A pilot investigation of anterior tilt use among power wheelchair users

To examine the influence of use of the anterior tilt-in-space power seat function on performance of functional activities, physical health, and user satisfaction on among power wheelchair users. Ten full-time power wheelchair users with a seat elevator on their current chair participated in a mixed-methods, repeated measures study. At Visit 1 participants completed the Wheelchair Outcome Measure, Functional Mobility Assessment, Wheelchair Users Shoulder Pain Index, Fatigue Severity Scale, and the Spinal Cord Injury Secondary Conditions Scale. Physical assessments were performed to examine transfer quality (transfer assessment instrument), functional reach, activities of daily living (performance assessment of self-care skills), seated balance (function in sitting test), spasticity, respiratory function, and speech production. Approximately 3 days later (Visit 2), participants were trained on use and provided a power wheelchair with anterior tilt to trial for two weeks. After two weeks (Visit 3), the Visit 1 protocol was repeated and a semistructured interview conducted. Participants lived with disabilities of cerebral palsy, spinal muscular atrophy and multiple sclerosis. With use of anterior tilt, significant improvements were seen among safety of meal preparation, <i>p</i> = 0.033, <i>d_z</i> = 0.91 and functional reach in the vertical direction, <i>p</i> = 0.000, <i>d_z</i> = 2.62. Subjectively, participants found anterior tilt helpful in performance of reaching tasks in but found the safety equipment restrictive. Preliminary results indicate that use of the anterior tilt may help to improve performance of functional activities. Additional research is needed to examine the long-term influence of the technology.Implications for rehabilitationThe anterior tilt seat function changes the seat angle orientation in relation to the ground in the sagittal plane and angles the seat forward. As a result, the individual using the assistive technology is positioned in a semistanding position.Preliminary results of this study indicate that with use of anterior tilt, safety of meal preparation and functional reach in the vertical direction significantly improved. Subjectively, participants found anterior tilt helpful in performance of reaching tasks but found the safety equipment restrictive.Additional research is needed to examine the long-term influence of anterior tilt on functional activities, physical health and user satisfaction on among a large and diverse group of power wheelchair users. The anterior tilt seat function changes the seat angle orientation in relation to the ground in the sagittal plane and angles the seat forward. As a result, the individual using the assistive technology is positioned in a semistanding position. Preliminary results of this study indicate that with use of anterior tilt, safety of meal preparation and functional reach in the vertical direction significantly improved. Subjectively, participants found anterior tilt helpful in performance of reaching tasks but found the safety equipment restrictive. Additional research is needed to examine the long-term influence of anterior tilt on functional activities, physical health and user satisfaction on among a large and diverse group of power wheelchair users.

本研究旨在探讨前向空间倾斜（anterior tilt-in-space）电动座椅功能对电动轮椅（power wheelchair）使用者的日常活动表现、身体健康状况及用户满意度的影响。本研究纳入10名全职电动轮椅使用者，其当前使用的电动轮椅均配备座椅升降功能，研究采用混合方法重复测量研究（mixed-methods, repeated measures study）设计。
在首次访视（Visit 1）中，受试者完成了轮椅结局量表（Wheelchair Outcome Measure）、功能移动性评估（Functional Mobility Assessment）、轮椅使用者肩痛指数（Wheelchair Users Shoulder Pain Index）、疲劳严重程度量表（Fatigue Severity Scale）及脊髓损伤继发状况量表（Spinal Cord Injury Secondary Conditions Scale）。同时开展多项身体评估，包括转移质量（转移评估工具）、垂直方向功能伸距、日常生活活动（自我护理技能表现评估）、坐位平衡（坐位功能测试）、痉挛、呼吸功能及言语产生能力。
约3天后（第二次访视，Visit 2），受试者接受了使用培训，并获得一台配备前向倾斜功能的电动轮椅进行为期2周的试用。
2周后（第三次访视，Visit 3），研究者重复了首次访视的评估流程，并开展了半结构化访谈（semistructured interview）。
受试者均患有脑瘫（cerebral palsy）、脊髓性肌萎缩症（spinal muscular atrophy）或多发性硬化（multiple sclerosis）。
使用前向倾斜功能后，受试者的备餐安全性（p = 0.033，d_z = 0.91）及垂直方向功能伸距（p = 0.000，d_z = 2.62）均得到显著改善。主观反馈方面，受试者认为前向倾斜功能对完成伸距任务有帮助，但认为安全装备存在束缚感。初步研究结果表明，使用前向倾斜功能或可改善日常活动表现，未来仍需开展更多研究以明确该技术的长期影响。

康复启示
前向倾斜座椅功能可改变座椅相对于地面的矢状面（sagittal plane）角度方向，使座椅向前倾斜。因此，使用该辅助技术的使用者可处于半站立位。本研究的初步结果显示，使用前向倾斜功能可显著改善备餐安全性及垂直方向功能伸距。主观反馈方面，受试者认为前向倾斜功能对完成伸距任务有帮助，但认为安全装备存在束缚感。未来仍需纳入更大规模、多样化的电动轮椅使用者群体，开展进一步研究以明确前向倾斜功能对日常活动表现、身体健康状况及用户满意度的长期影响。

前向倾斜座椅功能可改变座椅相对于地面的矢状面角度方向，使座椅向前倾斜。因此，使用该辅助技术的使用者可处于半站立位。本研究的初步结果显示，使用前向倾斜功能可显著改善备餐安全性及垂直方向功能伸距。主观反馈方面，受试者认为前向倾斜功能对完成伸距任务有帮助，但认为安全装备存在束缚感。未来仍需纳入更大规模、多样化的电动轮椅使用者群体，开展进一步研究以明确前向倾斜功能对日常活动表现、身体健康状况及用户满意度的长期影响。