In evaluating clients from early childhood through adult, various factors come into play that affect their mobility and seated posture. Conditions such as neurologic diseases and disorders, cardiac, congenital abnormalities, cognitive impairments, and decreased lung capacity become more common. Additionally, aging skin becomes fragile, increasing the risk of pressure injuries. Limitations of strength, endurance, ambulation status, joint range of motion, postural deformities, and pain can impact ability to perform mobility related activities of daily living (MRADL’s). In light of these challenges, manual wheelchairs equipped with tilt-in-space feature are often prescribed for this population. When the clinician and complex rehabilitation equipment provider completes a wheelchair mobility seating evaluation, it is also very important to consider home accessibility, transportation, ease of use, durability, and weight of frame when recommending a tilt-in-space wheelchair.
The Advantages of Tilt-In-Space Wheelchairs
Tilt-in-space wheelchairs incorporate a unique feature that allows the entire seat to tilt backward while maintaining the user’s position where common ranges are up to 50 degrees of posterior tilt. Traditionally, manual tilt-n-space wheelchair users were commonly considered to be more dependent and relying on the caregiver for mobility. Over the years, companies like PDG, which is now part of the Permobil family, have designed manual tilt-n-space wheelchairs that offer a variety of options to enhance independently mobility and positioning with lower seat to floor heights for foot propulsion, enhanced wheel access, transfer assistance, power tilt, and power assist options which will follow up in our next blog. Manual tilt wheelchairs offer several advantages, making them a valuable choice for clients with specific requirements:
Reduced Health Risks: For patients who are unable to independently shift their weight or change positions, the risk of pressure injuries can be high especially in vulnerable areas in the pelvic region, such as, the ischial tuberosities, sacrum, and coccyx. Tilt-in-space wheelchairs mitigate this risk by promoting regular repositioning by a caregiver.
Improved Posture Control: Gravity can take a toll on individuals with compromised muscle strength or endurance especially due to prolonged sitting. Tilt-in-space functionality helps maintain proper upright posture, accommodating postural asymmetries like posterior pelvic tilt, thoracic kyphosis, or lateral trunk lean due to scoliosis.
Enhanced Comfort: Tilt-in-space wheelchairs provide improved comfort by redistributing pressure. The ability to tilt back allows users to shift their weight and relieve pressure on specific areas, such as the pelvic region.
Physiological Benefits: Without seated in an upright posture, the visual, digestive, and respiratory system can become compromised, Tilt-in-space reorients the body, reducing the effects of gravity and promoting neutral posture, enhancing the visual field and opening the thoracic region.
When should we use tilt? Tilt-in-space should be considered when clients:
A client cannot independently weight shift: Individuals who struggle to shift their weight independently are at high risk of pressure injuries. Tilt helps redistribute pressure and provides relief at the ischial tuberosities.
Struggle to maintain proper posture: Clients with compromised muscle strength, low endurance, postural asymmetries, such as, scoliosis or kyphosis, may find it challenging to maintain upright posture.
A client may need change position with reduced risk: Tilt provides a change of position while minimizing the risk of extensor spasticity.
Agitated clients who require more reinforced frame construction can benefit from a manual tilt-n-space with reduced need for repairs.
When growth adjustable manual tilt frames are needed for pediatric clients as they grow or adults whose weight might fluctuate depending upon health status.
Choosing the right tilt range:
Optimal Pelvic Stability: Achieving posterior tilt range that provides pelvic stability without compromising function.
Pressure-Relieving Range: Most posterior tilt ranges can achieve up to or greater than 45 degrees, offering effective pressure relief.
Anterior Tilt: Some wheelchairs even offer an anterior tilt setting, aiding in transfers.
Effortless Tilt Mechanism For Caregiver: Depending on weight capacity of client, the design of the posterior tilt function for the caregiver can be very important when it comes to a small child or a client who could weight up to 600 lbs.
Considering transportation needs:
Transport Tie Down System: Having transport brackets on a manual tilt-n-space is an important feature to safely secure the wheelchair on a school bus, private adaptive vehicle, public transportation, or paratransit.
Weight: Aluminium and steel frame construction of manual tilt wheelchair frames can have a weight difference close to 20 lbs. Aluminium frames will provide a lighter weight frame. However, steel frames are considered more durable and needs to be considered based on client evaluation and environment whether it’s a private home or residential facility.
Portability: Especially in the case of pediatric clients who have transitioned from an adaptive stroller or standard wheelchair, managing a tilt-n-space wheelchair can be challenging for caregivers, especially if they have a standard vehicle like a sedan or small hatchback. Currently, there are folding tilt-n-space manual wheelchairs on the market, however, multiple seating components must be removed for folding frame mechanism to activate. For some caregivers, this can be a challenge and frame durability can be questioned if not assembled correctly. PDG did come out with an innovative design called the Take-Apart frame on their Fuze T50, Fuze T50n and Fuze JR models which reduces frame weight and makes it easier for caregivers to live frame and seating components in a vehicle.
Accessibility: Overall width of a manual tilt-n-space wheelchair can be a concern when it comes to home and community mobility. The overall width from common manual tilt wheelchair frames on average is seat width plus 6.5” to 12.0” wide. For example, a wheelchair seat width is 18.0”, but the actual overall width depending on frame can be anywhere 25” to 30” wide which could create obstacles with home accessibilty. The PDG Fuze T50n came up with a unique design that sets the rear wheels in-line with the seat frame minimizing seat width plus 4” which puts in a similar footprint of a standard transport wheelchair.
Whether it’s for pressure relief, postural support, or enhanced function, manual-tilt-n-space wheelchairs play a crucial role in improving the quality of life for individuals with mobility and seating challenges.
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David Miller, MA, OTR/L, ATP/SMS
Regional Clinical Education Manager
David Miller, MA, OTR/L, ATP/SMS is an occupational therapist and is the Regional Clinical Education Manager for Permobil in the Pacific Southwest and Hawaii. David joined Permobil in 2021 and prior to this time, practiced as a seating mobility specialist for over 25 years, providing complex rehabilitation solutions for pediatrics and adults at Helen Hayes Hospital Center for Rehabilitation Technology in New York. In addition, David worked at New York University Langone Health wheelchair clinic and private consultant. David is a member of RESNA and has presented at the International Seating Symposium, Medtrade, and frequently lectures to clinicians, students, and rehabilitation technology suppliers.