Presented at the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) Annual Conference, 2008, Arlington, VA

Sonenblum, Sharon Eve

Scholarly Materials And Research @ Georgia Tech

Why Full-time Power Wheelchair Users TiltSharon Eve Sonenblum, ScMMonday, June 30th, 2008RESNABackground• Pressure ulcers (PUs) are a problem• PUs are caused by loading • Managed clinically via:– cushions and support surfaces (magnitude)– pressure reliefs (duration)• When independent pressure reliefs are not an option, powered tilt or recline may be employed.Other purposes for tilting?• increased comfort and sitting tolerance secondary to the decreased pressure• increased function– Secondary to increased sitting tolerance and more time out of bed– variable positions available for access and reach in different situations– improved head and neck control – easier transfers• Improved sleep and rest• increased blood flow• easier feeding • improved respiratory function Lacoste et al: A Survey about Tilt and Recline• 40 people • how and why they used their systems – comfort/discomfort/pain– rest/relaxation– posture– functional independence– physiological functions (including pressure reliefs)• 97.5% reported using their tilt or recline system daily• > 70% used their tilt and recline systems for comfort, rest, relaxation, and pain• few participants reported using the chairs for prevention of pressure sores or other physiological functions. Lacoste M, Weiss-Lambrou R, Allard M, Dansereau J. Powered tilt/recline systems: why and how are they used? Assist Technol 2003;15(1):58-68.Purpose of the Current Studies• Monitoring Study: To explore how fulltime power wheelchair users utilized their tilt systems.– Did participants utilize their tilt feature?– Did participants perform regular weight shifts?– Why do people use their tilt?– Why don’t people perform regular pressure reliefs using their tilt system?• Tilt Angle Pilot Study: To determine if people know how far to tilt for pressure reliefsMonitoring StudyMethods: Subjects and Protocol• Convenience sample: N=16 (11 men, 5 women), • Fulltime power wheelchair users• Varying diagnoses• 2 weeks of monitoring• WhAMI (Wheelchair Activity Monitoring Instrument)– Occupancy switches– Accelerometer for tilt angle– Record every 2 seconds• Asked (n=15) why or when they use tilt (open ended) Monitoring StudyReview of Tilt ResultsAll Tilts (Position changes of 5º)• Nearly half of subjects tilted regularly (1x / 15 minutes)Pressure Relieving Tilts (>30º for > 1 minute)• Median subject = 1 pressure relieving tilt every 7 hours • Only 3 subjects performed pressure relieving tilts at least once per hour• Only 6 subjects tilted to 45º• Some subjects never reached 30ºTypical Position• Some subjects spent most of their time between 15º and 30ºSubjectComfort / Discomfort / PainRest / Relaxation PostureFunctional IndependencePhysiological Functions1 X X2 X X X3 X X4 X X5 X X X6 X X7 X X X8 X X9 X X X X10 X X11 X X12 X X X13 X X X14 X X15 XMonitoring StudyPurpose of Tilt Use Comfort/Discomfort/PainNo (6) Yes (9) p-valTypical Position ( ) 7 15 0.290Tilt Frequency / hour of wheelchair occupancy4.9 2.8 0.178PRT Frequency / hour of wheelchair occupancy0.6 0.1 0.194% Time > 30 12% 3% 0.194Rest/RelaxationNo (7) Yes (8) p-valTypical Position ( ) 15 6 0.102Tilt Frequency / hour of wheelchair occupancy4.2 1.6 0.248PRT Frequency / hour of wheelchair occupancy0.2 0.1 0.211% Time > 30 5% 3% 0.441Monitoring StudyMedian Tilt Use By Purpose Tilt use when used for physiological purposes including pressure reliefsPhysiologicalNo (4) Yes (11) p-valTypical Position ( ) 15 8 0.461Tilt Frequency / hour of wheelchair occupancy 2.8 3.2 0.292Pressure Relieving Tilt Frequency / hour of wheelchair occupancy 0.1 0.3 0.598% Time > 30 3% 4% 0.673Comparison with Lacoste et al.’s Survey ResultsSIMILARITIES• 14/15 subjects reported comfort, pain, or rest as a purpose of useDIFFERENCES• Many participants reported physiological purposes• Many participants had at least one day in which they did not use their tilt feature to change position more than 5º.Tilt Angle Pilot Study• Do people know how far to tilt for pressure relief?• Are people aware of how far they are tilted?• Does training help?Tilt Angle StudyAble-bodied Students• N = 11 able bodied students• Adjusted footrests on a tilt-in-space power wheelchair for optimal fit• Asked to tilt “as far as needed for pressure relief”, measure actual angle (x3)• Asked to tilt to 45º, measure actual angle (x3)• Shown 45º of tilt and asked to replicate the position, measure actual angle• 1 week later – ask subjects to tilt to 45ºTilt Angle StudyTilt Angle StudyAble-bodied Students: Before TrainingTaskAngle (degrees)45_DegreesPressure_Relief4540353025201510Tilt Angle StudyAble-bodied Students: Training Effectsangle (degrees)1_Week_Post_TrainingImmediately_Post_TrainingNo_Training555045403530252045subj245678910111223Tilt Angle StudyCurrent Tilt Users• Randomly selected people who use powered tilt wheelchairs were asked to “demonstrate a pressure relief” 3 times• Angle with horizon was measuredTilt Angle StudyCurrent Tilt UsersSubject NumberAvg Tilt Angle (degrees)16141210864207060504030UsingLoanerChairNoYesDiscussionMonitoring Study• Do frequent, small position changes offer restorative benefits to wheelchair users?• How can we predict who will take advantage of their tilt system?Tilt Angle Study• How can we improve training to make sure everyone knows how far to tilt?• What sort of follow-up can we provide to improve retention of knowledge about tilts and pressure reliefs?• If training successfully teaches people how far to tilt, why are some people still not tilting? Acknowledgements• Research Team and Co-Authors– Stephen Sprigle, Ph.D., PT– Chris Maurer, MPT, ATP– Frances Harris, Ph.D.• Many students helped with instrumenting participants and conducting the pilot study• Subjects• Funding Sources– NIDRR – RERC on Wheeled Mobility– NSF Graduate Research Fellowship ProgramQuestions?Future Work• Future work should identify the benefits of small position changes in terms of comfort, pain reduction, and pressure ulcer prevention. • Additionally, it should aim to demonstrate for which subjects the tilt feature will be most beneficial.

Why Full-time Power Wheelchair Users Tilt

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Why Full-time Power Wheelchair Users Tilt

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