Page 6 - Mobility Management, June/July 2020

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An Interview with Brad Peterson, Amylior
Tilt: When, Why &
How Much?
Posterior, Anterior, Lateral: Understanding the Many Functional Uses for Power Tilt
Brad Peterson
Power tilt is so common in today’s Complex Rehab Technology (CRT) power wheelchairs that it can be easy to take for granted. But tilt can be used for a number of reasons and in a wide range of scenarios. And evolving engineering capabilities also make it possible for CRT power chairs to tilt in different
directions: posterior (rearward),
anterior (forward) and lateral
(side to side).
Mobility Management spoke to CRT industry veteran Brad Peterson, VP of U.S. Sales for Amylior, about tilt’s functionality for consumers who use CRT wheelchairs, and how the use of tilt has changed over time.
A Functional History of Tilt
There are many clinical and functional reasons to add tilt to a power chair, but it all started with weight shifting.
“Pressure reduction was, and
still is, king,” Peterson said. “That was why tilt first came out: Pressure reduction without changing the hip angle and adding shear to a system or inducing tonal reflexes.”
Today, tilt can support a number of goals.
“In my experience, I’ve seen it used for a lot of
different things and usually not just one,” Peterson
noted. “Respiration. Pressure reduction. Comfort is huge. I’ve always been a firm advocate of ‘If someone’s not comfortable, they’re going to somehow move themselves into a position of comfort,’ which may compromise every- thing you’re trying to do for them from a seating and positioning standpoint. So they have to be comfortable.
“We’ve also used it a lot for visual field orientation: For people with fixed open hip angles, a combination of
tilt and recline can get them to a more level view. Also, transfers, environmental access, and van entry: People getting into vans can be too tall, or the doors to short so
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they tilt back a little bit. Environmental access is huge.” Moving from a client’s head to the client’s lower
extremities, “A lot of times you have people who need
a very low seat-to-floor height or a very compact chair, but they have interference with their front casters or they
have interference with some- thing up front,” Peterson said. “So they have to drive in 5° of tilt for ground clearance or for caster interference to still get the seat-to-floor height or the positioning they need.”
In fact, Peterson pointed out, people who don’t use wheel- chairs often still like a bit of tilt. “Most able-bodied people in cars, if they have a power seat, like to feel tilted back a little to let gravity take a bit of the load off of us, for head control and gravity-assisted repositioning.”
That same tactic can apply to power chair users, some of
whom are most functional and comfortable while sitting and driving in a slightly posterior tilt position.
A Matter of Degrees
What has also evolved over time is the understanding of what various ranges of tilt can accomplish.
“Over the years, we’ve said you need at least 45° of tilt to elicit adequate pressure reduction, to offload the ITs [ischial tuberosities] and the coccyx and move it some- where else,” “Peterson said. “It has also been said that optimal pressure reduction occurs with a combination of posterior tilt and recline. Our thinking is evolving based on how often people are using their power positioning and how useful prescribed functions actually are.
“There are some studies out there, not as many as there should be, that show what an effective weight shift or a pressure reduction is. But there are also studies that
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