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 sF3 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.

We studied the effect on breathing of a conventional and a newly designed abdominal binder in seven patients with complete tetraplegia. The indices of respiratory ability used were the transdiaphragmatic pressure on maximal sniff (sniff Pdi), the maximum static inspiratory mouth pressure (Pimax), and the vital capacity (VC). These were measured in patients with and without binders, in the supine position, raised up to 70°on a tilt

No abstract

On inspiration descent of the diaphragm is opposed by the passive properties of the abdominal wall, the tone of its muscles, and the inertia of the abdominal contents. As a result, intra-abdominal pressure rises and promotes rib cage expansion. In patients with high spinal injury the diaphragm is the most important muscle of inspiration and abdominal wall displacement is more evident than in normal subjects. Abdominal wall compliance has been measured by relating gastric pressure to abdominal wall displacement, which was determined by means of an optical contour mapping system. Six normal subjects and six tetraplegic patients were studied in the supine posture, during passive expiration from total lung capacity to functional residual capacity. Over this lung volume range the normal subjects partitioned an average of 31% of expired volume to the abdominal compartment, while the corresponding average figure in the patients was 77% of expired volume. Since the range of gastric pressure was similar in the two groups, it is concluded that abdominal wall compliance is greater in tetraplegic patients. This high compliance could have a detrimental effect on lower rib cage expansion.Many investigators have noted that the abdominal wall moves more during breathing in tetraplegic patients than in normal subjects. Bergofsky' and Mortola and Sant Ambrogio2 have suggested that it does so because the rib cage is fixed or moves paradoxically. Danon etal3 suggested that paralysis and disuse atrophy of respiratory muscles may disturb the partitioning of compliance between rib cage and abdomen. This paper describes a study of the distensibility of the abdominal wall during a relaxed expiration from total lung capacity (TLC) to functional residual capacity (FRC) in normal subjects and patients with tetraplegia. It was conducted to test the idea that there would be easier abdominal wall displacement and therefore less resistance to descent of the diaphragn in tetraplegic patients than in healthy subjects. The gastric pressure/displaced volume characteristic of the anterolateral abdominal wall was used as a measure of distensibility.

A study was undertaken to determine the ability of patients with complete tetraplegia below cervical sixth segment to transfer in relation to their anthropometric characteristics. Thirty-six chronic patients were assessed and spasticity was measured. A discriminant function analysis was carried out to assess the extent to which a number of anthropometric and anatomical variables could predict the patients' final ability to effect a transfer. Using nine of the original 23 predictor variables it is possible to correctly classify a patient's eventual ability to transfer in 92% of cases.