Tilted seat position for non-ambulant individuals with neurological and neuromuscular impairment: a systematic review

Abstract

Objective: To determine the effects of tilt-in-space seating on outcomes for people with neurological or neuromuscular impairment who cannot walk. Data sources: Search through electronic databases (MEDLINE, Embase, CINAHL, AMED). Discussions with researchers who are active in field. Review methods: Selection criteria included interventional studies that investigated the effects of seat tilt on outcome or observational studies that identified outcomes for those who had used tilt-in-space seating in populations with neurological or neuromuscular impairments. Two reviewers independently selected trials for inclusion, assessed quality and extracted data. Results: Nineteen studies were identified which fulfilled the selection criteria. Seventeen of these were essentially before-after studies investigating the immediate effects of tilting the seating. All studies looked at populations with neurological impairment, and most were on children with cerebral palsy (n ¼ 8) or adults with spinal cord injury (n ¼ 8). Reviewer's conclusion: Posterior tilt can reduce pressures at the interface under the pelvis.

Seating and pressure ulcers: Clinical practice guideline

“…The posterior tilting position by 20 degrees in a tilt-in-space wheelchair can reduce load taken through the ischial tuberosities [25].…”

Effect of Durations of Wheelchair Tilt-in-Space and Recline on Skin Perfusion Over the Ischial Tuberosity in People With Spinal Cord Injury

“…12 In the literature, there are several studies investigating the effect of wheelchair tilt-in-space and recline angles on seating interface pressure, but no research studies have been conducted to investigate the effect of the durations of tilt-in-space and recline on reducing soft tissue ischemia. 8, 11, 12 …”

Effect of Wheelchair Tilt-in-Space and Recline Angles on Skin Perfusion Over the Ischial Tuberosity in People With Spinal Cord Injury

“…Although evidence regarding the use of wheelchair tilt-in-space and recline to reduce seating interface pressure exists,16, 18, 21–23 the exact impact on skin blood flow and tissue viability is unclear 24, 25. Furthermore, inadequate pressure reduction by wheelchair tilt-in-space and recline may not benefit ischemic tissues 26.…”

“…The guideline indicates that wheelchair tilt-in-space and recline should be recommended for wheelchair users at risk for pressure ulcers. The need to study the effectiveness of wheelchair tilt-in-space and recline was also indicated by a recent systemic review on the wheelchair tilt system 21. In order to understand the specific benefits associated with wheelchair tilt-in-space and recline, more research studies are needed to study the efficacy of various settings (angles, frequencies, and durations) of wheelchair tilt-in-space and recline on tissue viability.…”