Manual Wheelchair Use Research Articles

A semi-structured interview to capture manual wheelchair use for mobility activities among individuals with spinal cord injury in real-life situations: development and content validity of the Wheelchair Mobility Activity Log (WC-MAL).

Mixed-method approach. To develop and assess the content validity of a semi-structured interview that captures the lived experience of using a manual wheelchair among individuals with SCI in the real world, the Wheelchair Mobility Activity Log (WC-MAL). SCIR-Group (UDESC)/Brazil. Developing the WC-MAL comprised five steps: (1) defining the construct-based on the International Classification of Functioning, Disability and Health (ICF); (2) identifying relevant activities from other assessment instruments and interviews with the end-users (14 Individuals with SCI and 13 rehabilitation professionals); (3) Selecting the items - activities were linked to ICF codes and grouped into sets; (4) developing the scoring scales based on interviews with the end-users; and, (5) evaluating content validity in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The content validity ratio (CVR) for each item and scale and the overall instrument content validity index (CVI) were calculated. From an initial draft of 295 activities identified, a set of 222 activities was linked to the ICF domain of "Mobility (d4)" and further refined to generate the 23 items in the WC-MAL. Three scales were developed to assess Frequency (how often), Performance (how well), and Assistance (assistance needed) levels. The items and scales showed a CVR superior to the critical value established (≥0.64). The general CVI value was 0.96. The WC-MAL is a promising clinical instrument with adequate content validity to assess the spontaneous use of the manual wheelchair in the real world among individuals with SCI.

The Influence of Age at Pediatric-Onset Spinal Cord Injury and Years of Wheelchair Use on Shoulder Complex Joint Dynamics During Manual Wheelchair Propulsion.

To assess the association of age at pediatric-onset spinal cord injury (SCI) and years of manual wheelchair use with shoulder dynamics. Upper extremity kinematics and hand-rim kinetics were obtained during manual wheelchair propulsion. An inverse dynamics model computed three-dimensional acromioclavicular, sternoclavicular, and glenohumeral joint dynamics. Linear mixed effects models evaluated the association of age at injury onset and years of wheelchair use with shoulder dynamics. Motion laboratory within a children's hospital. Seventeen manual wheelchair users (N=17; 6 female, 11 male; mean age: 17.2 years, mean age at SCI onset: 11.5 years) with pediatric-onset SCI (levels: C4-T11) and International Standards for Neurological Classification of SCI grades: A (11), B (3), C (2), and N/A (2). Not applicable. Acromioclavicular, sternoclavicular, and glenohumeral angles and ranges of motion, and glenohumeral forces and moments. We observed a decrease in maximum acromioclavicular upward rotation (ß [95% confidence interval {CI}]=3.02 [0.15,5.89], P=.039) and an increase in acromioclavicular downward/upward rotation range of motion (ß [95% CI]=0.44 [0.08,0.80], P=.016) with increasing age at SCI onset. We found interactions between age at onset and years of use for maximum glenohumeral abduction (ß [95% CI]=0.16 [0.03,0.29], P=.017), acromioclavicular downward/upward rotation range of motion (ß [95% CI]=-0.05 [-0.09,-0.01], P=.008), minimum acromioclavicular upward rotation (ß [95% CI]=-0.34 [-0.64,-0.04], P=.026). A decrease in glenohumeral internal rotation moment (ß [95% CI]=-0.09 [-0.17,-0.009], P=.029) with increasing years of use was found. Age at injury and the years of wheelchair use are associated with shoulder complex biomechanics during wheelchair propulsion. These results are noteworthy, as both age at SCI onset and years of wheelchair use are considered important factors in the incidence of shoulder pain. These results suggest that investigations of biomechanical changes over the lifespan are critical.

Effects of Speed, Curves, and Driver Behavior on Passive Securement Systems on Large Transit Buses

Wheeled mobility devices that are not secured properly on large transit vehicles pose risks to all passengers. The purpose of this study was to increase the understanding of the effects of horizontal and vertical curves, speed, and driver behavior on the safety and security of people using wheeled mobility devices in rear-facing passive containment systems on large transit buses. Testing included the use of manual wheelchairs and lightweight scooters on an articulated low-floor transit bus. The project conclusions were derived from data produced by accelerometers placed on the bus as well as visual observations of wheeled mobility device movement. The data showed a clear difference in the amount of movement of the wheeled mobility devices and the comfort of the seated passenger when the bus traveled on a combination of horizontal and vertical curves at different driving speeds.

Prevalence of shoulder pain and disability in adult using manual wheelchair, a cross sectional study

The objective of this study is to find out prevalence of shoulder pain and disability in adults using manual wheelchair in Pakistan. Study Design: Cross sectional study.Setting: Data was collected from Ghurki Trust Teaching Hospital, Pakistan Society for the Rehabilitation of the Disabled and Mayo hospital of Lahore. Methods: This is a cross-sectional study. After taking consent and IRB from UOL, this study was conducted on manual wheel chair use from at least three months of Lahore. It included both males and females of 25 above age. (SPADI) Shoulder pain disability index (SPADI) and the Wheelchair User's Shoulder Pain Index (WUSPI) will be used to collect data. The questionnaire was filled at the spot. Results: Out of total 127 participants 48.8% were female and 51.2% were male. The mean age of the study subjects was 32.32±4.719 years. The prevalence of shoulder pain was documented in 127 participants is 78% with moderate pain 27.6% and severe pain in 38.0%. There was mild disability in 29.9% health care provider and moderate disability in 31.5% wheelchair users. Conclusion: The finding of this study concluded that 78.7% prevalence of shoulder pain in manual wheelchair users and 69.3% shoulder disability in manual wheelchair users. As the duration of wheelchair usage increases the shoulder pain and disability also increases

Progression of rotator cuff tendon pathology in manual wheelchair users with spinal cord injury: A 1-year longitudinal study

Objective To investigate the progression of rotator cuff tendon pathology across one year in manual wheelchair (MWC) users with spinal cord injury (SCI) and matched able-bodied individuals, and to explore the association between pain, age, and duration of wheelchair use with the progression of rotator cuff pathology. Design Longitudinal cohort study, 1-year follow-up. Setting Outpatient clinic at a tertiary medical center. Participants Twenty-four adult MWC users with SCI (20 men) with an average age (SD) of 37(12) years and 24 age and sex-matched able-bodied individuals. Interventions Not applicable. Main outcome measure(s) Presence of shoulder pain was collected. Magnetic resonance imaging (MRI) abnormalities of rotator cuff tendons including tendinopathy and tendon tears at baseline and 1-year follow-up visits were graded by a board-certified musculoskeletal radiologist, and three categories of tendon pathology scores including individual tendon scores, unilateral cuff scores, and bilateral cuff scores were calculated for each participant. Results Fifty-four percent of the MWC users reported shoulder pain at both time points which was significantly higher than able-bodied cohort at baseline (17%, P = 0.012) and year 1 (21%, P = 0.021). Rotator cuff tendon pathology was detected as mainly mild tendinopathies and low-grade partial-thickness tears in both cohorts at both time points but was more common in MWC users. The results for the bilateral cuff scores indicated a significant (P < 0.008) progression of rotator cuff tendon pathology in the MWC users over one year. MRI findings did not change significantly for the able-bodied cohort across time. There was no association of pain, age, or duration of MWC use with progression of rotator cuff pathology in MWC user cohort. Conclusion MWC users had a higher prevalence of pain than matched able-bodied cohort, but pain was minimal and not function-limiting. Bilateral cuff TOTAL scores showed pathology progression in MWC users, but MRI findings remained stable in the able-bodied cohort. MWC users were 3.4 times more likely to experience pathology progression than the able-bodied cohort.

Turning in Circles: Understanding Manual Wheelchair Use Towards Developing User-Friendly Steering Systems

For people with physical disabilities, manual wheelchairs are essential enablers of mobility, participation in society, and a healthy lifestyle. Their most general design offers great flexibility and direct feedback, but has been described to be inefficient and demands good coordination of the upper extremities while critically influencing users’ actions. Multiple research groups have used Inertial Measurement Units (IMUs) to quantify physical activities in wheelchairs arguing that knowledge over behavioural patterns in manual wheelchair usage can guide technological development and improved designs. The present study investigates turning behaviour among fulltime wheelchair users, laying the foundation of the development of novel steering systems that allow directing kinetic energy by means other than braking. Three wearable sensors were installed on the wheelchairs of 14 individuals for tracking movement over an entire week. During detected “moving windows”, phases where the velocities of the two rear wheels differed by more than 0.05 m/s were considered as turns. Kinematic characteristics for both turns-on-the-spot as well as for moving turns were then derived from the previously reconstructed wheeled path. For the grand total of 334 km of recorded wheelchair movement, a turn was detected every 3.6 m, which equates to about 900 turns per day on average and shows that changing and adjusting direction is fundamental in wheelchair practice. For moving turns, a median turning radius of 1.09 m and a median turning angle of 39° were found. With a median of 89°, typical turning angles were considerably larger for turns-on-the-spot, which accounted for roughly a quarter of the recognised turns and often started from a standstill. These results suggest that a frequent pattern in daily wheelchair usage is to initiate movement with an orienting turn-on-the-spot, and cover distances with short, straightforward sections while adjusting direction in small and tight moving turns. As large bends often require simultaneous pushing and breaking, this is, perhaps, the result of users intuitively optimising energy efficiency, but more research is needed to understand how the design of the assistive devices implicitly directs users’ movement.

Estimating whole-body vibration limits of manual wheelchair mobility over common surfaces.

Whole-body vibration (WBV) experienced during manual wheelchair use was quantified across several types of terrain (tile, sidewalk, decorative bricks, expanded metal grates). Over-ground travel was controlled using a robotic propulsion system. Vibrations along the vertical axis were measured with a triaxial accelerometer mounted to the seat of the wheelchair. Root-mean-square acceleration values were compared to the health guidance exposure limits established by the European Council using the WBV calculator tool published by the Health and Safety Executive (HSE). Vibrations along the vertical axis were well below the exposure values associated with health risks. Even the most aggressive tactile surface (grates) tested in this study would require more than 14 h of daily travel to reach the “exposure action value,” and more than 24 h would be required to reach the “exposure limit value”. Considering the average cumulative duration of active self-propulsion among manual wheelchair users is around an hour or less, none of the tested conditions were deemed unsafe or damaging.

Exploration of pediatric manual wheelchair confidence among children, parents, and occupational therapists: a qualitative study

Purpose Manual wheelchair (MWC) confidence is a predictor of adult life-space mobility and social participation. To date, scientific literature specific to pediatric MWC confidence is scarce which prevents in-depth understanding. The objective of this study was to explore the perceptions of pediatric MWC users (PMWU), parents, and occupational therapists regarding pediatric MWC confidence. Methods Five focus groups were conducted with PMWUs (n = 12) and occupational therapists (n = 9), and semi-structured interviews were conducted with parents of PMWUs (n = 2). Inductive thematic analysis was performed following verbatim transcription of audio recorded material. Results Three overarching themes were identified across PMWUs, parents, and occupational therapists: (1) “MWC confidence is not a clinical priority” depicted the construct’s varying level of clinical priority and perceived abstractness; (2) “MWC confidence is both a child and parent consideration” revealed nuances between the PMWU’s MWC confidence and the parents’ perception of the PMWU’s MWC confidence; and (3) “Opportunities to develop MWC confidence are context-specific” contrasted afforded and unafforded opportunities to experience independent MWC mobility. Conclusions Pediatric MWC confidence is an important aspect of wheelchair use that is shaped by a multitude of factors in PMWU’s lives. This new area of pediatric study provides support for the need to measure this important construct. IMPLICATIONS FOR REHABILITATION This study is the first to explore children’s, parents’, and occupational therapists’ perceptions of pediatric MWC confidence. Pediatric MWC confidence impacts MWC use in a multifaceted fashion. Future studies should consider the development and validation of a self-report measure to assess pediatric MWC confidence.

Influence of Roulez avec confiance, a peer-led community-based wheelchair skills training program, on manual wheelchair users

Purpose Few studies have demonstrated that peer-led manual wheelchair (MWC) skills training can increase MWC skills, MWC use self-efficacy and satisfaction with participation of MWC users. Limited information is available on MWC skills training in the community. The primary objective was to measure the influence of Roulez avec confiance (RAC, which translated to “Wheeling with confidence”), a peer-led community-based wheelchair skills training program, on satisfaction with participation. The secondary objectives were to explore the: (1) influence of RAC on MWC use self-efficacy, MWC skills, and quality of life; (2) experiences of the participants who completed RAC and (3) three-month retention of outcomes. Methods A parallel mixed design was used with validated questionnaires on satisfaction with participation (WhOM), MWC use self-efficacy (WheelCon-M), MWC skills (WST-Q), quality of life (SWLS) and a semi-structured interview on participants’ experiences. Non-parametric longitudinal analyses of the questionnaires and thematic content analysis of the interviews were completed. Results Nineteen community-dwelling MWC users participated. There was a statistically significant increase (p < 0.0001) in all outcomes except quality of life (p = 0.16). Improvements were retained after three months. Participants mentioned their background influenced their experiences in RAC. Positive elements about RAC and areas for improvement were discussed. Participants reported overall positive social experiences and stated that the physical environment influenced RAC. Finally, participants spoke about what they learned and emotions they felt during RAC. Conclusions Peer-led community-based MWC training influenced satisfaction with participation, MWC skills, and MWC use self-efficacy. This study was a first step in demonstrating the efficiency of RAC. IMPLICATIONS FOR REHABILITATION Limited information is available on manual wheelchair skills training in the community. Peer-led community-based manual wheelchair training influenced satisfaction with participation, manual wheelchair skills and use self-efficacy. This study was a first step in demonstrating the efficiency of Roulez Avec Confiance.

Facilitating manual wheelchair skills following lower limb amputation using a group process: A nested mixed methods pilot study.

IntroductionThe manual wheelchair skills training programme is used to structure teaching manual wheelchair use for people following injury or disability. This pilot study aimed to explore the outcomes of introducing a group wheelchair skills training programme on skill performance, confidence and frequency of wheelchair use for people with lower limb amputation in a rehabilitation setting from the perspective of participants and group facilitators.MethodThis pilot study used a two‐phase mixed methods nested design. Eleven people with lower limb amputations received a minimum of two 45‐min wheelchair skills sessions, using the Wheelchair Skills Training Program, delivered in a mix of group and one‐to‐one sessions. In phase one, wheelchair skill performance, confidence and frequency were measured using the Wheelchair Skills Test Questionnaire‐Version 5.0, goal achievement was measured through the Functional Independence Measure and Goal Attainment Scale. These measures were repeated in phase two. Nested within phase two was qualitative data collection. Interviews were conducted with eight participants and a focus group held with three programme facilitators, to gather their perceptions of the training process. Descriptive statistics were used to analyse and report quantitative data and thematic analysis was used to combine qualitative data from the two participant groups.ResultsPost intervention, the mean Wheelchair Skills Test Questionnaire score increased in performance (42.3 ± 13.4), confidence (33.9 ± 20.7) and frequency (33.9 ± 27.3). Goal Attainment was achieved or exceeded by 91% of all participants. Four themes were developed from qualitative data including, “motivators driving learning,” “delivery methods, structure and profile of the Wheelchair Skills Training Program,” “managing risk and safety” and “confidence in wheelchair use.”ConclusionsThe pilot study found that The Wheelchair Skills Training Program can improve wheelchair performance, confidence and frequency to support enhanced safety, independence and quality of life for people with lower limb amputations.

Effect of an interventional educational wheelchair program on medical students' understanding of manual wheelchair use.

There is limited literature exploring the benefits of interactive wheelchair educational programs in medical student curricula. To identify the effect of an educational interactive wheelchair program on medical students' understanding of wheelchair use. Researchers hypothesized that the program would increase understanding. Repeated-measures survey study with postintervention comparison. Inpatient acute rehabilitation center. Out of 123 eligible fourth-year medical students on a mandatory physical medicine and rehabilitation clerkship, 79 students participated. All participants underwent a 2-hour educational wheelchair program consisting of (1) a disability lecture; (2) a video on the importance of proper wheelchair type and fit, wheelchair prescription, as well as recreational wheelchair use; and (3) an interactive wheelchair experience. Pre- and postsurvey Likert scale questions measured medical students' understanding of four main areas: (1) impact of manual wheelchair use, (2) challenges of manual wheelchair use, (3) manual wheelchair skills, and (4) wheelchair etiquette. A two-tailed sign test demonstrated a highly significant increase from pre- to postsurvey scores in each survey section (P < .001). Presurvey and postsurvey mean scores for impact of manual wheelchair use, challenges of manual wheelchair use, manual wheelchair skills, and wheelchair etiquette survey sections were 3.9 and 4.4, 3.1 and 4.4, 2.4 and 4.4, and 2.5 and 4.0, respectively. This study demonstrates that an interactive educational wheelchair program effectively increases medical students' understanding of manual wheelchair use. The addition of an educational interactive wheelchair program to medical student curricula is recommended to improve medical students' understanding of manual wheelchair use and its impact on users.

The Relationship between Clinical Tests, Ultrasound Findings and Selected Field-Based Wheelchair Skills Tests in a Cohort of Quadriplegic Wheelchair Rugby Athletes: A Pilot Study

Manual wheelchair use may determine shoulder joint overload and rotator cuff injury. Chronic shoulder pathologies can also influence the propulsion ability of wheelchair athletes with spinal cord injury (SCI) during sport activities. However, the relationship between shoulder pathology and wheelchair performances has never been explored. Therefore, the study aimed to investigate the correlation between shoulder pathologic findings with clinical tests and ultrasonography evaluation and the results of wheelchair performance tests. Nineteen quadriplegic wheelchair rugby players were evaluated to investigate the association between clinical and ultrasound shoulder pathologic findings and their correlation with the performance of field-based selected wheelchair skills tests (WSTs). The outcome measures were the International Wheelchair Rugby Classification Score, dominant and non-dominant Physical Examination Shoulder Score, and dominant and non-dominant Ultrasound Shoulder Pathology Rating Scale (USPRS). The WST was measured at the beginning and at one-year follow-up. A statistically significant correlation was found between the time since SCI and dominant USPRS (p &lt; 0.005). The non-dominant USPRS was strongly related to WST at the beginning (p &lt; 0.005) and the end of the study (p &lt; 0.05). Data suggest that the severity of the non-dominant shoulder pathology detected on the ultrasound is related to lower performance on the WST. Chronic manual wheelchair use could be responsible for dominant SCI shoulder joint and rotator cuff muscle damage, while non-dominant USPRS could be related to performance on the WST.

Effect of the Assistive Technology Professional on the Provision of Mobility Assistive Equipment

ObjectiveThe purpose of this study was to examine factors associated with variability in satisfaction with functional mobility (as measured by the Functional Mobility Assessment [FMA]) in users of mobility devices. Our primary hypothesis was that device type and Assistive Technology Professional (ATP) involvement will be the most significant predictors of FMA score. Our secondary hypothesis was that ATP involvement is associated with use of more custom-fitted manual wheelchairs and group 3 and 4 power wheelchairs. DesignRetrospective cohort study. SettingData were collected from equipment suppliers who collaborate with clinicians to administer the FMA and associated Uniform Data Set within various settings (ie, rehabilitation clinic, school, supplier place of business). ParticipantsA data set of 4743 cases was included in the analysis (N=4743). InterventionsNot applicable. Main Outcome MeasuresFMA questionnaire collected at baseline, client age, gender, primary diagnosis, years since disability onset, device type, device age, living situation, ATP involvement, and geographic area. ResultsOrdinal logistic regression modeling showed that geographic area, device type, ATP involvement, primary diagnosis, gender, age, device age, and years since onset of disability significantly predicted the variance in FMA scores at P<.05. Device type was the most significant predictor of variance in FMA score. Involvement of an ATP had a significant effect on the type of device that participants used (χ220=1739.18, P<.001; odds ratio, 0.589; 95% confidence interval, 0.49-0.708). If an ATP was involved, there were significantly higher proportions (all P<.05) of individuals using custom-fitted manual wheelchair and high-end groups 3 and 4 power wheelchairs prescribed compared with when no ATP was involved or when involvement was uncertain. ConclusionsThe relationship between ATP involvement and functional outcome supports the concept that ATP certification recognizes demonstrated competence in analyzing the needs of consumers with disabilities and selection of appropriate mobility assistive equipment with improved functional outcomes.

Duration of Static and Dynamic Periods of the Upper Arm During Daily Life of Manual Wheelchair Users and Matched Able-Bodied Participants: A Preliminary Report.

Background: Manual wheelchair (MWC) users with spinal cord injuries (SCI) are at a significantly higher risk of experiencing rotator cuff pathology than able-bodied individuals. A deeper understanding of where the arm is used dynamically within the humeral workspace during daily life may help explain why MWC users have higher shoulder pathology rates than able-bodied individuals. The purpose of this study was to report the daily percentage and consecutive durations MWC users and matched able-bodied individuals (controls) spent static and dynamic across the humeral elevation workspace.Methods: MWC users with SCI and controls wore three inertial measurement units on their bilateral arms and torso for 1 or 2 days. The percentages of time and average consecutive duration individuals were static or dynamic while in five humeral elevation ranges (0–30°, 30–60°, 60–90°, 90–120°, and >120°) were calculated and compared between cohorts.Results: Forty-four MWC users (10 females, age: 42.8 ± 12.0, time since injury: 12.3 ± 11.5) and 44 age- and sex-matched controls were enrolled. The MWC cohort spent significantly more time dynamic in 60–90° (p = 0.039) and 90–120° (p = 0.029) and had longer consecutive dynamic periods in 30–60° (p = 0.001), 60–90° (p = 0.027), and 90–120° (p = 0.043) on the dominant arm. The controls spent significantly more time dynamic in 0–30° of humeral elevation (p < 0.001) on both arms. Although the average consecutive static durations were comparable between cohorts across all humeral elevation ranges, the MWC cohort spent a significantly higher percentage of their day static in 30–60° of humeral elevation than controls (dominant: p = 0.001, non-dominant: p = 0.01). The MWC cohort had a moderate association of increased age with decreased time dynamic in 30–60° for both arms.Discussion: Remote data capture of arm use during daily life can aid in understanding how arm function relates to shoulder pathology that follows SCI and subsequent MWC use. MWC users spent more time dynamic in higher elevations than controls, and with age, dynamic arm use decreased in the 30–60° humeral elevation range. These results may exemplify effects of performing activities from a seated position and of age on mobility.

Risk Factors for the Development of Shoulder Pain in Elite Sled Hockey Players.

Shoulder pain is one of the most common injuries in adaptive athletes. There are minimal prior studies that investigate shoulder pain prevalence and associated risk factors in sled hockey players. To characterize the prevalence of shoulder pain in elite-level adaptive sled hockey athletes and identify associated risk factors. Cross-sectional observational study. 2019 USA Sled Hockey Classic in Chicago, IL from 7 February 2019 to 10 February 2019. Eighty-two elite sled hockey athletes who participated in a nationally sanctioned sports event. Not applicable. The primary outcome of the study was to describe the experience of shoulder pain using player-reported outcomes of pain including: binary (yes/no) pain reporting in the last month, Performance-Corrected Wheelchair User's Shoulder Pain Index (PC-WUSPI) reporting pain in the last week, and Visual Analog Scale (VAS) reporting pain in the last month. Associations were assessed between the measurements of pain and characteristics of participants. Of all participants, 70.5% endorsed shoulder pain in the last month. The average VAS for the past month was 2.13 and average PC-WUSPI for the past week was 15.46. Statistically significant associations were found between endorsement of pain in the last month and specific correlative factors including increased weight (P value .008; odds ratio [OR] 1.04, 95% confidence interval [CI] 1.01-1.07) and increased duration of manual wheelchair use (P-value .002; OR 1.13, 95% CI 1.04-1.22). Elite-level sled hockey athletes commonly report experiencing shoulder pain. There is evidence that an elite-level sled hockey player's weight and longer duration of manual wheelchair use are both associated with a greater likelihood for self-reporting shoulder pain rather than number of years of playing the sport.

Improvement and Retention of Wheelchair Skills Training for Students in Entry-Level Occupational Therapy Education.

Although an essential component of best practice, wheelchair skills training is often inadequate; occupational therapy practitioners' professional preparation is a contributing factor. To assess the effectiveness of a boot camp on capacity and self-efficacy in wheelchair skills and self-efficacy in clinical practice, retention of improvements, and effective boot-camp attributes. Concurrent, embedded, mixed-methods cohort design that used blinded, repeated-measures quantitative evaluation with 4-mo follow-up and directed content analysis of a qualitative questionnaire. University entry-to-practice program. Convenience sample (N = 42) of final-year students. A 4-hr boot camp with demonstration and supervised practice. Content incorporated skill performance, training and motor-learning strategies, and safe supervision. Skill performance capacity (Wheelchair Skills Test-Questionnaire), self-efficacy with manual wheelchair use (Wheelchair Use Confidence Scale), confidence in provision of manual wheelchair training services (Self-Efficacy in Assessing, Training, and Spotting test), and a boot-camp experience questionnaire. Within-subjects analysis of variance revealed significant improvements on all measures (p < .001) with large effect sizes (ηp² = .68-.88). All measures except skill capacity demonstrated retention; skill capacity decreased 5.3% (95% confidence interval [2.0, 8.5]) but was significantly higher than baseline. Three themes influenced practice confidence: knowledge acquisition, experiential learning, and client empathy. Results confirm improved wheelchair self-efficacy, capacity, and self-efficacy with clinical intervention skills. Retention of outcomes suggests the potential impact on future practice. Experiential learning supports performance component acquisition and imparts empathy of client experience, which may improve occupational therapy practitioners' perceptions of client potential. A 4-hr experiential boot camp can increase students' capacity and confidence to deliver wheelchair skills training to future clients. Experiential learning increased students' appreciation for clients' experience and expectation of client potential.

Clinically Relevant Outcomes in Manual Wheelchair Evaluation: A Systematic Review of the Literature

To determine the clinically relevant and objective wheelchair-use outcomes in manual wheelchair skill and use evaluations.

Managing shoulder pain in manual wheelchair users: a scoping review of conservative treatment interventions

Objective: To review the literature that has explored conservative treatments for the management of shoulder pain in manual wheelchair users. Methods: Five databases were systematically searched in february 2020 for terms related to shoulder pain and manual wheelchair use. Articles were screened and included if they investigated the conservative treatment of shoulder pain in wheelchair users. Participants’ physical characteristics, experimental design and primary and secondary outcome measures were extracted from studies. Studies were grouped according to treatment type to identify gaps in the literature and guide future research. Results: The initial search identified 407 articles, of which 21 studies met the inclusion criteria. Exercise-based treatment interventions were most prevalent (n = 12). A variety of exercise modalities were employed such as strengthening and stretching (n = 7), ergometer training (n = 3), Pilates classes (n = 1) and functional electrical stimulation (n = 1). Only three studies supplemented exercise with an additional treatment type. The Wheelchair Users Shoulder Pain Index was used by 18 studies as the primary measure of shoulder pain. Only seven of these included an objective measure of shoulder function. Participant characteristics varied among studies, and physical activity levels were frequently not reported. Conclusions: Despite the high prevalence of shoulder pain in manual wheelchair users, the number of studies to have explored conservative treatment types is low. Exercise is the most commonly used treatment, which is encouraging as physical inactivity can exacerbate other health conditions. Few studies have adopted interdisciplinary treatment strategies or included objective secondary measures to better understand the mechanisms of pain.

Improving the realism of a wheelchair simulator through tracking of upper body movements

Introduction Safe and efficient use of a manual wheelchair (MWC) requires appropriate training. New MWC users should learn how to maneuver in different environments (restricted spaces, uneven surfaces, etc.). Learning of appropriate balance skills is also crucial, to avoid falls when handling forward or side slopes. Moreover, long-term MWC use can lead to repetitive shoulder strain injuries, which can be avoided through adequate propulsion technique (increasing push amplitude, while decreasing cadence). We have developed a virtual reality MWC simulator for the training of MWC skills. The velocities of the rear wheels control a virtual MWC in a 3D scene presented on a computer screen in front of the participant, while force feedback simulates the effects of gravity and inertia. Our objective was to improve the realism of our existing wheelchair simulator, through the addition of upper body motion tracking that will provide feedback on trunk posture and propulsion movement. Material and methods Ten MWC users participated in the study. They propelled the virtual MWC while their trunk and arm movements were simultaneously recorded by three systems: – five inertial sensors placed on the trunk, arms and forearms; – a markerless, 3D depth camera system; – a high-precision motion capture system (gold standard). Upper body position as measured by the two low-cost approaches (inertial system and depth camera) was compared to the motion capture system. Results and conclusion Findings from this interdisciplinary study will optimize mobility of MWC users, through better MWC skills (balance and propulsion techniques), while possibly decreasing the incidence of falls and shoulder injuries.

Comparison of glenohumeral joint kinematics between manual wheelchair tasks and implications on the subacromial space: A biplane fluoroscopy study

Scapula and humerus motion associated with common manual wheelchair tasks is hypothesized to reduce the subacromial space. However, previous work relied on either marker-based motion capture for kinematic measures, which is prone to skin-motion artifact; or ultrasound imaging for arthrokinematic measures, which are 2D and acquired in statically-held positions. The aim of this study was to use a fluoroscopy-based approach to accurately quantify glenohumeral kinematics during manual wheelchair use, and compare tasks for a subset of parameters theorized to be associated with mechanical impingement. Biplane images of the dominant shoulder were acquired during scapular plane elevation, propulsion, sideways lean, and weight-relief raise in ten manual wheelchair users with spinal cord injury. A computed tomography scan of the shoulder was obtained, and model-based tracking was used to quantify six-degree-of-freedom glenohumeral kinematics. Axial rotation and superior/inferior and anterior/posterior humeral head positions were characterized for full activity cycles and compared between tasks. The change in the subacromial space was also determined for the period of each task defined by maximal change in the aforementioned parameters. Propulsion, sideways lean, and weight-relief raise, but not scapular plane elevation, were marked by mean internal rotation (8.1°, 10.8°, 14.7°, −49.2° respectively). On average, the humeral head was most superiorly positioned during the weight-relief raise (1.6 ± 0.9 mm), but not significantly different from the sideways lean (0.8 ± 1.1 mm) (p = 0.191), and much of the task was characterized by inferior translation. Scaption was the only task without a defined period of superior translation on average. Pairwise comparisons revealed no significant differences between tasks for anterior/posterior position (task means range: 0.1–1.7 mm), but each task exhibited defined periods of anterior translation. There was not a consistent trend across tasks between internal rotation, superior translation, and anterior translation with reductions in the subacromial space. Further research is warranted to determine the likelihood of mechanical impingement during these tasks based on the measured task kinematics and reductions in the subacromial space.