For many years, Permobil have produced powerchairs that are capable of incorporating a powered Anterior Tilt function into the seating system, pushing the boundaries of what is possible to create more independence for wheelchair users.
What is Anterior Tilt?
Anterior Tilt is when the position of the seat base is tilted forwards. Depending on your wheelchair configuration will depend on what level of anterior tilt you can achieve, and the advantages.
Anterior tilt can create different interactions and experiences for wheelchair users, as it brings you into a more functional position for daily tasks and allows you to interact with your environment in a whole new capacity.
Environmental benefits of Anterior Tilt.
If your seated in a wheelchair and you approach an area such as a worktop via the frontal plane, you are immediately impeded by various components of your wheelchair such as the footplates and castor wheels. This makes accessing the worktop quite difficult.
Anterior Tilt allows you easier access work surfaces, supermarket shelves and other interactive areas at the frontal plane, and increases your forward reach by up to 4.5" - allowing you to view the task at hand, reach beyond obstructions or reach into high cabinets. It's a functional position, which promotes greater independence, and allows you to access more of the world around you.
You might argue that you are able to approach shelves and work spaces side-on. However, A sideways reach increases the chance of shoulder injury due to weakened muscle force. This can lead to early shoulder dysfunction and even muscle or tendon tears, both of which can result in a significant loss of function at the shoulder girdle.
- Improves functional reach
- Reduces risk of shoulder injury
- Maximises use of available upper extremity strength
- Improves line of sight when reaching for items
Benefits when transferring using Anterior Tilt
Anterior tilt doesn't just have environmental advantages. If you have the ability to perform a standing transfer then adding anterior tilt puts you into a more favourable position, making the transfer easier.
A power seat elevator coupled with the anterior tilt places your wheelchair into a forward tilt position, which may help you perform safer and more independent transfers. The overall seat height is increased by lifting from the back of the seat which decreases the effort required to go from a seated position to standing. For individuals with a progressive condition, this feature may allow for the ability to perform a safe and independent transfer longer than one would be able to otherwise.
The anterior tilt may also make it easier to scoot forward towards the edge of the seat to achieve an ideal “starting position” for a sit to stand transfer.
If a person is unable to independently perform transfers, use of the anterior tilt may reduce the amount of assistance a caregiver must provide. It may also result in a more ergonomic position for the caregiver during transfers and could therefore reduce the risk of caregiver injury and falls.
- Safer transfers with less effort
- Reduces amount of effort required of caregiver
- Eases scooting forward in preparation for transfer
- Help to take weight off the pelvis to place a transfer board
Benefits of being seated in Anterior Tilt
Improved sitting position
Anterior Tilt can have a positive effect on posture. In a seated position, the natural curves of the spinal column are often flattened due to the position of the pelvis. Sitting in a seat in anterior tilt can reposition the pelvis, improve the natural curve in your lower back, facilitating extension in the thoracic spine.
If a person is able to actively use their core muscles, being seated in an Anterior Tilt position may help activate these muscles. With the use of the knee support, there is an additional point of contact for postural support. When the pelvis and trunk are stabilised and supported, functional reach and environmental access may be improved.
- May improve seated posture
- Maximises use of available core strength
- Enhance stability of neutral spinal alignment
- Work environment enhanced
Improved breathing
When seated for long periods of time, deep breathing may be limited due to increased intra-abdominal pressure, which can cause the diaphragm to not contract effectively. This can result in shallow breathing, decreased oxygenation throughout the body.
Prolonged seating positions may also cause a weak or absent active cough, which reduces the ability to evacuate mucus with bacteria from the upper respiratory tract. This can lead to respiratory infections or pneumonia.
Anterior Tilt may have a positive effect on breathing by allowing changes of position that promote an open angle at the hips and an open chest cavity.
Improved digestion
A second result of a prolonged seated position is the decrease of movement of the intestines. The time nutrients need to pass through the intestines (Transit time), increases. A longer transit time in the colon can increase the risk of constipation. Research has shown that food leaves the stomach much easier when individuals change position and is much more difficult when people stay in the same position for a long period of time.
- Provides change of hip angle during sitting
- Position to allow increased function of intestines
Tone Management
Many wheelchair users experience spasticity or changes in muscle tone. This can cause an inefficient amount of energy expenditure, increase pain and discomfort, fatigue, and can often result in unwanted changes in position - which can result in decreased function.
Clinicians often use weight bearing to manage spasticity. The result of even minimal weight bearing has a periodic effect and needs to be repeated quite regularly, which can be achieved with the assistance of Anterior Tilt.
In addition, a treatment recommendation may include passive range of motion, which may decrease the impact of prolonged spasticity on the muscles. Anterior Tilt offers the ability to change the hip and knee angle, which can accompany therapeutic goals within the range recommended by a clinician.
- Enhance therapy goals
- Promote reduction in spasticity
- Support existing range of motion
psycho-social benefits of Anterior Tilt
Because of the typical height when in a seated position, wheelchair users often experience a decreased visual field and a change of their communication possibilities. Users may experience tension in their neck musculature while maintaining eye contact with people of varying heights. A person who uses a wheelchair may also be approached differently because they are in a lower seated position, which can have a negative influence on their self-esteem and confidence.
The use of a Power Seat Elevator coupled with Anterior Tilt lifts the wheelchair seat higher and closer towards a conversation partner, and increases their visual field at the same time. The head and neck can be held in a more neutral position, decreasing the risk of neck pain. Active engagement and communication become easier and facilitate a more natural and less tiresome communication.
- Increase interaction
- Improve speech production
- Enhance engagement in activities
Powerchairs with Anterior Tilt
Anterior Tilt is available on all of the Permobil powerchairs that use the 'Corpus' seating system.
Permobil have branded their Anterior Tilt as 'Active Reach'. The Active Reach function combines both the powered seat elevator, with the anterior tilt function. Permobil have been the pioneer's when it comes to maximising independence and functionality using Anterior Tilt, and have created multiple reasons why it is the most under-rated powerchair function on the market.
Below, we'll detail the different anterior tilt options available.
10 Degrees Anterior Tilt - Available on M3 Corpus, M5 Corpus, F3 Corpus and F5 Corpus.
When any of the above powerchairs are configured with the Powered Seat Elevator, coupled with the 50 Degrees power tilt (Tilt-In-Space) - the 10 Degrees Anterior Tilt function comes at no extra cost. There are no additional power functions required to achieve 10 Degrees Anterior Tilt.
20 Degrees Anterior Tilt - Available on M3 Corpus, M5 Corpus, F3 Corpus and F5 Corpus.
As above, the power seat elevator and power tilt is required to achieve 20 Degrees Anterior Tilt. Technically, 20 degrees anterior tilt comes at no cost when the elevator and tilt are selected. However, because of the increased seating angle, it is also necessary to include both the power backrest recline, as well as the power elevating and power compensating legrest (Taken from the F5VS)
30 Degrees Anterior Tilt - Available on F3 Corpus and F5 Corpus.
Front Wheel Drive powerchairs are more stable than Mid Wheel Drive powerchairs, and as a result, they can achieve increased anterior tilt angles. All of the power functions listed above are required to achieve 30 degrees anterior tilt
45 Degrees Anterior Tilt - F5 Corpus.
Perhaps the highest amount of anterior tilt available on any non-standing powerchair, the F5 Corpus can achieve an incredible 45 Degrees Anterior Tilt. All power functions listed are required.
Interested in trying out a powerchair with Anterior Tilt? Get in touch to arrange a free, no obligation demonstration and assessment.
