CUSHIONS

Literature searches were conducted within MEDLINE and CINAHL. Other search engines were used as well, but with no new articles were found. Keywords used to identify possible articles included wheelchairs, seating, seating systems, cushions, posture, pressure sores, spasticity, tone and kyphosis. Combinations of the key words allowed for limiting the search to relevant articles. The same search strategy was completed in all search engines. In addition, proceedings that were available to the author from RESNA and other conferences (years 1999, 2000) were also reviewed to identify relevant findings within the wheelchair seating research. Although every effort was made to make the list all inclusive, it is possible that relevant research has been published, but has not been identified due to the varied keywords that authors use to identify their work. Should I have missed some work, it is purely by accident, and no intent to neglect research.

In December of 2000, numerous articles were identified by both MEDLINE and CINAHL that had been published in the past 2 years encompassing different aspects of seating, wheelchairs and mobility. Upon review of the information available (title, abstract), a decision was made about the inclusion of the article in this presentation. If the focus of the article was seating related it has been included. If the focus of the article was more product related (informational only) or was a review article concerning seating issues, the reference was noted, but has not been included for review within this talk. Table 1 shows the focus of articles that will be presented.

Table 1: Focus of Articles

• Seating: Pressure Ulcers; Cushions

• Seating – Posture

• Spasticity and Tone

•Wheelchairs : Transportation

Mobility issues

Biomechanics

Seating with respect to pressure ulcers, management of pressure and the integration of cushions to aid in pressure relief have had the greatest amount of research completed on it in the past several years. Included in these research findings are studies that have examined comparisons between different types of cushions and amount of pressure, cushions versus tilt-in-space chairs to relieve pressure, and mattresses designed to aid in pressure relief. Somewhat interrelated, research has also been conducted on pressure and posture with different wheelchair seating systems. For example a wheelchair with different types of leg rests may modify posture but also decrease pressure for the individual. Some research has examined the use of individualized programs to retrain subjects on how to sit, thereby helping with seated posture.

The research conducted in spasticity research has focused primarily on injections of Botulinum toxin. Various studies have shown that injections can reduce spasticity in both children and adults. Other studies have encompassed the validity of the pendulum test for assessing spasticity and treating spasticity with an exercise regime.

Research on wheelchairs has included issues in transportation (i.e. stability of SCI subjects in dynamic settings, wheelchair restraint systems), new types of wheelchairs such as the power assisted manual wheelchairs, as well as the biomechanics of wheelchair propulsion.

>Studies will be described with results and limitations emphasized. This review of the literature should be beneficial to all clinicians who have little time to read, and yet want to be more knowledgeable for their patients concerning the research that has been completed.

Selected References

Aissaoui R, Heydar S, Dansereau J, Lacoste M. Biomechanical analysis of legrest support of occupied wheelchairs: comparison between a conventional and compensatory legrest. (2000) IEEE Trans on Rehab Engineer, 8(1):140-148.

Beiring-Sorensen F, Schroder AK, Wilhelmsen M, Lomberg B, Nielsen H, Hoiby N. Bacterial contamination of bathwater from spinal cord lesioned patients with pressure ulcers exercising in the water. (2000) Spinal Cord,38(2):100-105.

Bertocci GE, Esteireiro J, Cooper RA, Young TM, Thomas C. Testing and evaluation of wheelchair caster assemblies subjected to dynamic crash loading. (1999) J Rehab Res Dev, 36(1):32-41.

Bolin I, Bodin P, Kreuter M. Sitting position: posture and performance in C5-C6 tetraplegia. (2000) Spinal Cord, 38(7):425-434.

Boninger ML, Baldwin M, Cooper RA, Koontz A, Chan L. Manual wheelchair pushrim biomechanics and axle position. (2000)Arch Phys Med Rehabil, 81(5):608- 613.

Brienza DM, Lin CT, Karg PE. A method for custom-contoured cushion design using interface pressure measurements. (1999)IEEE Trans on Rehab Engineer, 7(1):99-108.

Burns SP, Betz KL. Seating pressures with conventional and dynamic wheelchair cushions. (1999) Arch Phys Med Rehabil,80(5):566-571.

Defloor T, Grypdonck MHF. Do pressure relief cushions really relieve pressure(2000)Western J Nursing Research,22(3):335-350.

Defloor T, Grypdonck MHF.Sitting posture and prevention of pressure ulcers.(1999) Applied Nursing Research,12(3):136-142.

DiGiovine M, Cooper RA, Boninger ML, Lawrence BM, VanSickle DP, Rentschler AJ. User Assessment of Manual Wheelchair Ride Comfort and Ergonomics. (2000)Arch Phys Med Rehabil,81:490-494.

Ebe K, Griffen MJ. Quantitative prediction of overall seat discomfort. (2000)Ergonmics, 43(6):791-806.

Ferrarin M, Ludwig N. Analysis of thermal properties of wheelchair cushions with thermography. (2000) Medical & Biological Engineering & Computing, 38(1):31-34.

Fowler EG, Nwigwe AI, Ho TW. Sensitivity of the pendulum test for assessing spasticity in persons with cerebral palsy. (2000) Dev Medicine Child Neurology,42(3):182-189.

Garber S, Rintala DH, Hart KA, Fuhrer ML. Pressure ulcer risk in spinal cord injury: predictors of ulcer status over 3 years. (2000) Arch Phys Med Rehabil,81(4):465-471.

Goodman CM, Cohen V, Armenta A, Thornby J, Netscher DT. Evaluation of results and treatment variables for pressure ulcers in 48 veteran spinal cord-injured patients. (1999)Annals of Plastic Surgery, 42(6):665- 672.

Gray D. Pressure ulcer prevention and treatment: the Transair range. (1999). British J Nursing8(7):456-458.

Holdon KR, Titus MO. The effect of tiagabine on spasticity in children with intractable epilepsy: a pilot study. (1999)Pediatric Neurology,21(4):728-730.

Kamper DG, Adams TC, Reger SI, Parnianpour M, Barin K, Linden M. A low-cost, portable system for the assissement of the postural response of wheelchair users to perturbations. (1999)IEEE Trans on Rehab Engineer, 7(4):435-42.

Kamper DG, Barin K, Parnianpour M. Reger S, Weed H. Preliminary investigation of the lateral postural stability of spinal cord injured individuals subjected to dynamic perturbations. (1999) Spinal Cord,37(1):40-46.

McCarthy JJ, Betz RR. The relationship between tight hamstrings and lumbar hypolordosis in children with cerebral palsy. (2000) Spine,25(2):211-213.

Pellow TR A comparison of interface pressure readings to wheelchair cushions and positioning: A pilot study. (1999)Can J Occup Ther, 66(3):140-149.

Phillips VL, Temkin A, Vesmarovich S, Burns R, Idleman L. " Using telehealth interventions to prevent pressure ulcers in newly injured spianl cord injury patients post-discharge. (1999)International J Technology Assessment in Health Care,15(4):749-755.

Reid D, Rigby P, Ryan" Functional impact of a rigid pelvic stabilitzer on children with cerebral palsy who use wheelchairs: Users’ and caregivers’ perceptions. (1999) Pediatric Rehabilitation,3(3):101-118.

Rodriquez AA, McGinn M, Chappell R. Botulinum toxin kinjection of spastic finger flexors in hemiplegic patients. (2000) A J Phys Med Rehabil, 79(1):44- 47.

Sherwood AM, Graves DE, Priebe MM. Altered motor control and spasticiy after spinal cord injury: subjective and objective assessment. (2000) J Rehab Res Dev, 37(1):41-52.

Skold C, Levi R, Seiger A. Spasticity after traumatic spinal cord injury: nature, severity, and location. (1999)Arch Phys Med Rehabil 80(12):1548-1557.

Suputtitada A. Managing spasticity in pediatric cerebral palsy using a very low dose of botulinum toxin type A: preliminary report. (2000) A J Phys Med Rehabil, 79(4):320-326.

Tavakoli K, Rutkowski S, Cope C, Hassall M, Barnett R, Richards M, Vandervord J. Recurrence rates of ischial sores in para- and tetraplegics treated with hamstring flaps: An 8 year study. (1999)British J Plastic Surgery, 52(6):476-479.

Tefft D, Guerette P, Furumasu J. Cognitive predictors of young children’s readiness for powered mobility. (1999)Dev Med Child Neurology, 41(10):665-670.

Visser C, Eksteen CA. The efficacy of the Simplified Air Cushion (SAC) compared to the polyurethane foam cushion with regard to ischial tuberosity interface pressure relief. (1999)S Afr J Physiother,55(4):3-6.

Weiss-Lambrou R, Tremblay C, LeBlanc R, Lacoste M, Dansereau J. Wheelchair seating aids: how satisfied are consumers? (1999)Assistive Technology, 11(1):43-53.

Wissel J, Muller J, Dressnandt J, Heinen F, Naumann M, Topka H, Poewe W. Management of spasticity associated pain with botulinum toxin A. (2000)J Pain Symptom Management,20(1):44-49.