The impact of tilting on blood flow and localized tissue loading

Sonenblum, Sharon Eve; Sprigle, Stephen

doi:10.1016/j.jtv.2010.10.001

Cited by 26 publications

(41 citation statements)

References 20 publications

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“…Similar small movements of short duration were seen in a 2002 pilot study [36]. Although the effects of these movements on blood flow may be less significant [17,[43][44], they have the potential to change the internal deformation of tissue [11,45] and may provide important physiological benefits in terms of pressure ulcer prevention. Furthermore, small movements have the potential to help dissipate heat and reduce humidity [46].…”

Section: Ws Frequencymentioning

confidence: 56%

Everyday sitting behavior of full-time wheelchair users

Sonenblum

Sprigle

Martin³

2016

J Rehabil Res Dev

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Abstract-The objective of this study was to describe the inseat movement and weight-shifting behavior of full-time wheelchair users. We measured everyday sitting behavior for 192 d across 28 individuals who used manual wheelchairs as their primary mobility device. To obtain the measurements, we used eight thin force sensors placed under participants' wheelchair cushions. On a typical day, participants spent an average of 10.6 +/ 3.0 h in their wheelchair and transferred out of the wheelchair 8.4 +/ 4.3 times. Participants only performed pressure reliefs (90% off-loading of the entire buttocks for at least 15 s) 0.4 +/ 0.5 times per hour they were seated in the chair, but they performed weight shifts (WSs) (30%-90% off-loading of at least one side of the buttocks for 15 s) with a frequency of 2.4 +/ 2.2 times per hour. Despite the higher frequency of WSs, they were not performed in a routine manner. Half of the days studied included one segment of upright sitting lasting at least 2 h without a WS. Given these observations, we conclude that seating evaluations should emphasize positioning individuals in a way that facilitates reaching, leaning, and transferring in a safe manner, not only to improve function but also to affect buttocks loading.

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Section: Ws Frequencymentioning

confidence: 56%

Everyday sitting behavior of full-time wheelchair users

Sonenblum

Sprigle

Martin³

2016

J Rehabil Res Dev

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“…The rationale is that skin blood flow response to loading pressure has been widely used to determine the effectiveness of seating conditions [6,[17][18][19]. The purpose of periodically performing wheelchair tilt and recline is to develop reactive hyperemia to reperfuse the ischemic tissues because prolonged tissue ischemia has been determined to be critical factor leading to pressure ulcers.…”

Section: Introductionmentioning

confidence: 99%

Development of intelligent model for personalized guidance on wheelchair tilt and recline usage for people with spinal cord injury: Methodology and preliminary report

Jones

Jan

2014

J Rehabil Res Dev

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Abstract-Wheelchair tilt and recline functions are two of the most desirable features for relieving seating pressure to decrease the risk of pressure ulcers. The effective guidance on wheelchair tilt and recline usage is therefore critical to pressure ulcer prevention. The aim of this study was to demonstrate the feasibility of using machine learning techniques to construct an intelligent model to provide personalized guidance to individuals with spinal cord injury (SCI). The motivation stems from the clinical evidence that the requirements of individuals vary greatly and that no universal guidance on tilt and recline usage could possibly satisfy all individuals with SCI. We explored all aspects involved in constructing the intelligent model and proposed approaches tailored to suit the characteristics of this preliminary study, such as modeling research participants, using machine learning techniques to construct the intelligent model, and evaluating the performance of the intelligent model. We further improved the intelligent model's prediction accuracy by developing a two-phase feature selection algorithm to identify important attributes. Experimental results demonstrated that our approaches showed promise: they could effectively construct the intelligent model, evaluate its performance, and refine the participant model so that the intelligent model's prediction accuracy was significantly improved.Key words: artificial neural network, C4.5 decision tree, machine learning, pressure ulcer, random forest, skin blood flow, skin perfusion, spinal cord injury, support vector machine, wheelchair tilt and recline.

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“…There was a range of study designs adopted by the researchers, with eight being quantitative in design, [11][12][13][14][15][16][17][18] two descriptive, 1,8 and two mixed methods. 9,10 Lacoste et al 1 utilized a cross-sectional design.…”

Section: Methodsmentioning

confidence: 99%

“…Twelve studies 1,[8][9][10][11][12][13][14][15][16][17][18] were published during the 11-year period, 2001-2012. The studies focused on three broad themes: (1) the effect of TIS and back recline upon sliding, pressure/force redistribution, propulsion, and skin perfusion over the ischial tuberosities; 11,12,[15][16][17] (2) the reasons for usage of TIS and back recline; 1,8-10 and (3) comparing TIS with the use of a new rear anti-tip device.…”

Section: Critical Appraisalmentioning

confidence: 99%

“…The studies focused on three broad themes: (1) the effect of TIS and back recline upon sliding, pressure/force redistribution, propulsion, and skin perfusion over the ischial tuberosities; 11,12,[15][16][17] (2) the reasons for usage of TIS and back recline; 1,8-10 and (3) comparing TIS with the use of a new rear anti-tip device. 13,14 Two of these studies were unique in purpose, exploring the wheelchair occupant's use of power TIS in everyday use, moving beyond sole consideration of the isolated impact of the angle of TIS.…”

Section: Critical Appraisalmentioning

confidence: 99%

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Use of tilt-in-space in seating systems for adults with physical disabilities

Casey

Gittins

2013

Physical Therapy Reviews

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2 Oxford Health NHS Foundation Trust, UK Aims: Clinicians increasingly recommend tilt-in-space (TIS) within wheelchair and seating prescriptions to reportedly prevent pressure ulcers; however, it is often unclear what the optimum tilt angle should be. This review aims to determine the use and effectiveness of TIS in seating systems. Methodology: A search of eight electronic databases was completed, namely, Medline, CINAHL, BNI, EMBASE, ASSIA, PubMed, OTDBase, and ISI Web of Science Conference Proceedings; using the keywords TIS, seating, wheelchairs, pressure ulcer, and pressure sores. Databases were searched for articles written in English between 2000 and the end of August 2012. Articles included primary research; TIS as the intervention; and had adult participants. Results: After removal of duplicates and application of inclusion criteria, 12 studies were eligible for this review. Findings show that TIS was used to manage pressure and fatigue, prevent sliding, aid skin perfusion, and facilitate user comfort. Conclusions: Reasons for using TIS will influence the degree of tilt required for the chair occupant; nonetheless, it remains difficult to specify either the optimum degree of tilt or the duration for use in TIS seating systems. In order to build an evidence base, clinicians need to be very explicit on their reasons for prescribing TIS.

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The impact of tilting on blood flow and localized tissue loading

Cited by 26 publications

References 20 publications

Everyday sitting behavior of full-time wheelchair users

Everyday sitting behavior of full-time wheelchair users

Development of intelligent model for personalized guidance on wheelchair tilt and recline usage for people with spinal cord injury: Methodology and preliminary report

Use of tilt-in-space in seating systems for adults with physical disabilities

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