RESNA Position on the Application of Tilt, Recline, and Elevating Legrests for Wheelchairs Literature Update

Authors: Dicianno, MD; Lieberman, MSOTR/L, ATP; Schmeler, PhD, OTR/L, ATP; Souza, PhD, PT; Cooper, MPT, ATP; Lange, OTR, ABDA, ATP/SMS; Liu, PT, PhD; Jan, PT, PhD

Publisher: Rehabilitation Engineering and Assistive Technology Society of North America

Tilt, recline, and elevating legrests are features that can be operated manually or as power options that can be added to wheelchairs. The beneficial effects of these seat functions have been reported as a clinical consensus statement in prior work (Dicianno et al., 2009). The purpose of this manuscript is to update this RESNA Position on the application of tilt, recline, and elevating legrests with more current and additional scientific literature. It is RESNA’s position that these features are often medically necessary, as they enable certain individuals to:

• Realign posture and enhance function
• Enhance visual orientation, speech, alertness, and arousal
• Improve physiological processes such as orthostatic hypotension, respiration, and bowel and bladder function
• Improve transfer biomechanics
• Regulate spasticity
• Accommodate and prevent contractures and orthopedic deformities
• Manage edema
• Redistribute and relieve pressure
• Increase seating tolerance and comfort
• Independently change position to allow dynamic movement

Special precautions must be exercised when utilizing these features in order to avoid the risk of injury, such as shear wounds. A licensed medical professional (i.e. physical or occupational therapist) must be involved with the assessment, prescription, trials and training in the use of the equipment and a specialty certified professional is recommended.

Tilt systems allow clients to change their seat angle orientation in relation to the ground while maintaining a constant seat to back angle and seat to legrest angle. Traditional tilt operates in the sagittal plane. Most tilt systems tilt posteriorly in this plane, but some systems offer anterior tilt. Other tilt systems such as rotational and lateral tilt operate in coronal or oblique planes. 

Recline allows clients to change seat to back angle and maintain constant seat angle with respect to the ground. 

Elevating legrests allow clients to change the leg and/or footrest angle relative to the seat in order to flex or extend the knee. Some legrests articulate, that is, lengthen while extending the knee.

Full text: https://www.resna.org/Portals/0/Documents/Position%20Papers/RESNA%20PP%20on%20Tilt%20Recline_2017.pdf

Summary: It is RESNA’s position that tilt, recline, and elevating legrests are medically beneficial for wheelchair users by: improving functional reach and access to enable participation in ADLs; managing posture and fatigue; improving mobility and lower limb function in those with some preservation of lower limb strength; improving range of motion and reducing the risk of contractures; promoting vital organ capacity including pulmonary, bowel and bladder function; promoting bone health; improving circulation; reducing abnormal muscle tone and spasticity; reducing the occurrence of pressure ulcers and skeletal deformities; and providing numerous psychosocial and quality of life benefits. The findings in this paper are supported by select peer-reviewed literature and current clinical practice. 

“RESNA Position on the Application of Tilt, Recline, and Elevating Legrests for Wheelchairs Literature Update” Approved by RESNA Board of Directors on February 23, 2015.