The Clinical Benefits of Powered Tilt

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1 Asssted by gravty and daphragmatc movement Dgeston Gravty ads dgestve functon throughout the whole dgestve system, however, the dgestve system, cannot work effectvely f the ndvdual has a collapsed posture (posterorly tlted pelvc and kyphotc spnal curvature): Affects the ablty of food to pass along the dgestve track Affects bowel functon whch can lead to constpaton Can cause aspraton wth swallowng Can set off prmtve reflexes such as the gag reflex or tongue thrust Tltng the ndvdual wll extend ther trunk, whch n turn wll allow easy passage of food from the mouth to the oesophagus and mprove ther head and neck poston, whch are drectly related to the poston of the trunk. Vson Tlt extends the trunk as already mentoned, whch n turn, mpacts the poston of the head and neck. Indvduals who, when seated, exhbt a collapsed posture wth a flexed head and neck can be asssted va tlt to extend ther head and neck, helpng expand ther vsual feld. Expands vsual feld What are the contrandcatons for the prescrpton of tlt? Indvduals wth ndwellng catheters may experence backflow of urne, f, and when, n tlt Functonal reach may be mpacted Sensory processng ssues especally for those wth vestbular or tactle problems Elevatng the front of the wheelchar can affect access under tables etc. Greater tlt angles may cause a possble threat for physcally lmted users Usng a tray tems may slp or fall off

2 Anteror tlt consderatons for use Management of tone and abnormal reflexes Access under tables and surfaces Improved functonal reach Anteror tlt, a forward tlt angle as opposed to backwards, can have exceptonal benefts for a wheelchar user both functonally and physologcally. Stavness s paper enttled The effect of postonng for chldren wth cerebral palsy on upper extremty functon: a revew of the evdence, found the majorty of publshed studes support the postve effects of a neutral to slghtly anteror orentaton. The range of anteror slope may range from 0 15 degrees and s best utlsed wth a pelvc postonng belt. Anteror tlt can provde exceptonal benefts to wheelchar users, both functonally and physologcally. For some ndvduals just a small change n the angle of orentaton anterorly can effectvely manage tone and abnormal reflexes, whch can often nterfere wth functon. In addton, small amounts of anteror tlt lowers front seat-to-floor heght and can be the dfference between gettng under a table/desk or beng lmted by the lower extremtes. Many power wheelchar users would be able to use anteror tlt to assst wth functonal reach, makng the user ndependent when performng moblty-related tasks such as self-care, hygene, cookng, cleanng, laundry and much more! Settng the tlt on the TDX SP2: The Ultra Low Maxx seatng system on the TDX SP2 can be set to a predefned anteror or posteror tlt: 5 anteror tlt - reduces the maxmum possble tlt by 5 10 anteror tlt - reduces the maxmum possble tlt by 10 5 posteror tlt - ncreases the maxmum possble tlt by 5 For more controls nformaton n relaton to powerchars, take a look at our, Clncal Gude to Powechar Provson document avalable at clubtherappy.com. Invacare Australa Pty Ltd: ABN PO Box 5002, 1 Lenton Place, North Rocks, N5W 2151, Australa. Freephone: , Fax: EmaI: orders@nvacare.com.au Web: Invacare New Zealand: PO Box , 4 Westfeld Place, Mt. Wellngton, Auckland, New Zealand. Freephone , Freefax EmaI: sales@nvacare.co.nz Web: Invacare Asa Ltd: PO Box 5002, 1 Lenton Place, North Rocks, NSW 2151, Australa. Phone: , Fax: EmaI: asasales@nvacare.com Web: www. nvacare.com.au Makng Lfe's Experences Possble 2017 Invacare Internatonal Sàrl. All rghts reserved. Tlt fact sheet - ANZ - 07/2017

3 KB32 The Clncal Benefts of Powered Tlt What s tlt? Tlt systems change seat angle orentaton n relaton to the ground, whle mantanng the seat-to-back and seat-to-legrest angle (RESNA 2015). What s tlt most commonly prescrbed for? Enables weght shftng by redstrbutng pressure away from the buttocks, especally the Ischal Tuberostes (IT s), to the back Provdes a change n posture for users who cannot ndependently shft ther bodyweght Helps promote good seatng algnment and decreases the potental for postural devatons However, changes n body poston are also necessary to address ssues related to functon, physology, transfers and bomechancal ssues, contracture or orthopaedc deformtes, oedema, spastcty, comfort and dynamc movement. Does exstng research dentfy at what pont pressure becomes harmful to the human body? To date, research has not dentfed a specfc threshold at whch loads can be deemed harmful across people or stes on the body. However, t does show that the damagng effects of pressure are related to both ts magntude and duraton. Pressure magntude s managed by the support surface and postural controls as well as body posture, whle duraton s addressed va turnng and weght shftng frequency to actvely redstrbute pressure. Body weght Bone Seat surface Muscle Tssue Skn

4 What does research say about tlt n relaton to pressure relef? At present, there s no defned angle for optmal pressure relef, but at clnc level, t s suggested tltng anywhere from or as far back as the system wll go to releve pressure. Studes lookng nto the effects of tlt report the followng: A mnmum of 30 tlt s requred to: 1. Intate unloadng of the sacrum 2. Acheve a clncally sgnfcant reducton n pressure at the Ischal Tuberostes (IT s) (Gesbrecht et al, 2011) Tltng to 20 resulted n an 11% reducton n nterface pressure and elmnated shear forces. (Hobson et al, 1992) 45 tlt resulted n a 45% reducton of nterface pressure over the IT s. (Burns et al 1999) 25 tlt resulted n a 22% reducton of nterface pressure. (Vasbuch et al, 2000) An nterestng new fndng sheds lght on dosage of tlt. Performng tlt of 35 wth reclne of 120 for a duraton of three mnutes s more effectve than a duraton of one mnute n enhancng skn perfuson (Yh-Kuen Jan et al, 2012). RESNA 2015 Consderng the exstng research on tlt alone, t must be greater than 25 to acheve pressure relef and/or tssue perfuson at the schal tuberostes (IT s). Invacare TDX SP2 wth Ultra Low Maxx At Invacare, our TDX SP2 wth Ultra Low Maxx powerchar offers a maxmum tlt of 50. Not only does ths ensure effectve redstrbuton of pressure for schal relef and tssue reperfuson, t also warrants suffcent tlt for effectve postonng of the ndvdual. Not forgettng the mportance of comfort, the ablty to tlt to 50 offers the user the ablty to fnd a poston of comfort optmal for them. It should be noted, however, n order to provde the most effectve pressure relef, the lterature recommends the use of tlt n combnaton wth reclne. The TDX SP2 wth Ultra Low Maxx powerchar, therefore, offers 50 tlt wth 170 back rest reclne for optmal performance. Wth ts centre of gravty adjustment, the compact wheelbase remans stable durng both the tlt and reclne cycles.

5 When we st, the force of gravty pushes down on our body Benefts of tlt explaned Postural algnment - Gravty asssted postonng For ndvduals wth compromsed muscle strength, gravtatonal forces mpactng on the body cause the user to become slouched n ther wheelchar and exhbt a posterorly rotated pelvs and kyphotc (C-shaped) spne. Ths may happen due to fatgue caused by sttng n the wheelchar too long or reduced sttng ablty, n whch the user s muscles are not strong enough to fght aganst the force of gravty, preventng them from beng able to mantan an uprght posture. A slumped or kyphotc posture ncreases the rsk of secondary complcatons, such as tssue adaptaton and contractures; respratory and breathng problems, dgestve ssues, bowel and bladder problems or complcatons wth vson and communcaton. It can also compromse the cardac system, affectng blood flow around the body, ncreasng the lkelhood of pressure njures occurrng as oxygen and nutrents transported n the blood are unable to reach muscles and tssue. Tlt reduces the effects of gravty as llustrated n mages (a) and (b) below. Tltng the wheelchar helps control pelvc movement and prevent sldng, creates trunk extenson, as well as assstng wth trunk, head and neck postonng. gravty gravty a b Uprght seatng: Pelvs sldes nto posteror tlt Tlt: Pelvs n a neutral poston

6 Respraton and breathng When an ndvdual cannot mantan an uprght seated posture, such as n mage (a) above, respratory functon becomes compromsed as the daphragm s unable to functon optmally. The daphragm s a large dome shaped muscle whch separates the thoracc and abdomnal cavtes. As we breathe n (nhale), the daphragm contracts downwards, ths elongates the lungs fllng them wth ar whch pushes the abdomen forward, a process referred to as abdomnal breathng. Next, the ntercostals muscles draw the lower rbs upward, expandng the chest from sde to sde. Fnally, towards the end of nspraton, the upper rbs are drawn forward and up. In mage (A), the ndvdual s lungs are not able to fully expand, whch can result n shallower and faster breathng, dffcultes takng a deep breath or even the lower part of the lungs collapsng. Neuromuscular dsease and skeletal abnormaltes can both contrbute to a compromsed respratory system. In neuromuscular dsease, ncludng cervcal spnal njury, the daphragm may be weakened, placng a greater burden on the ntercostals and accessory muscles. Skeletal abnormaltes can also alter the shape of the daphragm, affectng ts overall functon. Indcatons that respraton s beng compromsed nclude shortness of breath or a shallower, faster breathng rate. Tlt helps to: Postural stablty supports the daphragm Create thoracc or trunk extenson allowng the daphragm to contract and relax optmally, permttng lung expanson and movement of the chest wall and abdomen. Posteror stablty of the spne provdes the anteror stablty for the rb cage to expand. Helps allevate back and neck pan whch may be assocated wth respratory dysfuncton as the muscles work to acheve postural control. Spastcty Jont angles reman statc stops spastcty beng trggered Indvduals who suffer from spastcty can fnd that movement of a jont trggers spastcty n ther body, makng t dffcult for them to mantan an optmal sttng poston. Tlt systems mantan statc jont angles, meanng they do not change.