As our parents age, it becomes important to consider decreases in strength and endurance, and also diseases that could cause disability. Strokes and other neurological diseases become increasingly common with aging. A stroke often reduces mobility and motor control on one side of the body, creating challenges for both mobility and seated posture. This difference in strength can create postural asymmetries. Sliding out of chairs or falling also becomes common. Heart conditions, decreased lung capacity, and arthritic changes decrease mobility and strength for moving.
In addition, the elderly’s skin becomes weak and frail, resulting in an increased risk of pressure injuries. Elderly clients who sit for long periods are at high risk of developing a pressure injury. Because of these high-risk factors, wheelchairs that incorporate tilt-in-space and reclining functions are routinely prescribed for this population.
When should we use tilt-in-space and reclining wheelchairs?
Tilt-in-space and reclining wheelchairs should be considered when patients:
* Are unable to independently weight shift
* Are unable to maintain pelvic, thoracic, or head position
* Balance against gravity for prolonged periods
* Are at risk of respiratory and digestive complications
* Require a change of position with reduced risk of extensor spasticity
Dynamic Tilt-in-Space
Provided changes in position for clients who cannot weight shift independently.
When patients are unable to weight shift independently or change positions while seated upright, they are at high risk of pressure injuries. The inability to redistribute pressure also compromises sitting tolerance.
To be effective for pressure relief at the ischial tuberosities, the angle of tilt must be 25 degrees or greater. Repositioning should occur for at least one to two minutes every 30 minutes.
Provides changes in position for patients who cannot maintain pelvic, thoracic, or head position and/or balance against gravity for prolonged periods of time.
While sitting upright, gravity pulls down on the body. If muscle strength or overall endurance is compromised, clients will be unable to maintain proper upright posture. This can lead to postural deviations such as a posterior pelvic tilt, thoracic kyphosis, and/or lateral lean.
Tilt helps to promote proper seating alignment and decreases the potential for postural deviations. Poor posture over time increases the risk for non-correctable orthopedic deviations and pressure injury on the sacrum and spine.
Upright posture must be actively maintained against gravity in a standard back support. Poor posture results in fatigue over time.
When tired, tilting chairs help maintain an upright position, facilitate thoracic extension, and promote a neutral pelvis.
It is essential we protect and promote a patient’s “life box” (circulation, respiration, and digestion). If a patient cannot maintain an upright posture, the respiratory system can become compromised. The diaphragm has less room to drop as it contracts, so the lungs do not fully expand.
This can result in:
* The collapse of lower parts of the lung (atelectasis)
* Immobilized secretions, potentially resulting in pneumonia
* Increased difficulty in taking deep breaths (breath is therefore shallower and more rapid)
Also of significance is the optimal positioning for the digestive system to work effectively. If patients cannot maintain an upright posture, the digestive system can become compromised with an increased risk of gastrointestinal complications:
* Food cannot pass as easily down the gastrointestinal tract – this can result in gastritis, gastric reflux, esophagitis, and/or bowel impaction.
* Head and neck position is not optimal:
* Aspiration with swallowing can occur.
* Risk of choking.
However, the challenge is to respect the patient’s need for comfort, postural support, and skin protection while promoting functional independence. Important functions include independent mobility, safe transfers, and postural stability for function and interaction.
In a qualitative study on the use of tilt-in-space and reclining wheelchairs, Shankar et al. identified promoting comfort and mobilizing for participation as important outcomes that result from prescribing this type of wheelchair. This study’s findings demonstrate that a patient’s independence with moving a wheelchair in their environment provided improved control in comfort, choice of where they wanted to be, and what they wanted to do. Additionally, studies have found that clients who were given the opportunity to self-propel their wheelchairs in the early stages of rehabilitation were much more likely to show improvements, such as ambulating at the time of discharge.
Many elderly patients have difficulty standing to get out of their wheelchairs. We also know that transfers pose a safety risk to both patients and caregivers. A safe and effective transfer can make a big difference in the health and well-being of our patients. Therefore, it is important to consider seat-to-floor height with this type of wheelchair—not only for foot propulsion but also for safe transfers.
Inspired by the above research, Water Orthopedics developed our Tilt-in-Space and reclining wheelchairs.
The forward pivot location provides low knee rise during tilt, enabling easy foot propulsion and clearance under tables for easier social engagement. Additionally, with its low seat-to-floor height, safe and functional transfers are made much easier, even for more involved clients.
It has the following features:
* Ability to choose a tilt range that provides optimal pelvic stability and skin protection without compromising mobility
* Offers an anterior tilt setting to help with transfers
* More rigid than a folding chair, offering efficient mobility and propulsion
* Higher standard weight capacity (136 kg)
* Large offering of options to satisfy individual needs
About Water Orthopedics:
Founded in 2018, Water Orthopedics is one of the most reputable manufacturers of orthopedics and rehabilitation products in China. We supply quality products worldwide at competitive prices.
After being in the industry for two decades, we have established comprehensive product ranges, including wheelchairs, walkers, walking sticks, crutches, shower chairs, commodes, anti-decubitus mattresses, manual and electric beds, etc. We firmly believe that independent living and quality orthopedic products enrich life.