Manual wheelchairs with adjustable axle position appear to improve wheelchair propulsion and reduce the risk of upper extremity injury.

The use of an ultralight wheelchair may improve propulsion efficiency in those with SCI. 

Body weight management is important in reducing the forces required to propel a wheelchair and reducing the risk of upper extremity injury.

The evidence appears to be inconclusive as to whether there is an advantage to one stroke pattern over another.

Physical conditioning and strengthening of the upper extremity during initial inpatient rehabilitation is important to the development of wheelchair propulsion skills.

Wheeling cross slope can play a role on the cadence and power that is required for wheelchair propulsion.

There is insufficient evidence to determine if Spinergy wheels are more effective in reducing spasticity by absorbing vibration forces when wheeling.

Tires with less than 50% inflation cause an increase in energy expenditure.

Use of flexible handrims may reduce upper extremity strain during wheelchair propulsion.

The use of power-activated power-assist wheelchairs provide manual wheelchair users with paraplegia and tetraplegia with a less strenuous means of mobility, improve functional capabilities and reduce the risk of upper extremity injury.

Power wheelchair use for the individual needs to be determined by more than distance and speed travelled indoor/outdoor use and wheelchair occupancy.

For the SCI population power wheelchair provision needs to include at a minimum customizable programmable controls.

Consideration should be given to the potential provision of both power and manual wheelchairs to meet basic living needs for the SCI population.

It cannot be assumed that a change in interface pressure through use of tilt/recline equates to an increase in blood flow at the ischial tuberosities.

The variability in blood flow and interface pressure changes associated with tilt/recline, supports the need for an individualized approach to education around power positioning device use for pressure management.

Segway Personal Transporters may present an alternative form of mobility for individuals with SCI who are able to stand and walk short distances.

Individual attention to spinal/pelvic positioning for SCI clients is essential for appropriate wheelchair prescription and set-up.

Use of lateral trunk supports in specialized seating improve spinal alignment and reduce lumbar angles.

The wheelchair user’s posture and level of SCI has the greatest impact for selection of a wheelchair and seating equipment.

Contoured foam cushions compared to flat foam cushions seem to provide a seat interface that reduces the damaging effects of external loading and tissue damage.

Pressure mapping studies using non-disabled subjects should not be generalized to the SCI population because pressure differences exist between the two groups.

Typical areas of high pressure for the SCI population include sacrum, coccyx and/or ischial tuberosities.

Data generated from pressure mapping studies on seniors should not be generalized to the SCI population.

Pressure mapping is a useful tool for comparing pressure redistribution characteristics of cushions for an individual but it needs to be a part of the full evaluation not the main part or only evaluation.

Shifting pressure from the ischial area to the back support as well as the middle and anterior aspects of the cushion appears to decrease average ischial interface pressure. 

Leaning forward at least 45° and lateral trunk leaning to 15° reduces pressure at the sitting surface but may also result in ischial tuberosity shifting across the sitting surface in the opposite direction.

There is an inverse relationship between tilt angle and pressure at the sitting surface. Significant pressure reduction starts around 30° of tilt with maximum tilt providing maximum pressure reduction. The amount of reduction realized is variable by person.

Backrest recline to 120° decreased mean maximum pressures in the ischial tuberosity area but also causes the greatest ischial tuberosity shift (up to 6 cm).

Wheelchair seat ‘squeeze’ did not increase peak pressures at the ischial tuberosities, however the sacrum was supported up against the backrest.

Peak interface pressure is greater for dynamic movement in SCI subjects than static sitting but cumulative loading is comparable between dynamic and static loading for the SCI population.

Peak pressures appear to be located slightly anterior to the ischial tuberosities.

There is insufficient evidence to determine if electric stimulation of the buttock area is of clinical benefit to reduce pressure at the ischial tuberosities.