Clinical evaluation of seating in persons with complete thoracic spinal cord injury

Abstract

Study Design: Consecutive male patients studied with photographic measurement of a combination of clinical methods. Objectives: To describe seating in individuals with complete thoracic spinal cord injury (SCI) by using a combination of clinical methods. Setting: Spinalis SCI unit, Stockholm, Sweden. Methods: Wheelchair specifications were documented. Measurements of posture from photographs in 30 male subjects with complete thoracic SCI, sitting in a relaxed and an upright position on a standardized surface and in a wheelchair were calculated. A comparison was made between positions and seating surfaces. An examiner's classification of lower trunk position in wheelchair was compared to subjects' evaluations. SCI subjects reported sitting support, satisfaction, and wishes for improvement. Results: Most SCI subjects used similar wheelchair specifications. None of the backrests were custom designed. Relatively small differences were found between the relaxed and upright position in the wheelchair regarding measurements of posture and according to the examiner's classification of the lower trunk position. Only 13/30 SCI subjects were sitting with the lower trunk centered relative to the backrest in the upright position. The examiner's classification and the subjects' evaluation of asymmetric sitting were not always in agreement. Only 12/30 SCI subjects were satisfied with their way of sitting. Conclusion: Current wheelchair specifications and adjustments seem to inhibit a postural correction towards upright sitting and fail to provide sufficient lateral support. Findings indicate an inability for SCI subjects to vary their sitting position in a wheelchair to a large extent. Both an examiner's classification and subjects' evaluation of asymmetric sitting are necessary to obtain a sufficient knowledge base for subsequent adjustment. By using methods regarding different aspects of seating, a more comprehensive view of seating was achieved. The combination of clinical methods seems to be useful in order to describe seating in individuals with complete thoracic SCI.

Influence of different types of seat cushions on the static sitting posture in individuals with spinal cord injury

“…The greater ASIS misalignment is probably the cause or consequence of a misalignment of the trunk, which favors more evident postures with lateral inclination of the trunk. These results can be compared with those obtained by Alm et al, 5 which indicate that most individuals with SCI did not have their lumbar spine centered in the wheelchair.…”

“…Studies that have evaluated the seated posture have used imprecise methods of analysis, such as photo printing with manual measurements of posture 5 or expensive equipments, which are not used in clinical practice, such as tridimensional-movement analysis or radiological evaluations. 11,12 The computerized photogrammetry has been used for quantitative postural evaluation, which provides an accurate value for the analysis.…”

“…1 Owing to the use of the non-postural muscles to compensate for the functional loss of the erector spine muscle 2 and the differences in the location of the center of gravity, the posture of individuals with spinal cord injury (SCI) usually changes. 3,4 Individuals with SCI have difficulty in maintaining a sitting position with back straight or in varying this position, 5 and usually postural disorders such as lateral deviation of the pelvis and/or spinal cord and reduced lumbar lordosis, or the presence of the kyphosis lumbar and posterior pelvic rotation, are observed. 5,6 The wheelchair cushions were developed for pressure management mainly in the ischial tuberosity.…”

“…3,4 Individuals with SCI have difficulty in maintaining a sitting position with back straight or in varying this position, 5 and usually postural disorders such as lateral deviation of the pelvis and/or spinal cord and reduced lumbar lordosis, or the presence of the kyphosis lumbar and posterior pelvic rotation, are observed. 5,6 The wheelchair cushions were developed for pressure management mainly in the ischial tuberosity. There are many cushion materials, such as water, gel, foam, convoluted (egg-crate), viscoelastic 7,8 and the contoured cushion, which is shaped to fit the individual's body.…”

Effects of Actuated Pelvis Control on Shear and Pressure Distribution

“…Among wheelchair dependent patients, a poor sitting posture is often seen [1] which contributes to all kinds of physical problems during long term sitting [2]. Because pelvic tilt is crucial for the adopted sitting posture [3], chair configurations enforcing proper pelvic alignment are necessary.…”