validation of the seating and mobility script concordance test. Assist Technol, 21(1), 47-56.
Collinger, J., Boninger, M., Koontz, A., Price, R., Sisto, S., Tolerico, M., et al. (2008). Shoulder Biomechanics during the push phase of wheelchair propulsion: a multisite study of persons with paraplegia. Archives of Physical Medicine and Rehabilitation, 89, 667-676.
Collins, F. (2001). An adequate service? Specialist seating provision in the UK. Journal of Wound Care, 10(8), 333-337.
Collins, F. (2001). How to assess a patient's seating needs: some basic principles. Journal of Wound Care, 10(9), 383-386.
Collins, F. (2008). An essential guide to managing seated patients in the community. British Journal of Community Nursing, 13(3), S39-40, S42-33, S45-36.
Cooper, R. A. (2009). SMARTWheel: From concept to clinical practice. Prosthetics and Orthotics International 33(3), 198-209.
Crane, B. A., Holm, M. B., Hobson, D., Cooper, R. A., & Reed, M. P. (2007). Responsiveness of the TAWC tool for assessing wheelchair discomfort. Disability and Rehabilitation: Assistive Technology, 2(2), 97-103.
DiGiovine CP, Cooper RA, Wolf E, Fitzgerald SG, Boninger ML.
Analysis of whole-body vibration during manual wheelchair propulsion: a comparison of seat cushions and back supports for individuals without a disability. Assist Technol. 2003 Winter;15(2):129-44.
Whole-body vibration exposure has been found to be detrimental to the health of humans owing to effects such as degraded comfort, disc degeneration, and lower back pain. The purpose of this study was to determine if selected seat cushions and back supports minimize the transmission of vibrations during manual wheelchair propulsion. Ten unimpaired participants traversed an activities of daily living course using four seat cushions and four back supports. Vibrations were measured using triaxial accelerometers. The time domain and frequency domain transmissibility was used to determine if differences exist among seat cushions and back supports. Differences were found among the four seat cushions and four back supports. Seat cushion and back support manufacturers should concentrate on single-event shocks and repeated shocks, as opposed to oscillatory motions and self-generated vibrations, because the vibrations generated by these events tend to reside in the range of frequencies most sensitive to humans. Vibrations in this range of frequencies have the greatest effect on the transmission of whole-body vibration during manual wheelchair propulsion. Differences among the seat cushions and back supports appear to be due to the seat cushion/back support design and postural support. From a clinical perspective, the time domain transmissibility best describes the transmission of whole-body vibration.
Di Marco A. Russell M. Masters M Standards for wheelchair prescription.
Australian Occupational Therapy Journal. 2003 Mar; 50(1): 30-9. (34 ref)
Wheelchair prescription for individuals with a spinal cord injury is a highly complex and challenging clinical intervention. Evidence exists that successful outcomes are not always achieved for the wheelchair user and that therapists are experiencing increasing pressure to be accountable for and to justify their wheelchair prescription practice. This paper describes the process of establishing an evaluation of wheelchair prescription practices by occupational therapists in a spinal injury rehabilitation unit in South Australia. The evaluation process centred on the development of standards of practice to monitor performance and led to improvements in: (i) service delivery practices; (ii) wheelchair user participation; and (iii) accountability and justification of service delivery. Steps taken to develop the standards of practice to monitor performance and the benefits and limitations of the evaluation are described.
Ding D, Cooper RA, Cooper R, Kelleher A. Monitoring Seat Feature Usage among Wheelchair Users. Conf Proc IEEE Eng Med Biol Soc. 2007;1:4364-7.
Drinka PJ. Hypotensive syncope in a wheelchair. J Am Med Dir Assoc. 2007 May;8(4):271.
Edlich RF, Winters KL, Woodard CR, Buschbacher RM, Long WB, Gebhart JH, Ma EK. Pressure ulcer prevention. J Long Term Eff Med Implants. 2004;14(4):285-304.
Eitzen I. Pressure mapping in seating: a frequency analysis approach. Archives of Physical Medicine and Rehabilitation. 2004 Jul; 85(7): 1136-40.
OBJECTIVES: To discuss the methodologic challenges related to pressure mapping in seating and to present a new approach to the analysis and interpretation of results: the frequency analysis approach. DESIGN: Pressure mapping was performed on 3 prototypes of a newly developed foam and gel seat cushion. SETTING: Data collection was done in a private laboratory. PARTICIPANTS: Eight nondisabled men. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Average pressure, peak values, and the size of the contact area were measured continuously for 74 minutes on each cushion prototype. A supplementary frequency analysis provided information on the number of times each value occurred during the measurement period. RESULTS: Average pressure and peak values showed only very small, nonsignificant changes over the measurement period for all variants. The frequency analysis, however, showed significant differences that enabled the manufacturer to select the prototype best suited for further development. CONCLUSIONS: Verifying significant differences in pressure-relieving properties between products has to date been difficult. Findings from this study indicate that a frequency analysis approach may enable more adequate and precise ways to perform such studies
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Ferguson-Pell, M., Nicholson, G., Bain, D., Call, E., Grady, J., & deVries, J. (2005). The role of wheelchair seating standards in determining clinical practices and funding policy. Assistive Technology, 17(1), 1-6.
The development of international standards for wheelchair seating offers practical benefits in the process of matching technical characteristics of assistive technologies to individual user needs. However, information provided in technical test reports must be treated with caution when aggregating technical characteristics to classify products or when implementing funding policy. This article suggests that clustering technical characteristics of seat cushions in isolation of clinical and other user requirements is not a viable way to establish product funding codes that are responsive to clinical need.
Fernandes T. Equipment. Choosing a manual wheelchair: the options.
International Journal of Therapy and Rehabilitation. 2007 Feb; 14(2): 89-90, 92-3.
There are a variety of manual wheelchairs available on the market designed to help individuals with mobility difficulties to carry out daily living tasks as independently as possible. Participation in such activities is crucial in enabling users to integrate into society and prevent isolation as a result of a disability. A holistic approach to assessment should take into account all aspects of individual need and will result in the selection of the most appropriate piece of equipment, which in turn may result in an improvement in the quality of life for any individual with an impairment of function. This article will look at the considerations that need to be taken into account when prescribing manual wheelchairs as well as highlighting some of the options available on the market.
Finley MA, Rodgers MM. Effect of 2-speed geared manual wheelchair propulsion on shoulder pain and function.Arch Phys Med Rehabil. 2007 Dec;88(12):1622-7.
Fuchs, R. H., & Gromak, P. A. (2003). Wheelchair use by residents of nursing homes: effectiveness in meeting positioning and mobility needs. Assistive Technology, 15(2), 151-163.
Gagnon B, Noreau L, Vincent C. Reliability of the seated postural control measure for adult wheelchair users. Disabil Rehabil. 2005 Dec 30;27(24):1479-91.
PURPOSE: To evaluate the test-retest and interrater reliability of the Seated Postural Control Measure for Adults 1.0 (SPCMA 1.0).METHOD: The participants were evaluated first by two raters and then, 3 weeks later, by one rater. Section 1 (one item, seven-point scale) evaluates the adult's overall ability to control its posture in a sitting position. Sections 2 and 3 (22 items each, scored on a seven-point scale), evaluate the adult's postural alignment in a static position and the changes in postural alignment induced by a dynamic activity.RESULTS: For the test-retest reliability, the intraclass correlation coefficient (ICC) of section 1 was excellent (0.95) and moderate to good for sections 2 and 3 (0.60 - 0.62) and their subsections (0.47 - 0.78). For interrater reliability, the three sections had good to excellent ICCs (0.68 - 0.93) and their subsections had moderate to good ICCs (0.41 - 0.69). A large range was observed in Kappa coefficients (test-retest and interrate!
r reliability) for the item analysis of the sections 2 and 3, due to a lack of variability in some items.CONCLUSIONS: The results confirm that the SPCMA is reliable as a whole. Suitable information has been obtained for the development of the SPCMA 2.0 and, although further psychometric testing is needed, the latter should improve clinical evaluation of seated postural control in adult wheelchair users.
Gagnon B, Vincent C, Noreau L. Adaptation of a seated postural control measure for adult wheelchair users. Disabil Rehabil. 2005 Aug 19;27(16):951-9.
Gavin-Dreschnack, D. (2004). Effects of wheelchair posture on patient safety. Rehabilitation Nursing, 29(6), 221-226.
Wheelchairs originally were designed to transport people from one place to another quickly and easily. They have evolved to rank among the most important therapeutic de-vices used in rehabilitation. Currently, an estimated 2.2 mil-lion people who use wheelchairs generally are living longer and moving about more. However, the increased use of wheelchairs has been accompanied by many types of ad-verse events and repetitive stress injuries. Wheelchair prescription, posture, training, and maintenance are critical components of safety in this population, and may be enhanced through increased awareness and education. Since nurses and nursing staff are most often involved directly with wheelchair users (particularly in long-term-care settings), providing specialized programs for adaptive wheelchair fitting allows for a proactive approach to seating problems.
Gefen A. The biomechanics of sitting-acquired pressure ulcers in patients with spinal cord injury or lesions. Int Wound J. 2007 Sep;4(3):222-31
Geyer MJ, Brienza DM, Bertocci GE, Crane B, Hobson D, Karg P, Schmeler M, Trefler E. Wheelchair seating: a state of the science report. Assist Technol. 2003 Winter;15(2):120-8.
Regardless of the field, agenda-setting processes are integral to establishing research and development priorities. Beginning in 1998, the National Institute on Disability and Rehabilitation Research mandated that each newly funded Rehabilitation Engineering and Research Center (RERC) hold a state-of-the-science consensus forum during the third year of its 5-year funding cycle. NIDRR's aim in formalizing this agenda-setting process was to facilitate the formulation of future research and development priorities for each respective RERC. In February 2001, the RERC on Wheeled Mobility, University of Pittsburgh, conducted one of the first such forums. The scope encompassed both current scientific knowledge and clinical issues. In preparation, expert interviews were carried out to establish the focus for the forum. Because a stakeholder forum on wheelchair technology had recently been held, opinion favored wheelchair seating as the focus and included the following core areas: seating for use in wheelchair transportation, seated postural control, seating discomfort, and tissue integrity management. The aim of this report is to present a summary of the workshop outcomes, describe the process, and increase awareness of this agenda-setting process in order to enhance future participation in a process that critically influences the field of wheeled mobility.
Gilinsky G. Smith C, New wheelchair or new solutions? Rehab Management: The Interdisciplinary Journal of Rehabilitation. 2006 Jan-Feb; 19(1): 34, 36, 38-9.
Informed evaluations help experts determine appropriate wheelchair seating solutions for patients' individual requirements.
Grady S. Adaptive seating standards. Rehab Manag. 2006 Jan-Feb;19(1):50, 52, 54.
Gregorio-Torres TL. Wheelchair and seating evaluation: an occupational therapy approach. OT Practice. 2006 Jun 26; 11(11): Suppl: CE-1-CE-8, 2p.
"Occupational therapy practitioners' understanding of their clients' daily occupational needs, abilities, and contexts make them ideal collaborators in the design, development, and clinical application of new or customized technological devices" (American Occupational Therapy Association [AOTA], 2004, p. 678). It is understood that occupational performance results from the complex interaction of an individual performing an occupation within contexts (AOTA, 2002). An effective wheelchair mobility system is perhaps the most essential tool that persons with mobility impairments use to regain some of the control lost as a result of trauma or disease. Having an optimal wheelchair and seating system is crucial to occupational success whether a person is pursuing a career, managing a household, or volunteering in the community. An appropriate mobility system improves the likelihood that a person will have a healthy, productive life.
Prescribing an appropriate wheelchair and seating system can be daunting for any occupational therapist, especially for today's therapist. Over the past 20 years, an explosion of new technology has greatly enhanced the effectiveness of seating for persons needing a wheelchair. At the same time, these advances in mobility technology have presented many challenges to occupational therapy practitioners who wish to stay abreast of the latest options (Cooper, 1998; Isaacson, 2004). In contrast, as wheelchair technology has expanded, financial issues surrounding the payment for such systems have become increasingly complex and, at times, very limiting. Most recently, changes in Medicare coverage guidelines for powered mobility challenge therapists to adapt their practice in this area once again. This article presents an overview of the elements of an effective evaluation for mobility and seating systems, with an emphasis on occupational outcomes, and outlines resources and ways to continue to remain current in this ever-changing aspect of practice
Gutierrez EM, Alm M, Hultling C, Saraste H. Measuring seating pressure, area, and asymmetry in persons with spinal cord injury.Eur Spine J. 2004 Jul;13(4):374-9. Epub 2003 Nov 25.
Hastings JD. Fanucchi ER. Burns SP Wheelchair configuration and postural alignment in persons with spinal cord injury.
Archives of Physical Medicine and Rehabilitation. 2003 Apr; 84(4): 528-34.
OBJECTIVE: To determine whether postural alignment and shoulder flexion range differ for persons with spinal cord injury (SCI) seated in wheelchairs with standard configurations versus wheelchairs with posterior seat inclination and a low backrest set perpendicular to the floor. DESIGN: Prospective repeated-measures study. SETTING: Outpatient SCI clinic. PARTICIPANTS: Fourteen subjects with C6-T10 motor-complete SCI. INTERVENTIONS: Subjects sat in 3 manual wheelchairs: standard setup E&J Premier (S1), standard setup Quickie Breezy (S2), and test configuration Quickie TNT (T) with posterior seat inclination and a low backrest set perpendicular to the floor. MAIN OUTCOME MEASURES: Shoulder and neck alignment and pelvic tilt were determined from sagittal plane digital photographs at rest and with maximal vertical reach. RESULTS: At rest, T produced less shoulder protraction than either standard configuration (difference between the mean values, S1: 1.6 cm, P=.048; S2: 1.2 cm, P=.013). S1 and S2 showed a greater head-forward position than T (differences between the mean values, S1: 6.5 degrees, P=.008; S2: 6.3 degrees, P=.013). T allowed greater humeral flexion than S2 (difference between the mean values: 3.7 degrees, P=.036) and greater vertical reach above the seat plane than either conventional configuration (differences between the mean values, S1: 4.7 cm, P=.005; S2: 4.1cm, P=.002). The indirect pelvic tilt measurement showed a trend (P=.06) toward greater posterior pelvic tilt with S1 and S2. CONCLUSION: The alternate configuration produces more vertical postural alignment and greater reach ability versus the standard factory setup wheelchairs.
Hatta, T., Nishimura, S., Inoue, K., Yamanaka, M., Maki, M., Kobayashi, N., et al. (2007). Evaluating the relationships between the postural adaptation of patients with profound cerebral palsy and the configuration of the Seating Buggy's seating support surface. Journal of Physiological Anthropology 26(2), 217-224.
Huhn K, Guarrera-Bowlby P, Deutsch JE.
The clinical decision-making process of prescribing power mobility for a child with cerebral palsy. Pediatr Phys Ther. 2007 Fall;19(3):254-60.
Kennedy, P., Berry, C., Coggrave, M., Rose, L., & Hamilton, L. (2003). The effect of a specialist seating assessment clinic on the skin management of individuals with spinal cord injury. Journal of Tissue Viability, 13(3), 122-125.
Kirby RL. Smith C. Seaman R. MacLeod DA. Parker K. The manual wheelchair wheelie: a review of our current understanding of an important motor skill. Disability and Rehabilitation: Assistive Technology. 2006 Jan-Jun; 1(1-2): 119-27.
Purpose. To review the current understanding of the manual wheelchair wheelie.
Method. Review of the literature.
Results. A rear wheelchair wheelie occurs when the front wheels, ordinarily in contact with the support surface, are intentionally caused, by means of transient or sustainable rear pitch, to lift from the surface while the rear wheels remain on the surface. Pitch control (partial or full) is the foundation of many wheelchair skills (e.g., negotiating thresholds, potholes, curbs, steep inclines and gravel). Yet, most wheelchair users never learn to perform this valuable skill. Wheelie capability is affected by the characteristics of the clinician, the wheelchair user, the wheelchair and the environment. Although our understanding of wheelie biomechanics and training methods is evolving, much remains to be learned. Three recent wheelchair developments have wheelie-related implications: new type of rear anti-tip device (Arc-RAD) that permits wheelie-like function, pushrim-activated power-assisted wheelchairs (PAPAWs) that make wheelie-dependent skills more dangerous and diffi!
cult, and powered wheelchair that has robotic wheelie capabilities (the IBOT).
Conclusions. Improvements in our understanding of the nature of wheelies, formalization of training protocols and innovations in wheelchair design hold promise for improved activities and participation by wheelchair users.
Krey CH, Calhoun CL. Utilizing research in wheelchair and seating selection and configuration for children with injury/dysfunction of the spinal cord. J Spinal Cord Med. 2004;27 Suppl 1:S29-37.
Krey CH, Special seating considerations for the child with a spinal cord injury.
International Journal of Therapy and Rehabilitation. 2005 Feb; 12(2): 84-6.
Although wheelchair and seating set-up for the paediatric population is a specialty itself, the child who has sustained a spinal cord injury has several distinct orthopaedic needs that must be addressed, specifically, the issues of neuromuscular scoliosis and hip subluxation. These two factors, as well as the biomechanics and kinematics of wheelchair propulsion, will be discussed.
This article reviews current published research regarding orthopaedic needs in paediatric spinal cord injury, wheelchair pushrim biomechanics in adults with spinal cord injury and clinical experience. It concludes that preventative measures such as proper seating positioning and wheelchair set-up should be taken early on to decrease the chance of, or at least slow the rate of development of a scoliotic curve, hip subluxation or an upper extremity over-use injury.
Lalonde NM, Dansereau J, Pauget P, Cinquin P, Aissaoui R. Accessing the influence of repositioning on the pelvis' 3-D orientation in wheelchair users. IEEE Trans Neural Syst Rehabil Eng. 2006 Mar;14(1):76-82
Lin F, Parthasarathy S, Taylor SJ, Pucci D, Hendrix RW, Makhsous M.
Effect of different sitting postures on lung capacity, expiratory flow, and lumbar lordosis. Arch Phys Med Rehabil. 2006 Apr;87(4):504-9.
Lim D, Lin F, Hendrix RW, Moran B, Fasanati C, Makhsous M. Evaluation of a new sitting concept designed for prevention of pressure ulcer on the buttock using finite element analysis. Med Biol Eng Comput. 2007 Nov;45(11):1079-84.
Linder-Ganz E, Scheinowitz M, Yizhar Z, Margulies SS, Gefen A. How do normals move during prolonged wheelchair-sitting? Technol Health Care. 2007;15(3):195-202.
McDonald, R. L., & Surtees, R. (2007). Longditudinal study evaluating a seating system using a sacral pad and kneeblock for children with cerebral palsy. Disability and Rehabilitation, i-First article, 1-7
Makhsous M, Rowles DM, Rymer WZ, Bankard J, Nam EK, Chen D, Lin F.
Periodically relieving ischial sitting load to decrease the risk of pressure ulcers. Arch Phys Med Rehabil. 2007 Jul;88(7):862-70
Makhsous M, Priebe M, Bankard J, Rowles D, Zeigler M, Chen D, Lin F.
Measuring tissue perfusion during pressure relief maneuvers: insights into preventing pressure ulcers. J Spinal Cord Med. 2007;30(5):497-507.
Makhsous, M., Lin, F., Knaus, E., Zeigler, M., Rowles, D. M., Gittler, M., et al. (2009). Promote pressure ulcer healing in individuals with spinal cord injury using an individualized cyclic pressure-relief protocol. Advances in Skin Wound Care, 22(11), 514-521.
Maurer CL, Sprigle S. Effect of seat inclination on seated pressures of individuals with spinal cord injury. Phys Ther. 2004 Mar;84(3):255-61.
McNamara, L., & Casey, J. (2007). Seat inclinations affect the function of children with cerebral palsy: a review of the effect of different seat inclines. Disability and Rehabilitation: Assistive Technology, 2(6), 309-318.
Miller, W. C., Miller, F., Trenholm, K., Grant, D., & Goodman, K. (2004). Development and preliminary assessment of the measurement properties of the Seating Identification Tool (SIT). Clinical Rehabilitation, 18(3), 317-325.
Mills TL, Holm MB, Schmeler M. Test-retest reliability and cross validation of the functioning everyday with a wheelchair instrument. Assist Technol. 2007 Summer;19(2):61-77.
Morress C. Bottom-up or top-down? An occupation-based approach to seating. OT Practice. 2006 Sep 11; 11(16): 12-7.
Mortenson, W. B., & Miller, W. C. (2008). The wheelchair procurement process: perspectives of clients and prescribers. Canadian Journal of Occupational Therapy, 75(3), 167-175.
Olshansky K. The chair: low-tech device helps prevent pressure ulcers.
Adv Skin Wound Care. 2006 Mar;19(2):68.
Paleg G. Pediatric seating and support. Rehab Manag. 2006 Jan-Feb;19(1)
Paleg G. A proper position. Determining the appropriate seating and positioning for transporting the pediatric client. Rehab Manag. 2007 Aug-Sep;20(7):16, 18, 20.
Ragan R. Kernozek TW. Bidar M. Matheson JW. Seat-interface pressures on various thicknesses of foam wheelchair cushions: a finite modeling approach. Archives of Physical Medicine and Rehabilitation. 2002 Jun; 83(6): 872-5.
OBJECTIVE: To investigate the effect of cushion thickness on subcutaneous pressures during seating by using a finite element modeling approach. DESIGN: Seat-interface pressure measurements were used in a computational model. SETTING: Biomechanics laboratory. PARTICIPANT: A single healthy man (weight, 70 kg). INTERVENTIONS: Subject sat upright either with or without cushions of various heights. Seat-interface pressures measured by using a sensor mat interfaced to a personal computer sampling at 15 Hz. MAIN OUTCOME MEASURES: Peak seat-interface pressure; finite-element software was used to model the buttock, ischial tuberosity, and seat cushion. Subcutaneous stresses were calculated from the model. RESULTS: The region of highest subcutaneous stress in the soft tissue was concentrated within 1 or 2 cm of the ischial tuberosity, with the maximum compressive stress inferior to the bottom surface of the ischial tuberosity. The maximum subcutaneous stress, maximum seat-interface pressure, and maximum subcutaneous shear stress each changed with cushion thickness. Subcutaneous pressures decreased with thicker cushions, but almost all of the reduction was obtained with an 8-cm cushion. The amount of subcutaneous shear stress increased slightly for thicker cushions. The maximum subcutaneous stress was greater than the maximum interface pressure but not by a constant factor. Instead, the former was consistently larger by 0.7 to 0.8 N/cm(2). CONCLUSIONS: Cushion use reduced the maximum subcutaneous stress inferior to the ischial tuberosity. However, increasing the cushion thickness beyond 8 cm was ineffective in further reducing subcutaneous stress. It was also found that seat-interface pressures were a good indicator of the subcutaneous stress reduction in seating.
Rigby, P. J., Ryan, S. E., & Campbell, K. A. (2009). Effect of adaptive seating devices on the activity performance of children with cerebral palsy. Arch Phys Med Rehabil, 90(8), 1389-1395.
Rindflesch AB. Miller NE Technical perspectives. The thoracic suspension orthosis -- a seating option for patients with pressure ulcers. Journal of Spinal Cord Medicine. 2002 Winter; 25(4): 306-9.
BACKGROUND/OBJECTIVE: For patients with pressure ulcers, wound healing and prevention are important steps in reducing disability. Ulcers that fail to heal adequately may interfere with normal sitting. By relieving pressure, the thoracic suspension orthosis (TSO) may allow some patients with recurrent pressure ulcers to return to sitting and sit for longer periods. METHODS: In this retrospective case series, 6 patients with chronic pressure ulcers were managed with TSO. Each patient had at least one of the following: (1) severe, non-healing pressure ulcers unresponsive to standard therapy, (2) recurrent ulcers requiring multiple surgeries, (3) chronic pain associated with sitting, or (4) bilateral lower extremity amputation resulting in instability or ischial pain in the seated position. RESULTS: Each participant had a favorable functional outcome. Patients were able to resume modified sitting. Others were able to sit for longer periods. Some have used the TSO for long-term management. CONCLUSIONS: A TSO is an additional seating option for patients with chronic pressure ulcer, chronic pain associated with sitting, or bilateral lower extremity amputation. It is recommended after less restrictive, conservative measures have failed. In some patients, it has been used in lieu of extreme surgical measures.
Rithalia S. A guide to evaluating different wheelchair seat cushions. International Journal of Therapy and Rehabilitation. 2005 May; 12(5): 226-9.
Over the years, there has been a considerable increase in the number and variety of wheelchair seat cushions. People required to select a cushion are faced with a confusing and often misleading array of commercial literature. The cost of these products range from less than f 100 to several hundred pounds, so the importance of a logical approach to their selection cannot be overstated. Inappropriate selection not only wastes capital resources, but it can also be very harmful to the patient.
Although the effectiveness of a wheelchair cushion is best evaluated through clinical trials, these are expensive to conduct and in the case of new products, such evidence is not readily available. In order to overcome this drawback, researchers have developed experimental methods of evaluation based upon existing knowledge of pressure ulcer aetiology. This article describes the most common methods, along with a new technique known as pressure relief index.
Rosen L. Sit on it: recommending the correct wheelchair cushion is key to maintaining the health of patients. Rehab Management: The Interdisciplinary Journal of Rehabilitation. 2005 Mar; 18(2): 36, 38-41.
Ryan, S. E., Campbell, K. A., Rigby, P. J., Fishbein-Germon, B., Hubley, D., & Chan, B. (2009). The impact of adaptive seating devices on the lives of young children with cerebral palsy and their families. Arch Phys Med Rehabil, 90(1), 27-33.
Sabol TP. Haley ES, Wheelchair evaluation for the older adult. Clinics in Geriatric Medicine. 2006 May; 22(2): 355-75.
This article focuses on basic principles of seating and wheelchair evaluation for the general population. The discussion includes wheelchair options, components, and accessories. Basic principles to guide the clinician in the process of selection for maximum function are addressed.
Sawatzky BJ, Denison I. Wheeling efficiency: the effects of varying tyre pressure with children and adolescents. Pediatr Rehabil. 2006 Apr-Jun;9(2):122-6.
Schindler, K., Dietz, P., & Bennett, R. (2008). Fitting wheelchairs to residents. Provider, 34(5), 31-33.
Shirado O, Kawase M, Minami A, Strax TE. Quantitative evaluation of long sitting in paraplegic patients with spinal cord injury. Arch Phys Med Rehabil. 2004 Aug;85(8):1251-6.
Sprigle S, Maurer C, Holowka M. Development of valid and reliable measures of postural stability. J Spinal Cord Med. 2007;30(1):40-9.
Stavness C. The effect of positioning for children with cerebral palsy on upper-extremity function: a review of the evidence. Phys Occup Ther Pediatr. 2006;26(3):39-53.
Stinson, M. D., Crawford, S. A., & Porter-Armstrong, A. P. (2008). Interface pressure measurements: visual interpretation of pressure maps with MS clients. Disabil Rehabil, 30(8), 618-624.
Stockton, L., Gebhardt, K. S., & Clark, M. (2009). Seating and pressure ulcers: clinical practice guideline. Journal of Tissue Viability, 18(4), 98-108.
Stockton L. Parker D. Pressure relief behaviour and the prevention of pressure ulcers in wheelchair users in the community.
Journal of Tissue Viability. 2002 Jul; 12(3): 84, 88, 90 passim. (18 ref)
This study aims to provide an insight into wheelchair users' preventative health behaviours with respect to pressure-relief behaviour, perceived risk and attribution of responsibility for preventative health measures. Wheelchair users who are dependent upon a wheelchair for their indoor and outdoor mobility have a long-term risk of developing a pressure ulcer. In an attempt to lessen the risk they need to perform pressure-relieving movements frequently. The Department of Health currently advises wheelchair users to perform a pressure-relieving movement every 15 minutes. Many wheelchair users responding to this large scale survey reported that although they were physically capable of performing pressure-relieving movements without help, they either did not do them or did not adhere to current advice. Of those who responded, 20.8% moved only once an hour and a further 54.7% moved less often than once an hour. This study is part of a wider study investigating the preventative health behaviours of wheelchair users.
Stockton, L., & Rithalia, S. (2008). Is dynamic seating a modality worth considering in the prevention of pressure ulcers? Journal of Tissue Viability, 17(1), 15-21.
Trefler, E., Fitzgerald, S. G., Hobson, D. A., Bursick, T., & Joseph, R. (2004). Outcomes of wheelchair systems intervention with residents of long-term care facilities. Assistive Technology, 16(1), 18-27.
Tsai KH, Yeh CY, Lo HC, Lin SY.
Controllability and physiological evaluation of three unilaterally-propelled wheelchairs for patients with hemiplegia.
J Rehabil Med. 2007 Nov;39(9):693-7.
Turner C. Posture and seating for wheelchair users: an introduction. British Journal of Therapy & Rehabilitation. 2001 Jan; 8(1): 24, 26-8.
Despite the fact that postural management in mobility seating is so important, many people seem to forget about it. To the uninitiated a wheelchair is merely a method of moving a person from point A to point B. The recognition of the functional independence benefits of good postural management for people in wheelchairs is becoming self-evident.
van Geffen, P., Reenalda, J., Veltink, P. H., & Koopman, B. F. (2008). Effects of sagittal postural adjustments on seat reaction load. Journal of Biomechanics, 41(10), 2237-2245.
Vekerdy Z. Management of seating posture of children with cerebral palsy by using thoracic-lumbar-sacral orthosis with non-rigid SIDO frame. Disabil Rehabil. 2007 Sep 30;29(18):1434-41.
Waugh, K. G. (2005). Measuring the right angle. Rehab Management, 18(1), 40, 43-47.
Wick JY, Zanni GR. Wheelchair-bound residents in nursing facilities: the basics. Consult Pharm. 2007 Feb;22(2):119-22, 132-4, 137-9
Wright, C., Casey, J., & Porter-Armstrong, A. (2010). Establishing best practice in seating assessment for children with physical disabilities using qualitative methodologies. Disability and Rehabilitation: Assistive Technology, 5(1), 34-47.