Page 8 - Mobility Management, June/July 2020

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Tilt: Why, When & How Much
who use it just to put their feet on the floor for an assisted caregiver transfer. For something like that, you don’t necessarily need a big 45° of anterior tilt. You just need something that will lower the knees in relation to the hips.
“I’ve seen anterior tilt help with tone reduction for people who are hypertonic. If you put them in anterior tilt and you align their shoulders over their hips, their tone will actually decrease; they’re not always extending. And it can also help with visual field orientation: Instead of tilting them back, you tilt them forward.”
Part of the reason anterior tilt can facilitate environ- mental access is what it does for a client’s ability to
We have to look at why aren’t they using it? Is it just non-compliance? Is it someone who just doesn’t want to be tilted that much?
— Brad Peterson
reach: “I think what a lot of manufacturers are doing now is not just opening up the seat and back like a seat lift chair and lowering the feet, but also bringing everything forward. So you’re anteriorly tilting them, but you’re also moving the whole seating system forward, and that’s for things like reach and environmental access.
“So anterior tilt, especially now when you can do it without adding a lot of seat-to-floor height, it’s comfort, it’s pain reduction, it’s pressure. There are so many things that anterior tilt can do.”
Peterson called himself “a huge fan” of lateral, or side- to-side tilt. “We all move in different planes,” he pointed out. “So the ability to move yourself anterior, posterior, laterally — I’ve seen quite a few people who could not find comfort or could not reduce their pain or have
a sustained sitting tolerance by just posteriorly tilting. They had to posteriorly tilt, laterally tilt, and just be able to move and take pressure off their bodies and spines throughout the day by moving in different directions.”
An Ongoing Evolution
The ability to move in different planes isn’t the only factor of tilt that’s evolving. Peterson said that while using recline with tilt had become extremely popular, it’s becoming more common for clinicians to opt for tilt only in some situations.
8 JUNE-JULY 2020 | MOBILITY MANAGEMENT
“They might do it because they want to simplify it for somebody,” he said. “They might do it because they don’t see an indication for recline. They might do it to reduce complexity. There are a lot of reasons for doing or not doing recline. It’s a solution, something you can pull out of your toolbag and use based on someone’s functional needs.”
Tilt has become very common on power chairs, but Peterson still advocates for a thorough assessment any time tilt is being considered.
“When I first started in this industry,” he noted, “tilt
was a big deal. Now, it’s almost like ‘Everybody gets a
tilt chair.’ I’m not saying it’s mis-prescribed or over-pre- scribed. I’m just saying sometimes people forget what you have to look at with a tilt chair. Now you’re getting systems with limited amounts of tilt, which may be perfect for someone. But it also might preclude you from adding to that chair in the future, and you have to look at things like the environment and battery size and all kinds of things when it comes to prescribing any power chair.”
And seating teams should also keep in mind that tilt can initially be disorienting.
“So many times, I put a therapist into a tilt [chair], a tilt/ elevator, a tilt/recline, who’s never been tilted. And they grab onto that armrest like they’re about to go over,” Peterson said. “So you have to make sure that [clients] try it, because a lot of times, I think the reason you’re not seeing compliance is because of fear.
“Fear, lack of stability — a lot of people are getting out of their comfort level, especially people with tone. For people with cerebral palsy, fear and stability are
big things you should assess for when you’re adding tilt. That’s why a lot of the electronics that people have now allow you to do things like proportional actuators, where you can tilt back at your speed instead of just being at one speed. You can limit how much tilt they have until they get comfortable. You can ease someone into it.”
As common as tilt is, Peterson said it’s not an option that should be automatically applied to every client.
“We try to paint it with a brush,” he said. “But it’s different. Rehab is not black and white; it’s very gray. And using tilt depends on dozens of different things on a case-by-case basis.”
“Tilt, while considered the simplest, most ubiquitous of power positioning functions, brings with it many things to consider, clinically, functionally and environmentally. We must not overlook the function and independence it can unlock, keep exploring and asking questions.” m
—Laurie Watanabe
MobilityMgmt.com