AA

Key Points

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  • Manual wheelchairs with adjustable axle position appear to improve wheelchair propulsion and reduce the risk of upper extremity injury.
  • The use of an ultralight wheelchair may improve propulsion efficiency in those with SCI.
  • Body weight management is important in reducing the forces required to propel a wheelchair and reducing the risk of upper extremity injury.
  • The evidence appears to be inconclusive as to whether there is an advantage to one stroke pattern over another.
  • Physical conditioning and strengthening of the upper extremity during initial inpatient rehabilitation is important to the development of wheelchair propulsion skills.
  • Wheeling cross slope can play a role on the cadence and power that is required for wheelchair propulsion.
  • There is insufficient evidence to determine if Spinergy wheels are more effective in reducing spasticity by absorbing vibration forces when wheeling.
  • Tires with less than 50% inflation causes an increase in energy expenditure.
  • Use of flexible handrims may reduce upper extremity strain during wheelchair propulsion.
  • The use of power-activated power-assist wheelchairs (PAPAW’s) provide manual wheelchair users with paraplegia and tetraplegia with a less strenuous means of mobility, improve functional capabilities and reduce the risk of upper extremity injury.
  • Considerations for how individuals use power wheelchairs should include more than distance and speed travelled, indoor/outdoor use and wheelchair occupancy.
  • For the SCI population power wheelchair provision needs to include at a minimum customizable programmable controls.
  • Consideration should be given to the potential provision of both power and manual wheelchairs to meet basic living needs for the SCI population.
  • There is limited evidence related to the benefit and use of conventional versus alternative driving controls.
  • Patterns of use for power positioning devices are variable but typically in small ranges of amplitude, with the primary reasons for use being discomfort and rest.
  • Segway Personal Transporters may present an alternative form of mobility for individuals with SCI who are able to stand and walk short distances.
  • Pressure mapping can be used to augment clinical decision-making related to pressure management.
  • Individual attention to spinal/pelvic posture and positioning for SCI clients is essential for appropriate wheelchair prescription and set-up.
  • Use of lateral trunk supports in specialized seating improve spinal alignment, reduce lumbar angles and reduce muscular effort for postural control.
  • The wheelchair user’s posture and functional performance have important implications on the selection of a wheelchair and seating equipment.
  • No one cushion is suitable for all individuals with SCI.
  • Cushion selection should be based on a combination of pressure mapping results, clinical knowledge of prescriber, individual characteristics and preference.
  • More research is needed to see if decreasing ischial pressures or decreasing risk factors such as skin temperature via the use of specialty cushions will help
    prevent pressure ulcers post SCI.
  • Pressure mapping is a useful tool for comparing pressure redistribution characteristics of cushions for an individual but it needs to be a part of the full evaluation not the main part or only evaluation.
  • Contoured foam cushions compared to flat foam cushions seem to provide a seat interface that reduces the damaging effects of external loading and tissue damage.
  • Peak interface pressure is greater for dynamic movement in SCI subjects than static sitting but cumulative loading is comparable between dynamic and static loading for the SCI population.
  • Peak pressures appear to be located slightly anterior to the ischial tuberosities.
  • The use and integration of forward reaching into daily life activities can be used as a means to promote regular pressure redistribution. Caution however is needed to ensure the movement is of adequate distance and duration to affect pressure management.
  • Leaning forward at least 45° and lateral trunk leaning to 15° reduces pressure at the sitting surface but may also result in ischial tuberosity shifting across the sitting surface in the opposite direction.
  • For most individuals with SCI, the use of a push-up/vertical lift is unlikely to be of sufficient duration to be beneficial for managing sitting pressure and has potential to contribute to repetitive strain injuries.
  • The back support plays an important role in pressure management on the sitting surface.
  • Backrest recline alone to 120° decreased average maximum pressures in the ischial tuberosity area but also causes the greatest ischial tuberosity shift (up to 6 cm). Further research on the effect of friction/shear on the sitting surface in relation to the ischial tuberosity shift is required to determine if there is benefit in using backrest recline alone.
  • There is an inverse relationship between tilt angle and pressure at the sitting surface. Significant pressure redistribution realized was variable by person but on average started around 30° of tilt with maximum tilt providing maximum pressure redistribution.
  • It cannot be assumed that a change in interface pressure through use of tilt/recline equates to an increase in blood flow at the ischial tuberosities.
  • The variability in blood flow and interface pressure changes associated with tilt/recline, supports the need for an individualized approach to education around power positioning device use for pressure management.
  • The type and duration of position changes for pressure management must be individualized.
  • More research is needed to determine the parameters of position changes in relation to interface pressure and blood flow at the sitting surface tissues to help prevent pressure ulcers post SCI.