Wheelchair Configuration and Postural Alignment in Persons with Spinal Cord Injury

Hastings JD, Rogers Fanucchi E, Burns SP. Wheelchair configuration and postural alignment in persons with spinal cord injury. Arch Phys Med Rehabil 2003;84:528-34. Objective: To determine whether postural alignment and shoulder flexion range differ for persons with spinal cord injury (SCI) seated in wheelchairs with standard configurations versus wheelchairs with posterior seat inclination and a low backrest set perpendicular to the floor. Design: Prospective repeated-measures study. Setting: Outpatient SCI clinic. Participants: Fourteen subjects with C6-T10 motor-complete SCI. Interventions: Subjects sat in 3 manual wheelchairs: standard setup E[amp]J Premier (S1), standard setup Quickie Breezy (S2), and test configuration Quickie TNT (T) with posterior seat inclination and a low backrest set perpendicular to the floor. Main Outcome Measures: Shoulder and neck alignment and pelvic tilt were determined from sagittal plane digital photographs at rest and with maximal vertical reach. Results: At rest, T produced less shoulder protraction than either standard configuration (difference between the mean values, S1: 1.6cm, P[equals].048; S2: 1.2cm, P[equals].013). S1 and S2 showed a greater head-forward position than T (differences between the mean values, S1: 6.5[deg], P[equals].008; S2: 6.3[deg], P[equals].013). T allowed greater humeral flexion than S2 (difference between the mean values: 3.7[deg], P[equals].036) and greater vertical reach above the seat plane than either conventional configuration (differences between the mean values, S1: 4.7cm, P[equals].005; S2: 4.1cm, P[equals].002). The indirect pelvic tilt measurement showed a trend (P[equals].06) toward greater posterior pelvic tilt with S1 and S2. Conclusion: The alternate configuration produces more vertical postural alignment and greater reach ability versus the standard factory setup wheelchairs