A specialist seating assessment clinic: changing pressure relief practice

Coggrave, Maureen; Rose, Lone

doi:10.1038/sj.sc.3101527

Cited by 102 publications

(69 citation statements)

References 7 publications

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“…Recently, the guidelines for pressure relief by weight-relief lifting have been revised in the Netherlands, 27 as a result of a study by Coggrave and Rose, 28 who found that traditional lifting was not efficient. In the light of the results of our study and other research 13,28 this policy change makes sense.…”

Section: Weight-relief Liftmentioning

confidence: 99%

Mechanical Load on the Upper Extremity During Wheelchair Activities

Drongelen

Woude

Janssen

et al. 2005

Archives of Physical Medicine and Rehabilitation

144

110

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ABSTRACT. van Drongelen S, van der Woude LH, Janssen TW, Angenot EL, Chadwick EK, Veeger DH. Mechanical load on the upper extremity during wheelchair activities. Arch Phys Med Rehabil 2005;86:1214-20.Objective: To determine the net moments on the glenohumeral joint and elbow joint during wheelchair activities.Design: Kinematics and external forces were measured during wheelchair activities of daily living (level propulsion, riding on a slope, weight-relief lifting, reaching, negotiating a curb) and processed in an inverse dynamics biomechanic model.Setting: Biomechanics laboratory. Participants: Five able-bodied subjects, 8 subjects with paraplegia, and 4 subjects with tetraplegia.Interventions: Not applicable. Main Outcome Measure: Net moments on the glenohumeral joint and elbow joint.Results: Peak shoulder and elbow moments were significantly higher for negotiating a curb and weight-relief lifting than for reaching, level propulsion, and riding on a slope. Overall, the elbow extension moments were significantly lower for subjects with tetraplegia than for those with paraplegia.Conclusions: The net moments during weight-relief lifting and negotiating a curb were high when compared with wheelchair propulsion tasks. Taking the effect of frequency and duration into account, these loads might imply a considerable risk for joint damage in the long term.Key Words: Activities of daily living; Biomechanics; Elbow; Rehabilitation; Shoulder; Wheelchairs. © 2005 by American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and RehabilitationI N HANDRIM WHEELCHAIR USERS, the upper extremities are at serious risk of overuse injuries. Wheelchair use requires continuous use of the upper extremities, not only for mobility but also for transfers, weight-relief lifts, and reaching activities. Studies 1,2 have shown that shoulder pain and impingement frequently occur among people with a spinal cord injury (SCI). Pain is experienced during wheelchair-related activities of daily living (ADLs), such as wheelchair propulsion and performing transfers. Because these activities are essential for functional independence, quality of life, and even the life expectancy of people after an SCI, 3 evaluating the mechanical load on the shoulder is important to an understanding of the mechanisms that may cause upper-extremity joint degeneration. Factors that have been mentioned as contributors to the development of shoulder complaints are the relatively high load and high frequency of this load on the shoulder during wheelchair propulsion. 4 In addition, and possibly even more important, the load on the shoulder during other wheelchairrelated tasks, such as transfers and weight-relief lifts, has been mentioned. [5][6][7] In our study, we used net moments around the elbow and the glenohumeral joint (GHJ) to quantify the mechanical load on those joints. Net joint moments are generally used to analyze (working) conditions and to classify these conditions. 8 To show the high loading at the shoulder, studies 9-12 have ...

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Section: Weight-relief Liftmentioning

confidence: 99%

Mechanical Load on the Upper Extremity During Wheelchair Activities

Drongelen

Woude

Janssen

et al. 2005

Archives of Physical Medicine and Rehabilitation

144

110

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show abstract

“…The study concluded that the biggest reduction in maximum pressure at the ischial tuberosities was found at 45° of tilt-inspace and 120° of backrest recline and that an effective weight shift could be achieved only when tilt-in-space is >15° [4]. As for the time required for pressure relief, Coggrave and Rose described measuring transcutaneous oxygen tension to effectively determine when pressure relief becomes adequate [10]. They measured the time taken for subjects to return their tissue oxygen to unloaded levels and found that brief pressure lifts for 15 to 30 seconds did not relieve pressure for most people, while longer lifts for an average of 111 seconds were required to return tissue oxygen to unloaded levels.…”

Section: Introductionmentioning

confidence: 99%

Usage of tilt-in-space, recline, and elevation seating functions in natural environment of wheelchair users

Ding

Leister²,

Cooper³

et al. 2008

JRRD

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Abstract-This study examined the usage of powered seating functions, including tilt-in-space, backrest recline, and seat elevation, among a group of wheelchair users during their typical daily activities. Twelve individuals who used a power wheelchair with seating functions participated in the study. They drove their own wheelchair and used the seating functions as needed in their community environment for about 2 weeks while the seating function usage was recorded with a portable device. We found that subjects occupied their wheelchair for 11.8 +/-3.4 hours a day (all data shown as mean +/-standard deviation). While occupying their wheelchairs, they accessed tilt-in-space, backrest recline, and seat elevation 19 +/-14 times a day for 64.1% +/-36.8%, 12 +/-8 times for 76.0% +/-29.8%, and 4 +/-4 times for 22.5% +/-34.9%, respectively. Subjects chose to stay in tilted and reclined positions in their wheelchair for 39.3% +/-36.5% of their time each day. They spent little time in a fully upright position. Subjects changed their seating positions every 53.6 +/-47.0 minutes. Time spent in positions of different seating pressures varied among subjects. The information collected could enhance clinical practice of wheelchair provision, resulting in better compliance with clinical instructions and appropriate use of seating functions among wheelchair users.

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“…The ability to sustain a weight shift is dependent on myriad factors, including functional ability, strength, flexibility, and postural control [46]. A 2003 study measured tissue perfusion to investigate the length of time required for tissue to rep erfuse in an SCI cohort ( n = 46) [48]. The mean duration of weight shift required to return transcutaneous partial pressure of oxygen to unloaded levels following upright sitting was 1 minu te 51 seconds (range = 42-210 seconds).…”

Section: Weight Shiftingmentioning

confidence: 99%

Assessing evidence supporting redistribution of pressure for pressure ulcer prevention: A review

Sprigle¹,

Sonenblum²

2011

JRRD

102

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Abstract-The formation and underlying causes of p ressure ulcers (PUs) are quite complex, with multiple influencing factors. However, by definition pressure ulcers cannot form without loading, or pressure, on tissue. Clinical interventions typically target the magnitude and/or duration of loading. Pressure magnitude is managed by the selection of support surfaces and postural supports as well as body posture on supporting surfaces. Duration is addressed via turning and weight shifting frequency as well as with th e use of dynamic s urfaces that actively redistribute pressure on the body surfaces. This article shows that preventative interventions must be targeted to both magnitude and duration and addresses the rationale behind several common clinical interventions-some with more scientific evidence than others.

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A specialist seating assessment clinic: changing pressure relief practice

Cited by 102 publications

References 7 publications

Mechanical Load on the Upper Extremity During Wheelchair Activities

Mechanical Load on the Upper Extremity During Wheelchair Activities

Usage of tilt-in-space, recline, and elevation seating functions in natural environment of wheelchair users

Assessing evidence supporting redistribution of pressure for pressure ulcer prevention: A review

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