Backrest Shape Affects Head–Neck Alignment and Seated Pressure
Unstable back support against gravity results in a forward head posture and contributes to buttocks pressure ulcers. However, the association between these health problems and a wheelchair backrest is unclear. Our newly developed wheelchair (N-WC) supports the back of the pelvis and thorax from obliquely underneath. The purpose of this study was to investigate the effect of different backrest shapes on head–neck alignment and seated pressure. Data from 28 healthy subjects were analyzed. Outcome measures were head–neck alignment angles, support angles of the backrest, and pressure distributions on the supporting surfaces. Compared with a typical wheelchair that has a flat backrest, the seat pressure decreased and the center of pressure was located in the middle of both the seat and backrest in the N-WC. Moreover, the head–neck alignment when seated in the N-WC was upright. These results highlight the importance of the shape of the wheelchair backrest.
World Health Organization, Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva, 2008, http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/, Accessed January 10, 2015.
World Health Organization, Wheelchair Service Training Package—Basic level. Geneva, 2012, http://www.who.int/disabilities/technology/wheelchairpackage/en/, Accessed January 10, 2015.
W. B. Mortenson, J. L. Oliffe, W. C. Miller, and C. L. Backman, “Grey spaces: the wheeled fields of residential care,” Sociology of Health & Illness, vol. 34, pp. 3315–3329, 2012.View at: Google Scholar
United Nations Department of Economic and Social Affairs, World Population Prospects: the 2012 Revision, Methodology of the United Nations Population Estimates and Projections, New York, 2014.
Japan Ministry of Internal Affairs Communication, Historical Statistics of Japan. Chapter 2 Population and Households. 2012, http://www.stat.go.jp/english/data/chouki/02.htm, Accessed January 14, 2015.
Cabinet Office, Government of Japan, White paper on aging society. The aging situation and the implementation status of aged society measures, 2014, http://www8.cao.go.jp/kourei/whitepaper/w-2014/gaiyou/pdf/1s1s.pdf, Accessed January 14, 2015.
Japan Ministry of Health, Labour and Welfare, Survey on care payment costs, 2014, (in Japanese), http://www.mhlw.go.jp/toukei/saikin/hw/kaigo/kyufu/13/dl/04.pdf, Accessed January 14, 2015.
E. M. Giesbrecht, W. B. Mortenson, and W. C. Miller, “Prevalence and facility level correlates of need for wheelchair seating assessment among long-term care residents,” Gerontology, vol. 58, no. 4, pp. 378–384, 2012.View at: Google Scholar
G. Green and J. Young, “The provision of wheelchairs for older people in the United Kingdom,” European Geriatric Medicine, vol. 2, no. 1, pp. 52–55, 2011.View at: Google Scholar
J. Rader, D. Jones, and L. L. Miller, “Individualized wheelchair seating: reducing restraints and improving comfort and function,” Topics in Geriatric Rehabilitation, vol. 15, no. 2, pp. 34–47, 1999.View at: Google Scholar
T. Kemmoku, K. Furumachi, and T. Shimamura, “Force on the sacrococcygeal and ischial areas during posterior pelvic tilt in seated posture,” Prosthetics and Orthotics International, vol. 37, no. 4, pp. 282–288, 2013.View at: Google Scholar
D. P. Greene and S. L. Roberts, “Body segment parameters,” in Kinesiology: Movement in the Context of Activity, Kathy Fal, Ed., p. 168, Elsevier Mosby, USA, 2nd edition, 2005.View at: Google Scholar
Y. L. Kuo, E. A. Tully, and M. P. Galea, “Video analysis of sagittal spinal posture in healthy young and older adults,” Journal of Manipulative and Physiological Therapeutics, vol. 32, no. 3, pp. 210–215, 2009.View at: Google Scholar
Y. Yukawa, F. Kato, K. Suda, M. Yamagata, and T. Ueta, “Age-related changes in osseous anatomy, alignment,and range of motion of the cervical spine. Part I: Radiographic data from over 1,200 asymptomatic subjects,” European Spine Journal, vol. 21, no. 8, pp. 1492–1498, 2012.View at: Google Scholar
M. S. Park, S. H. Moon, H. M. Lee et al., “The effect of age on cervical sagittal alignment: normative data on 100 asymptomatic subjects,” Spine, vol. 38, no. 8, pp. E458–463, 2013.View at: Google Scholar
J. Quek, Y. H. Pua, R. A. Clark, and A. L. Bryant, “Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults,” Manual Therapy, vol. 18, no. 1, pp. 65–71, 2013.View at: Google Scholar
U. J. Park and S. H. Jang, “The influence of backrest inclination on buttock pressure,” Annals of Rehabilitation Medicine, vol. 35, no. 6, pp. 897–906, 2011.View at: Google Scholar
F. Lin, S. Parthasarathy, S. J. Taylor, D. Pucci, R. W. Hendrix, and M. Makhsous, “Effect of different sitting postures on lung capacity, expiratory flow, and lumbar lordosis,” Archives of Physical Medicine and Rehabilitation, vol. 87, no. 4, pp. 504–509, 2006.View at: Google Scholar
D. E. Grondin, J. J. Triano, S. Tran, and D. Soave, “The effect of a lumbar support pillow on lumbar posture and comfort during a prolonged seated task,” Chiropractic & Manual Therapies, vol. 21, no. 1:21, 2013.View at: Google Scholar
K. Samuelsson, M. Bjork, A. K. Hansson, and B. Rustner, “The effect of shaped wheelchair cushion and lumbar supports on under-seat pressure, comfort, and pelvic rotation,” Disability and Rehabilitation: Assistive Technology, vol. 4, no. 5, pp. 329–336, 2009.View at: Google Scholar
F. Parent, J. Dansereua, M. Lacoste, and R. Aissaoui, “Evaluation of the new flexible contour backrest for wheelchairs,” Journal of Rehabilitation Research and Development, vol. 37, no. 3, pp. 325–333, 2000.View at: Google Scholar
Y. K. Jan, B. A. Crane, F. Liao, J. A. Woods, and W. J. Ennis, “Comparison of muscle and skin perfusion over the ischial tuberosities in response to wheelchair tilt-in-space and recline angles in people with spinal cord injury,” Archives of Physical Medicine and Rehabilitation, vol. 94, no. 10, pp. 1990–1996, 1990.View at: Google Scholar
J. M. Black, L. E. Edsberg, M. M. Baharestani et al., “Pressure ulcers: avoidable or unavoidable? Results of the National Pressure Ulcer Advisory Panel Consensus Conference,” Ostomy Wound Management, vol. 57, no. 2, pp. 24–37, 2011.View at: Google Scholar
M. W. Morningstar, B. R. Pettibon, H. Schlappi, M. Schlappi, and T. V. Ireland, “Reflex control of the spine and posture: a review of the literature from a chiropractic perspective,” Chiropractic & Osteopathy, vol. 13:16, 2005.View at: Google Scholar
J. Treleaven, “Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control,” Manual Therapy, vol. 13, no. 1, pp. 2–11, 2008.View at: Google Scholar
Japan Ministry of Internal Affairs Communication, Historical Statistics of Japan. Chapter 24 Health and Medical Care. 2012, http://www.stat.go.jp/english/data/chouki/24.htm, Accessed February 15, 2015.
L. M. Straker, P. B. O’Sullivan, A. J. Smith, M. C. Perry, and J. Coleman, “Sitting spinal posture in adolescents differs between genders, but is not clearly related to neck/shoulder pain: an observational study,” The Australian Journal of Physiotherapy, vol. 54, no. 2, pp. 127–133, 2008.View at: Google Scholar
M. K. Constand and J. C. Macdermid, “Effects of neck pain on reaching overhead and reading: a case-control study of long and short neck flexion,” BMC Sports Science, Medicine and Rehabilitation, vol. 5, no. 1:21, 2013.View at: Google Scholar
S. Borel, P. Schneider, and C. J. Newman, “Video analysis software increases the interrater reliability of video gait assessments in children with cerebral palsy,” Gait & Posture, vol. 33, no. 4, pp. 727–729, 2011.View at: Google Scholar
S. M. van Niekerk, Q. Louw, C. Vaughan, K. Grimmer-Somers, and K. Schreve, “Photographic measurement of upper-body sitting posture of high school students: a reliability and validity study,” BMC Musculoskeletal Disorders, vol. 9:113, 2008.View at: Google Scholar
T. Hatta, S. Nishimura, K. Inoue et al., “Evaluating the relationships between the postural adaptation of patients with profound cerebral palsy and the configuration of the Seating Buggy’s seating support surface,” Journal of Physiological Anthropology, vol. 26, no. 2, pp. 217–224, 2007.View at: Google Scholar
K. H. Chang and C. Chen, “3D shape engineering and design parameterization,” Computer-Aided Design & Applications, vol. 8, no. 5, pp. 681–692, 2011.View at: Google Scholar
Z. R. Dey, N. R. Nair, and N. Shapcott, “Evaluation of the Force Sensing Application pressure mapping system,” Journal of Medical Engineering & Technology, vol. 37, no. 3, pp. 213–219, 2013.View at: Google Scholar
S. K. Miller, L. Aberegg, K. Blasiole, M. Parker, and J. Fulton, “A prospective assessment of sacral pressures in healthy volunteers seated upright and reclined with legs elevated in a recliner,” Ostomy Wound Management, vol. 60, no. 9, pp. 52–59, 2014.View at: Google Scholar
W. J. Kim and M. Chang, “A Comparison of the average sitting pressures and symmetry indexes between air-adjustable and foam cushions,” Journal of Physical Therapy Science, vol. 25, no. 9, pp. 1185–1187, 2013.View at: Google Scholar
J. Rader, D. Jones, and L. Miller, “The importance of individualized wheelchair seating for frail older adults,” Journal of Gerontological Nursing, vol. 26, no. 11, pp. 24–32, 2000.View at: Google Scholar
R. H. Fuchs and P. A. Gromak, “Wheelchair use by residents of nursing homes: effectiveness in meeting positioning and mobility needs. Assistive Technology,” The Official Journal of RESNA, vol. 15, no. 2, pp. 151–163, 2003.View at: Google Scholar
K. H. E. Kroemer and E. Grandjean, Fitting the task to the human: a textbook of occupational ergonomics, Taylor & Francis, UK & USA, 5th edition, 1997, pp. 75-78.
K. Kobara, A. Eguchi, S. Watanabe, and K. Shinkoda, “The influence of the distance between the backrest of a chair and the position of the pelvis on the maximum pressure on the ischium and estimate shear force,” Disability and Rehabilitation: Assistive Technology, vol. 3, no. 5, pp. 285–291, 2008.View at: Google Scholar
D. P. Greene and S. L. Roberts, “Forces acting on the head and torso,” in Kinesiology: Movement in the Context of Activity, Kathy Falk, Ed., pp. 82–85, Elsevier Mosby, USA, 2nd edition, 2005.View at: Google Scholar
M. Reddy, S. S. Gill, S. R. Kalkar, W. Wu, P. J. Anderson, and P. A. Rochon, “Treatment of pressure ulcers: a systematic review,” JAMA, vol. 300, no. 22, pp. 2647–2662, 2008.View at: Google Scholar
S. Sprigle and S. Sonenblum, “Assessing evidence supporting redistribution of pressure for pressure ulcer prevention: a review,” Journal of Rehabilitation Research and Development, vol. 48, no. 3, pp. 203–213, 2011.View at: Google Scholar
T. Taule, K. Bergfjord, E. E. Holsvik et al., “Factors influencing optimal seating pressure after spinal cord injury,” Spinal Cord, vol. 51, no. 4, pp. 273–277, 2013.View at: Google Scholar
O. Stojadinovic, J. Minkiewicz, A. Sawaya et al., “Deep tissue injury in development of pressure ulcers: a decrease of inflammasome activation and changes in human skin morphology in response to aging and mechanical load,” PLoS One, vol. 14;8, no. 8:e69223, 2013.View at: Google Scholar
National Pressure Ulcer Advisory Panel, “European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance,” in Prevention and Treatment of Pressure Ulcers: Quick Reference Guide, Emily Haesler, Ed., pp. 14–32, Cambridge Media, Western Australia, 2014.View at: Google Scholar