For people who spend the majority of their days sitting in standard wheelchairs or lying in beds, pressure sores are a very probable reality. Yet they don't have to be, thanks to assistive technology like tilt or recline wheelchairs that help distribute pressure to other parts of the body.
While pressure relief is the main objective to using either a tilt wheelchair or a recline wheelchair, each has its unique qualities that help with posture. (Even though some chairs come with both tilt and recline options, for clarity purposes, they will be addressed as two separate seating systems.)
"Obviously, a tilt wheelchair does a better job of providing postural stability by not changing any of the angles of the knee and hip, while recliners allow the pelvis and hips to move through approximately 90 degrees of motion. Both seating systems have their own specific functions," noted David Kreutz, PT, seating specialist at the Shepherd Center in Atlanta.
Reclining wheelchair move the body from a flexed position to an extended position, making the chairs more likely to elicit a spastic response in the user.
Because tilt and recline chairs use gravity to their advantage and come with head rests, patients who have poor head, neck and trunk control may benefit from the stability and balance they provide. When in tilt or recline, gravity helps the patient improve balance and head control.
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Once a tilt chair is prescribed for a patient, it is important to teach the caregivers how to use the tilt function and position the patient correctly. If a patient is cognitively intact, it is also important to teach that individual how he or she should be positioned in the chair, to be able to instruct caregivers.
Candidates who would be suited for a recliner chair are those who cannot achieve a 90-degree hip-to-back angle when sitting. For example, patients who have hip precautions following total hip replacement surgery, patients who have had cardiac surgery and might develop complications from sitting upright and patients who have orthostatic hypotension--a condition where blood pressure dramatically declines when the person is brought to a vertical sitting position--would be ideal candidates for recliner chairs.
For patients with significant generalized weakness, a reclined position along with cushioning can help prevent them from sliding or leaning too far forward, according to Tina Getsios, OTR/L. She works in a nursing home and sees many patients with weakness due to stroke, Parkinson disease or orthopedic conditions like hip fractures, who find a reclined position useful.
Getsios, however, doesn't use a regular recline wheelchair. Instead, she uses a reclining back adaptation on a standard manual wheelchair. The difference between this adaptation and a recliner chair is that it doesn't go as far back as a recliner chair. It allows patients to recline anywhere from 90 to 125 degrees, as opposed to the 135 degrees or more offered by a recliner wheelchair, explained Getsios, rehab director at Park Terrace Nursing Home in Rego Park, NY.
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All that's required to do this is removing the back rest of the standard manual chair and screwing in the adaptation. Additionally, she said that it's a "nice adaptation because it can be made by the therapist without any tools.
What's more, the price of the adaptation is about one sixth of the price of a recline wheelchair.
If a patient doesn't need to recline as far back as a recline wheelchair will reach, and needs help to prevent sliding, this adaptation will help him maintain stability in the chair, reiterated Getsios.
And because it's a standard wheelchair and only reclines to 125 degrees of tilt, patients who are independent can wheel themselves around without the threat of tipping over or developing shoulder problems.
Thus they increase their independence in mobility.
The adaptation comes with vinyl-covered pockets on the back that can be filled with foam specifically to the patient's needs.
"If a patient has weakness on the right side, and they're leaning, then I would put extra foam in the right pocket to give extra support to the patient," Getsios explained.
The foam and pockets are useful because they prevent the patient from having to use a back cushion; because the surface is vinyl, it's easily washed and maintained.
Whether wheelchairs are tilt or recline, in the power or manual form, if they are used properly, pressure relief will increase, as well as patients' general health.
