Page 285 - Handbook of Electronic Assistive Technology

274 HANDBOOK OF ELECTRONIC ASSISTIVE TECHNOLOGY

• There may be a reduced need for additional supports if the tilt and recline is used
in increments when the person starts to lose position.
• Tilt/recline works in conjunction with the seating, including pressure distributing
cushions, to achieve the same aims; this may help defer the deterioration of a
scoliosis, although there is little evidence to support this claim (ethically, one could
not assign subjects to a control group).
• May help to reduce a flexible kyphosis, which may in turn reduce pressure on
internal organs.
• Provides a counter-posture (Pope, 2007) to upright sitting, that is to say in
changing the orientation of the trunk relative to gravity, the reverse forces are
applied compared to an upright sitting position.
• If the arms can be supported on a tray or bean bag, this takes further load off the
shoulders and spine, which may provide further improvement to alignment.
• Using a little tilt when driving outdoors, and in particular when driving down slopes,
can make the person feel more secure and less concerned about tipping forward.
• Relief of discomfort from constipation and internal pressure on the abdomen: It is
not uncommon for people who are unable to stand and walk to have problems with
constipation (Freeman et al., 2016), which is often reflected in the proportion of
people on medication for this condition. The use of a reclined position, where hip
flexion is reduced, may also relieve pressure on the abdomen, which may improve
comfort and sitting tolerance. Consider how people push back their chair from the
table after a meal so they can slide themselves forward. They may also loosen their
belt; it is a lot to ask of someone to sit in the same position all day.
• Hoisting: Since hoist slings tend to lift the person in a tilted orientation for the
purposes of stability, a tilted position in the wheelchair is very useful as the person
can be positioned with their pelvis to the back of the seat; this reduces the need for
further correction of posture and the associated manual handling risks to carers.
• Toileting:
• Use of a reclined position can help when managing toileting in a chair because it is
easier to position a urinal bottle when the hip angle is more open.
• It is usually necessary to move into an upright position to use a urinal bottle, and a
large angle of tilt can lead to problems with catheter drainage.
• Lying orientation:
• When used with elevating leg rests, a chair able to offer a large amount of recline
can create a lying or semi-lying position, either for resting during the day or to offer
a position for changing clothes.
• If an individual uses incontinence pads then the lying position could act as a
changing bed when out and about.
• Manual recline: Rather than a powered actuator, a manual mechanism is provided
which is operated typically either by a finger lever and Bowden cable (operated by the
occupant or attendant, depending on where it is sited) or by a hand wheel; it is fitted
on some powered chairs as standard and can be sufficient if the feature is seldom used,
perhaps where tilt is used more often. This will usually cost less than a powered recline.