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For Healthcare Professionals

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Clinical Information

Powered tilt systems, powered recline systems, powered tilt-and-recline systems and powered elevating leg rests are all useful modalities for meeting the independent mobility, functional needs and clinical requirements for persons with tetraplegia and/or similar conditions. While there are certain clinical benefits that are unique to tilt systems and others to recline systems, the combination of tilt-and-recline is essential to addressing the clinical needs of the individual in many cases. This is most beneficial when the powered tilt feature is used to accommodate different requirements. Nevertheless, there are also valid clinical implications for independent power/motorized elevating leg rests. You may also wish to visit our Education and Learning page for CEU courses and educational articles.

The following is a list of some of the clinical benefits/applications for each system:

 

Powered Tilt Systems

  • Pressure relief/re-distribution
  • Independent performance of weight shifts
  • Decreased fatigue associated with high muscle tone
  • Increased sitting tolerance in the course of the day
  • Improved postural/proximal stability
  • Improved upper extremity function through increased postural stability
  • Improved head control
  • Increased power wheelchair driving capabilities through increased head control/upper extremity functioning
  • Reduced caregiver/attendant hours due to the ability to independently perform weight shifts resulting in
    increased sitting tolerance
  • Effective “shear displacement” management during position changes (shear displacement results in sliding out of position)
  • Absent to minimal triggering of abnormal muscle tone or reflexes during position change
  • Gravity-assisted caregiver re-positioning of the user in the chair
  • Gravity-assisted postural support (by holding the individual to the seating contours)
  • Improved “line of sight” (visual field)
  • Easiest accommodation of lower extremity contractures
  • Easiest accommodation of trunk postural asymmetries
  • Muscle tone management:
  • Positioning for relaxation of high muscle
  • Positioning for stability with low muscle
  • Positioning for improved swallowing due to relaxed muscle tone in the neck region
  • Positioning for feeding
  • Lower extremity edema management (limited unless combined with elevating legs)
  • Reduced respiratory difficulty through reducing pressure on the diaphragm by facilitating extension of spine & trunk
  • Independent initial management of hypertensive episodes through independence with return to an upright position
  • Effective use with limited hip range of motion
  • Postural/balance accommodation when traversing challenging terrain
  • Comfort
  • Pain relief

 

Powered/Motorized Recline Systems

  • Pressure relief/redistribution (allowing the largest available surface area to distribute pressure)
  • Passive range of motion (PROM) of the hip joints (and knees with power or mechanical elevating leg rests) during recline
  • Decreased fatigue
  • Increased sitting tolerance
  • Positioning for bladder management
  • Positioning for toileting hygiene
  • Lower extremity edema management (limited unless combined with elevating leg rests)
  • Positioning for respiratory care
  • Muscle tone management
  • Improved blood flow to the lower extremities reducing incidents of venous stasis and concomitant vascular problems
  • Positioning for safe supine transfers
  • Independent performance of weight shifts
  • Arm rest/lap trays stay perpendicular to the floor during recline
  • Pressure relief performance without moving from accessing a table or a desk
  • Reduced respiratory difficulty by decreasing pressure on the diaphragm and increasing extension of the trunk
  • Improved “line of sight”
  • Independent initial management of hypertensive episodes through independence with return to an upright position
  • Improved postural/proximal stability
  • Improved upper extremity function through increased postural stability
  • Improved head control
  • Increased power wheelchair driving capabilities through increased head control/upper extremity functioning
  • Reduced caregiver/attendant hours required due to the ability to independently perform weight shifts & resulting in increased sitting tolerance•
  • Reduced pain
  • Comfort

 

Powered/Motorized Tilt and Recline Systems

  • Provides all the clinical benefits/application of tilt and/or recline systems
  • Allows combination of benefits/applications (i.e., tilt for pressure relief with recline for pressure relief with recline for bladder management; recline for pressure management with tilt to abate swallowing difficulties)
  • Most effective means of managing lower extremity edema – particularly when combined with elevating legs
  • Most effective means of reducing respiratory distress and facilitating respiratory therapy interventions
  • Allows end user to choose and manage pressure relief options and combinations thus reducing reliance on caregivers


Elevating Leg Rests


The elevating leg rest feature is almost always appropriate when the “recline” feature is clinically indicated. A patient cannot fully recline if the knees remain flexed without exposing themselves to unnecessary skin shear – a contributing factor to skin breakdown and pressure ulcers. Another important fact to consider is if the knees remain flexed, there is a very high likelihood the patient will become “out of position” when returning to the sitting position from the recline position. This can result in a multitude of problems with poor positioning and postural support.


Independent Power/Motorized Elevating Leg Rests


The independent power/motorized elevating leg rest (IPELR) feature has been proven clinically appropriate for managing several conditions common to persons with tetraplegia and/or similar conditions. These include, but are not limited to, such diagnosis as chronic edema of the lower extremities, flexion contractures of the knees and legs, hypotensive episodes and intermittent episodes of autonomic dysreflexia. IPELR may also be indicated for the treatment and management of lower extremity decubitus (pressure) ulcers. IPELR is also useful in accommodating differences in mass, tone and range of motion between the lower extremities. IPELR allows the individual to raise the feet in response to terrain requirements, i.e. transitioning from a steep decline to a level surface. The fundamental benefit of IPELR is that it allows the patient to react to clinical needs and control their environment while maintaining independent mobility. Lacking IPELR, many people with high-level quadriplegia would require full-time attendant care.

Finally, it is important to understand that there are several functional as well as clinical advantages that come with the ability to operate the elevating leg rest function independent from the recline function. For example, IPELR would be clinically indicated for patients with:

  • Significant differences in mass between the extremities which hinder the proper operation of mechanical elevating leg rests
  • Differences in spasticity and tone that create forces against the elevating leg rest function
  • Anomalies such as partial fusion of one knee or differences in leg length
  • Vascular conditions effecting only one lower extremity such as deep vein thrombophlebitis


Elevating Seat

  • Allow independent/less assisted transfers to and from wheelchair
  • Allow independent safe meal preparation
  • Independent home ADLs, i.e,. dressing, hygiene, housekeeping, access, etc.
  • Independent community ADLs, i.e., shopping
  • Meet vocational requirements/needs
  • Social interaction benefits


Manual Tilt-in-Space Wheelchairs


Clinical & Functional Application Benefit

Pressure Relief:

  • Provides weight shift/pressure re-distribution by increasing the seating surface area and redistributing pressure away from critical areas under the pelvis
  • Best accommodates position changes for those with limited hip and/or knee range of motion

Positioning:

  • Allows gravity assisted positioning against the contours and supports of the seating system
  • Allows accurate positioning following transfer into the chair by adjustment of posture from the tilt position
  • Allows effective re-positioning in the course of the day
  • Best accommodates shear displacement (sliding out of position) during position changes

Orthopedic/Neurological Considerations:

  • Allows effective re-positioning in the course of the day
  • Easiest accommodation of postural/orthopedic asymmetries and extremity contractures
  • Promotes absent to minimal triggering of abnormal muscle tone or reflex responses during position change
  • Can minimize some reflexive responses associated with position of the head (ATNR, STNR, TLR’s) through the increased head control of postural stability
  • Muscle tone management
  • Positioning for relaxation of high muscle tone
  • Positioning to reduce the fatigue associated with high muscle tone
  • Positioning to inhibit some high muscle tone through increased postural support
  • Positioning for stability/support with low muscle tone

Endurance:

  • Can increase overall endurance for tolerance of the day
  • Can increase sitting tolerance in the course of the day
  • Positioning for comfort
  • Positioning for pain relief

Function:

  • Provides postural/proximal stability, required for function
  • Can increase U.E. function through proximal stability
  • Can increase head control through improved postural support
  • Positioning to improve vision (“line of sight”)
  • Can enhance postural balance when traversing challenging terrain
  • Anterior tilt can make transfers into the chair easier and in some cases possible
  • Positioning for safer/easier swallowing due to relaxed muscle tone in the neck region
  • Positioning for feeding

Medical:

  • Initial management of hypertensive episodes (A.D.) by immediately sitting the user upright
  • L.E. Edema management (if used with elevating leg rests)
  • Management of pain & discomfort associated with edema
  • Can reduce respiratory difficulty through decreasing pressure on the diaphragm while facilitating an extension of the spine/trunk
  • Allows use with ventilators

Caregiver Issues:

  • Reduce attendant care required (through easier management of weight shift/pressure relief with less transfers in and out of the chair and overall increased sitting tolerance
  • Allows easier positioning for respiratory care for some
  • Allows easier positioning for bowel/bladder management for some
  • Allows positioning for toileting hygiene for some
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