Prospective Controlled Trial
SCI group (n=12): Mean Age=40.9 yr; Gender: males=10, females=2; Level of injury: paraplegia=7, tetraplegia=5; Severity of injury: complete; Mean time since injury=19.5 yr.
Able-Bodied group (n=10): Mean age=39.3 yr; Gender: males=6, females=4.
Intervention: Comparison of Pressure mapping and shear measurements from midline neutral posture to eight typical wheelchair-sitting postures (trunk bending left and right, forward trunk flexion 30 and 50 degrees, back recline 110 and 120 degrees and tilt 10 and 20 degrees).
Outcome Measures: Tangentially induced shear (TIS) measuring shear forces; Pressure distribution – Oxford Pressure Monitor Device measuring average and maximum pressure and peak pressures gradient.
|1. Mean maximum pressure was on average 26% higher in the SCI group versus the able-bodied group.
2. Forward trunk flexion reduced the average pressure for both groups; however, SCI group encountered a 10% increase in pressure at the initial 30° of forward flex before a reduction occurred.
3. SCI subjects had a mean peak pressure gradient that was 1.5-2.5 greater than able-bodied subjects. Maximum decrease of pressure gradient from a neutral position happened after the backrest reclined to 120°.
4. When a sitting position change occurred, a similar shift to the anterior/posterior midline location of maximum pressure was experienced in both groups. From neutral, a forward trunk flexion at 30° and 50° produced a 2.4 and 2.7 cm posterior shift. When the backrest reclined to 120°, the greatest posterior shift occurred at 6 cm.
Gutierrez et al. 2004
SCI group: Gender: males=25; Level of injury: paraplegia=25; Severity of injury: AIS A=25.
Able-bodied group: Gender: males=8.
Intervention: Posture changes as related to pressure, contact area and symmetry of loading, on a standardized hard surface and for SCI, in their wheelchair as well.
Outcome Measures: Pressure distribution via Tekscan Pressure Mat.
|1. Significant differences were found between the groups. SCI group had increased pressure (p<0.01), decreased contact area (p<0.01) and increased asymmetry (p<0.05).
2. Sitting in their own wheelchair improved pressure distribution, as compared to the hard surface. Although total seating area force increased (p<0.01), the pressure reduced and the contact area increased (p<0.01).
3. No improvements occurred when comparing relaxed and upright position in their own wheelchair.