Car Transfer and Wheelchair Loading Techniques in Independent Drivers with Paraplegia.

Lisa Lighthall Haubert,Somboon Maneekobkunwong,Valerie J Eberly,Patricia E Hatchett,Sara J Mulroy,Joanne K Gronley,Philip S Requejo

doi:10.3389/fbioe.2015.00139

Lisa Lighthall Haubert, Somboon Maneekobkunwong + Show 5 more

Open Access

https://doi.org/10.3389/fbioe.2015.00139

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Abstract

Car transfers and wheelchair (WC) loading are crucial for independent community participation in persons with complete paraplegia from spinal cord injury, but are complex, physically demanding, and known to provoke shoulder pain. This study aimed to describe techniques and factors influencing car transfer and WC loading for individuals with paraplegia driving their own vehicles and using their personal WCs. Sedans were the most common vehicle driven (59%). Just over half (52%) of drivers place their right leg only into the vehicle prior to transfer. Overall, the leading hand was most frequently placed on the driver’s seat (66%) prior to transfer and the trailing hand was most often place on the WC seat (48%). Vehicle height influenced leading hand placement but not leg placement such that drivers of higher profile vehicles were more likely to place their hand on the driver’s seat than those who drove sedans. Body lift time was negatively correlated with level of injury and age and positively correlated with vehicle height and shoulder abduction strength. Drivers who transferred with their leading hand on the steering wheel had significantly higher levels of shoulder pain than those who placed their hand on the driver’s seat or overhead. The majority of participants used both hands (62%) to load their WC frame, and overall, most loaded their frame into the back (62%) vs. the front seat. Sedan drivers were more likely to load their frame into the front seat than drivers of higher profile vehicles (53 vs. 17%). Average time to load the WC frame (10.7 s) was 20% of the total WC loading time and was not related to shoulder strength, frame weight, or demographic characteristics. Those who loaded their WC frame into the back seat had significantly weaker right shoulder internal rotators. Understanding car transfers and WC loading in independent drivers is crucial to prevent shoulder pain and injury and preserve community participation.

Highlights

Shoulder pain is a common problem in individuals with spinal cord injury (SCI.) Its prevalence increases with time post-injury affecting as many as 70% of individuals by 20 years after SCI (Sie et al, 1992)
Volunteers with paraplegia resulting from SCI [American Spinal Injury Association Impairment Scale (AIS) A, B, or C] were recruited from outpatient clinics at Rancho Los Amigos National Rehabilitation Center (RLANRC)
Documentation of the techniques utilized for car transfer from different WCs into a variety of vehicles and the loading of these WCs is a necessary preliminary step to optimize future biomechanical testing in the laboratory

Summary

Introduction

Shoulder pain is a common problem in individuals with spinal cord injury (SCI.) Its prevalence increases with time post-injury affecting as many as 70% of individuals by 20 years after SCI (Sie et al, 1992). The development of shoulder pain in this population has been associated with the increase in upper limb weight-bearing demands for performance of transfers, pressure relief raises, and manual wheelchair (WC) propulsion. Shoulder pain negatively impacts independence and functional mobility, and is associated with significantly reduced subjective quality of life and physical activity in individuals with paraplegia (Gutierrez et al, 2007). The demands of functional mobility on the shoulder joint following SCI have been explored in the laboratory, during WC propulsion and depression raises and transfers. Van Drongelen et al (2005) reported that the shoulder contact force was significantly greater (300%) during a weight relief lift than during level WC propulsion on an ergometer at 0.83 m/s

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