OBJECTIVE: To investigate the efficacy of wheelchair tilt-in-space and recline on enhancing skin perfusion over the ischial tuberosity in wheelchair users with spinal cord injury (SCI). DESIGN: Repeated-measures, intervention, and outcomes-measure design. SETTING: A university research laboratory. PARTICIPANTS: Wheelchair users with SCI (n = 11; 9 men, 2 women; mean +/- SD age 37.7 +/- 14.2y; body mass index, 24.7 +/- 2.6kg/m2; duration of injury 8.1 +/- 7.5y). INTERVENTIONS: Protocols (n = 6) of various wheelchair tilt-in-space and recline angles were randomly assigned to participants. Each protocol consisted of a 5-minute sitting-induced ischemic period and a 5-minute wheelchair tilt-in-space and recline pressure-relieving period. Participants sat in a position without tilt or recline for 5 minutes and then sat in 1 of 6 wheelchair tilted and reclined positions, including (1) 15 degrees tilt-in-space and 100 degrees recline, (2) 25 degrees tilt-in-space and 100 degrees recline, (3) 35 degrees tilt-in-space and 100 degrees recline, (4) 15 degrees tilt-in-space and 120 degrees recline, (5) 25 degrees tilt-in-space and 120 degrees recline, and (6) 35 degrees tilt-in-space and 120 degrees recline. A 5-minute washout period (at 35 degrees tilt-in-space and 120 degrees recline) was allowed between protocols. MAIN OUTCOME MEASURES: Laser Doppler flowmetry was used to measure skin perfusion over the ischial tuberosity in response to changes in body positions caused by performing wheelchair tilt-in-space and recline. Skin perfusion response to wheelchair tilt-in-space and recline was normalized to skin perfusion of the upright seated position (no tilt/recline). RESULTS: Combined with 100 degrees recline, wheelchair tilt-in-space at 35 degrees resulted in a significant increase in skin perfusion compared with the upright seated position (no tilt/recline; p < 0.05), whereas there was no significant increase in skin perfusion at 15 degrees and 25 degrees tilt-in-space (not significant). Combined with 120 degrees recline, wheelchair tilt-in-space at 15 degrees, 25 degrees, and 35 degrees showed a significant increase in skin perfusion compared with the upright seated position (p < 0.05). CONCLUSIONS: Our results indicate that wheelchair tilt-in-space should be at least 35 degrees for enhancing skin perfusion over the ischial tuberosity when combined with recline at 100 degrees and should be at least 25 degrees when combined with recline at 120 degrees. Although smaller angles of wheelchair tilt-in-space and recline are preferred by wheelchair users for functional purposes, wheelchair tilt-in-space less than 25 degrees and recline less than 100 degrees may not be sufficient for effective pressure reduction for enhancing skin perfusion over the ischial tuberosity in people with SCI.

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