title: Influence of wheelchair footrest height on ischial tuberosity pressure in individuals with paraplegia.
abstract: OBJECTIVE
  To describe the effect of wheelchair footrest height on sitting pressures in persons with paraplegia.
  
  
  METHODS
  Seventeen manual wheelchair users with paraplegia underwent a seat pressure examination while footrests were elevated from the initial position with the thighs parallel to the seat (p0), by 10% (position p10) and by 20% of the fibula length (position p20). We analyzed average pressure (AP), the contact surface of the body with the seat (CS), pressures on the ischial tuberosities-left (LIP) and right (RIP)--and average pressure on both ischial tuberosities (AIP).
  
  
  RESULTS
  A gradual increase in footrest elevation was accompanied by significant increases in AP (p0: 57.24±14.31; p10: 60.65±14.85; p20: 62±15.3 mm Hg; Kendall coefficient of concordance W=0.962), AIP (p0: 159.35±54.95; p10: 176.35±53.3; p20: 184.26±54.09 mm Hg; W=0.896), LIP (p0: 165.24±54.05; p10: 183±52.08; p20: 193.18±56.32 mm Hg; W=0.751) and RIP (p0: 153.71±71.23; p10: 167.35±72.19; p20: 175.35±70.84 mm Hg; W=0.524) and a significant decrease in CS (p0: 1218.2±100.8; p10: 1131.8±134.6; p20: 1065±142.6 cm(2); W=0.985). There was a moderate correlation between the relative increase in LIP and RIP between p0 and p10, and between p10 and p20 (Pearson's correlation coefficient for LIP r=0.66; P=0.04, for RIP r=0.77; P=0.003), and a high correlation between relative changes in AIP (r=0.87; P<0.0001).
  
  
  CONCLUSIONS
  Wheelchair footrest elevation caused a steady rise in AIP; however, left to right side pressure differences changed variably, suggesting that the risk of pressure ulcers may increase disproportionately with footrest elevation.
authors.affiliation: 1] Department of Rehabilitation, Medical University of Warsaw, Warsaw, Poland [2] Department of Physiotherapy, College of Rehabilitation, Warsaw, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Tederko
authors.affiliation: Department of Physiotherapy, College of Rehabilitation, Warsaw, Poland.
authors.forename: T
authors.initials: T
authors.lastname: Besowski
authors.affiliation: Department of Physiotherapy, College of Rehabilitation, Warsaw, Poland.
authors.forename: K
authors.initials: K
authors.lastname: Jakubiak
authors.affiliation: Department of Physiotherapy, College of Rehabilitation, Warsaw, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Łyp
authors.affiliation: Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland.
authors.forename: K
authors.initials: K
authors.lastname: Bobecka-Wesołowska
authors.affiliation: Department of Physiotherapy, College of Rehabilitation, Warsaw, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Kiwerski
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007512:Ischium; D007866:Leg; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000150:complications* / Q000534:rehabilitation*; D011187:Posture; D011312:Pressure; D003668:Pressure Ulcer / Q000209:etiology; D012306:Risk; D013119:Spinal Cord Injuries / Q000150:complications / Q000534:rehabilitation; D014910:Wheelchairs / Q000009:adverse effects*; D055815:Young Adult