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European Journal of Physical and Rehabilitation Medicine 2013 October;49(5):619-28


language: English

The impact of abnormal muscle tone from hemiplegia on reclining wheelchair positioning: a sliding and pressure evaluation

Huang H. C. 1, 2, Lin Y. S. 1, Chen J. M. 1, Yeh C. H. 1, Chung K. C. 3

1 Department of Physical Medicine and Rehabilitation Chia-Yi Christian Hospital, Chia-Yi, Taiwan; 2 Department of Sports Management Chia‑Nan University of Pharmacy and Science, Tainan, Taiwan; 3 Institute of Biomedical Engineering National Cheng Kung University, Tainan, Taiwan


Background: Little is known about the influence of existing muscle tone abnormality on the sitting posture of stroke patients in reclining wheelchairs.
Aim: To investigate the impact of muscle tone abnormality from hemiplegia on the forward sliding and pressure of stroke patients while sitting in reclining wheelchairs.
Design: Experimental study.
Setting: The Assistive Devices/Technology Center at the Rehabilitation Department of hospital.
Population: 14 able-bodied elders and nonambulatory elderly stroke patients with flaccid (N.=12) or spastic hemiplegia (N.=13) participated in this study. Of the 12 patients with flaccid hemiplegia, 8 suffered from left-sided hemiplegia and 4 from right-sided hemiplegia. Of the 13 patients with spastic hemiplegia, 6 suffered from left-sided hemiplegia and 7 from right-sided hemiplegia.
Methods: We performed 3 reclining cycles in wheelchairs with conventional seats and V-shaped seats for each participant. The sliding along the backrest (BS) plane and the seat (SS) plane, mean sitting pressure (MP), and sacral peak pressure (SPP) of the participants were recorded. The Kruskal-Wallis test was used to compare the difference in BS, SS, MP, and SPP between able-bodied elders and stroke patients.
Results: The BS, SS, and SPP during repetitive reclining were generally greatest in flaccid hemiplegic participants, followed by spastic hemiplegic participants, and finally by able-bodied participants. There was no significant difference in MP among three subject groups on both conventional seats and V-shaped seats in most comparisons. Able-bodied participants’ buttocks tended to slide forward on conventional seats but backward on V-shaped seats, whereas hemiplegic participants’ buttocks slid forward on both seat types.
Conclusion: Stroke patients with flaccid hemiplegia are the most vulnerable to sacral sitting and higher sacral pressure in reclining wheelchairs, followed by patients with spastic hemiplegia. There is a difference in the displacement pattern between participants with normal muscle tone and those with abnormal muscle tone during wheelchair positioning. People who have hemiplegia with spasticity do not have incremental forward sliding with repetitive reclining in the same way as those who have a flaccid hemiplegia.
Clinical Rehabilitation Impact: The findings are valuable for wheelchair prescription and caregiver education.

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