Tilt-in-Space Justifications

All treatments, equipment, medications, etc. must be documented in the patient care plan before given, placed, or initiated. Healthcare facilities require written orders on their patients by Attending Physicians, Physical Therapists, Nurse Practitioners, or other qualified care providers before the order/placement of medical equipment (such as a Broda chair) in that facility.

Criteria for individuals who present with one or more of the following conditions:

Decreased postural control

Justification:

Tilting a seating surface in a posterior direction can reduce the effects of gravity on one’s trunk/upper body, which facilitates a more functional and proper upright posture. Proper postural control also assists with higher and more practical use of the upper extremities. Posterior tilt efficiently opens the diaphragm allowing for more significant thoracic expansion resulting in improved oxygenation, blood flow, and organ function. The tilt-in-space feature facilitates positioning for comfort, pain management, and pain relief.

At risk of skin breakdown and/or decreased skin integrity

Justification:

Tilt seating systems maintain a constant seat to back angle allows for patient repositioning throughout the day without the risk of shear displacement. Tilting the seating surface provides repositioning for those who are unable to independently shift their weight. The posterior tilt of the seating surface moves the weight and pressure away from critical areas under the pelvis. Proper repositioning improves blood flow, oxygenation, and retention of the skin tissue which is vital for maintaining skin integrity. Posterior tilt facilitates position changes associated with pressure relief for individuals with limited range of motion.

Musculoskeletal deformities/conditions and other medical conditions which preven proper positioning when seated in a non-tilting wheelchair (i.e., kyphosis or lordosis)

Justification:

Tilt-in-space chairs are commonly prescribed for individuals with musculoskeletal deformities or conditions. Posterior tilt reduces the effects of gravity on the trunk and upper body, helping to eliminate postural deviations. Tilt-in-space best accommodates conditions such as, but not limited to, hypertonicity, hypotonicity, kyphosis, and lordosis. Posterior tilt helps decrease fatigue associated with hypertonicity and improves postural support and stability for individuals with hypotonicity.

Decreased head/neck control and/or unable to feed themselves

Justification:

Clinicians use customized positioning to maximize breathing and speaking ability. This special positioning maintains vital organ capacity and also reduces the risk of aspiration. Posterior tilt provides stability and improved postural support for thos who cannot keep an upright posture when seated. Tilting a patient can be used to realign posture and enhance functions such as feeding, communication, and completion of activities of daily living. Postural deviations can be decreased with the use of posterior tilt, such as but not limited to slumping, sliding, falling forward, lateral lean, and head drop.

Individuals who are at risk for falls or injuries from using a non-tilting wheelchair

Justification:

Tilt provides postural stability and support for those who cannot maintain an upright posture when seated. Tilting the seating surface in a posterior direction maximizes the body’s weight and gravity, allowing the patient to remain seated, perpendicular and engaged in function activities. Tilting the patient in a posterior direction provides proper seating alignment, decreasing patient fatigue and postural deviations. With the decrease in postural deviations and improvement of postural support and stability, falls can be significantly reduced.

Other Justifications

  • To manage edema
  • To regulate spasticity
  • To decrease postural deviation
  • To realign posture and function
  • To improve transfer biomechanics
  • To prevent shear displacement (skin shearing)
  • To enhance visual orientation, speech, alertness, and arousal
  • For patients with range of motion limitations that prohibit a recline system
  • For accommodation and prevention of contractures and orthopedic deformities
  • To maintain a fixed seat to back angle for optimal positioning and pressure redistribution
  • For pressure redistribution that reduces the risk of pressure sores, resulting in increased comfort and sitting tolerance
  • To improve physiological processes such as orthostatic hypotension, respiration, and bowel and bladder function

When Not to Use:

Caution should be taken with the use of Tilt and/or Recline when;

  1. Using recline to position a patient as skin shearing can occur
  2. The use of a Tilt-in-Space chair is not listed or indicated in the patients care plan
  3. Adjusting/closing the back to seat angle to a point that it puts stress on the hip joints
  4. The patient presents with a condition that may cause the use of Tilt-in-Space to become unsafe
  5. An individual presents with an indwelling catheter as they may experience backflow of urine when using a tilt/recline system
  6. An individual utilizes a leg bag or other type of collection device as leakage may occur when higher levels of tilt and/or recline are utilized
  7. An individual regularly uses a tray to place items on. When tilted/reclined the items on the tray may slide off injuring the patient

Tilt-in-Space vs Restraints

Seating & Positioning

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