Timur Ekiz (Department of Physical Medicine and Rehabilitation, Training and Research Hospital, Ankara, Turkey) and others report in Spinal Cord that for 55% of patients with a spinal cord injury who use a wheelchair, the wheelchair is inappropriate for their needs. This includes 66.7% of patients with inappropriate seat height—which could lead to pressure ulcers or other complications.
Ekiz et al comment that although wheelchair biomechanics and set-up in spinal cord injury have been studied before, wheelchair appropriateness has not been described in these patients. They add: “We believe that describing the inappropriate parts of the wheelchair—the most missed parts in daily clinical practice—will guide clinicians to provide the patients with appropriate wheelchairs regarding their clinical features, homes/environment and works so that wheelchair-related complications can be reduced.”
The authors reviewed the wheelchairs of 27 patients with spinal cord injury (mean duration of wheelchair use was 19.63±23.03 months; mean functional independence measure motor scale was 39.11±16.06), and deemed a wheelchair to be inappropriate if at least three parts of the chair were not appropriate. Overall, 55% of the patients were found to be using inappropriate wheelchairs, with Ekiz et al noting that “seat height (66.7%), cushion (59.3%), and back height (48.1%) were the most common inappropriate parts”.
If the seat height is too short, the authors claim, the hips will be in the flexed position and this can increase the risk of hip flexor becoming contracted, which can cause the tuber of ischium to bear much more weight than normal and lead to the development of pressure sores. “On the contrary, if the seat height is higher than normal, the ankle will be in the flexed position and the Achilles tendon will be susceptible to be contracted,” Ekiz et al state. They add that, in their study, 22.2% of patients with lack of sitting balance did not have a seat belt despite seat belts being “crucial for providing trunk control” in such patients, explaining that “this inappropriateness might lead to falls in patients with spinal cord injury”. Five patients in the study had a history of at least one fall while using their wheelchair.
To avoid inappropriate wheelchairs, the authors advise that physicians should prescribe personally designed wheelchairs for patients with spinal cord injuries (44.4% of patients in the study used a wheelchair without prescription). They conclude: “After getting the wheelchair, patients should be trained in its use and maintenance. Concerning the associations between the comorbidities, compliance, and wheelchair appropriateness, long-term follow-up studies with large sample sizes are awaited.”