Manual Wheelchair Use Research Articles

Differences in participation based on self-esteem in power and manual wheelchair users on a university campus: a pilot study

Objectives: To examine the relationship of self-esteem and wheelchair type with participation of young adult manual and power wheelchair users with diverse physical disabilities. Design: Cross-sectional survey study. Setting: Large University Campus. Participants: A convenience sample of college students (N = 39) with self-reported physical disabilities who are full time wheelchair users (>40 per week) and are two or more years post illness or injury. Interventions: Not applicable. Main outcome measures: The Rosenberg Self-Esteem Scale was used to measure self-esteem, and the Craig Handicap Assessment and Reporting Technique was used to measure participation. Results: Self-esteem correlated highly with cognitive independence (CI) (r = 0.58), mobility (r = 0.67) and social integration (SI) (r = 0.52). Use of manual wheelchair was significantly related to higher levels of CI and mobility while longer use of any wheelchair (power or manual) was significantly associated with higher levels of mobility and SI. In addition higher self-esteem independently predicted a significant proportion of the variance in CI, mobility and SI, while type of wheelchair predicted a significant proportion of the variance in CI (p < 0.005). Conclusions: High self-esteem was found to be the strongest predictor of participation in a population of young adults with mobility limitations. Better understanding of the factors influencing participation may help to facilitate new interventions to minimize the disparities between persons with disabilities and their able bodied peers. Implication for Rehabilitation A total of 46.8% of wheelchair users report the desire for increased community participant but face significant barriers. The type of wheelchair has been identified as having a large impact on participation. This study found self-esteem to be the strongest predictor of participation, which is notable because self-esteem is a characteristic that is potentially modifiable with treatment.

Factors influencing optimal seating pressure after spinal cord injury

Retrospective, cross-sectional design. To identify factors that predict unsatisfactory seating pressure in spinal cord-injured (SCI) individuals. Seating Clinic at the University Hospital, Norway. All wheelchair users with traumatic SCI hospitalized between 1 January 2007 and 31 December 2010 were included. Individual assessment by a team was performed. To measure seating pressure, a computerized seating pad with sensing points 40 × 40 cm was used. Primary end points were defined as satisfactory or unsatisfactory seating position based on measured pressure (more or less 100 mm Hg), clinical findings and physical activity level. To explore possible risk factors for high seating pressure, both univariate and multivariate regression analysis were performed. A total of 75 persons with SCI were assessed, 39 (52%) with unsatisfactory result. Statistical analysis revealed that use of manual wheelchair (odds ratio (OR)=6.86, confidence interval (CI) 1.77-26.63) and history of pressure ulcer (OR=8.47, CI 2.46-29.13) significantly increase the risk of unsatisfactory seating pressure. Paraplegia caused significantly higher risk (OR=2.5, CI 0.99-6.34) in the univariate model, probably because the SCI with tetraplegia do prefer electrically powered wheelchairs. Use of manually driven wheelchairs and persons with previous pressure ulcer are at significant risk of high seating pressure and consequently developing new pressure ulcers. The patients from these subcategories need close follow-up regarding seating position and prevention of pressure ulcers.

Measure for the assessment of confidence with manual wheelchair use (WheelCon-M) version 2.1: Reliability and validity

To evaluate the measurement properties of the Wheelchair Use Confidence Scale for manual wheelchair users version 2.1 (WheelCon-M 2.1). Cohort study. Volunteer sample of 83 community-dwelling, experienced manual wheelchair users. Participants completed the WheelCon-M 2.1 twice to assess retest reliability. Validity was assessed by evaluating hypothesized relationships between the WheelCon-M 2.1 and relevant variables. Responsiveness was assessed using the standard error of measurement (SEM) and smallest real difference (SRD). The median (interquartile range) WheelCon-M 2.1 score was 84.6 (71.3-92.0) of a possible 0-100. The one-week retest intraclass correlation coefficient was 0.84 with 95% bias-corrected and accelerated confidence intervals of 0.77-0.90. Cronbach's alpha was 0.92. Correlations ranging from rs = -0.19 (p = 0.780) to rs = 0.58 (p < 0.001) were found between the WheelCon-M 2.1 and other relevant outcome measures with all correlations being statistically significant except for age (p = 0.780) and social support (p = 0.057). A statistically significant difference was not found between the sexes (p = 0.140). The SEM and SRM were 5.9 and 16.4, respectively. WheelCon-M 2.1 has high internal consistency, strong retest reliability, and support for concurrent validity, construct validity and responsiveness. This new test holds promise as a clinical and research tool.

A Transformative Subfield in Rehabilitation Science at the Nexus of New Technologies, Aging, and Disability

We argue that a silo research and training approach is no longer sufficient to provide real solutions to the complex humanitarian, social, and financial problems brought about by global trends in aging and the increased prevalence of multiple chronic conditions that limit independence and activities of daily living. This perspective highlights the opportunities for collaborative research and training in a new multidisciplinary science of rehabilitation enabled by growing knowledge and information along scientifically and clinically meaningful lines. The recent proliferation of eHealth technologies offers opportunities for development of low-cost, simple, interactive media prevention, health maintenance, and continued functional recovery programs using a chronic care model designed to promote engagement and participation. With two examples – long-term disability consequential to (1) hip fracture and (2) manual wheelchair use – we outline the developing science for a collaborative and transformative nexus team capable of accelerating an understanding of ways to restore independence and improve quality of life, in the long-term. We conclude with a set of recommendations for the design of interactive media systems to both increase acceptability and stimulate research.

Manual wheelchair use: bouts of mobility in everyday life.

Background. This study aimed to describe how people move about in manual wheelchairs (MWCs) during everyday life by evaluating bouts of mobility or continuous periods of movement. Methods. A convenience sample of 28 MWC users was recruited. Participants' everyday mobility was measured using a wheel-mounted accelerometer and seat occupancy switch for 1-2 weeks. Bouts of mobility were recorded and characterized. Results. Across 29,200 bouts, the median bout lasted 21 seconds and traveled 8.6 m at 0.43 m/s. 85% of recorded bouts lasted less than 1 minute and traveled less than 30 meters. Participants' daily wheelchair activity included 90 bouts and 1.6 km over 54 minutes. Average daily occupancy time was 11 hours during which participants wheeled 10 bouts/hour and spent 10% of their time wheeling. Spearman-Brown Prophecy analysis suggested that 7 days were sufficient to achieve a reliability of 0.8 for all bout variables. Conclusions. Short, slow bouts dominate wheelchair usage in a natural environment. Therefore, clinical evaluations and biomechanical research should reflect this by concentrating on initiating movement, maneuvering wheelchairs, and stopping. Bouts of mobility provide greater depth to our understanding of wheelchair use and are a more stable metric (day-to-day) than distance or time wheeled.

Metabolic Cost of Wheelchair Propulsion Using an Ergonomic Hand Drive Mechanism

Conventional manual wheelchair (CMW) use is associated with a high prevalence of shoulder and wrist pain, which may interfere with mobility and lead to increased risk of cardiovascular problems. Previous lever-activated propulsion designs have been shown to shift and reduce shoulder muscular demands, decreasing the risk of incurring repetitive strain injuries. However, these designs do not consider the anthropometrics of the user (height, arm length, etc.). The novel ergonomic hand drive mechanism (EHDM) used in this study was designed to shift awkward postures while accommodating different users without additional metabolic cost. PURPOSE: To evaluate metabolic cost (VO2 and HR) while using an EHDM. METHODS: Eight adult full-time manual wheelchair users participated (46.8±21.8 yrs, 74.0±12.7 kg, 174.6±13.6 cm). All participants were medically and functionally stable and at least six months post injury. Participants propelled around a circuit for three and a half minutes at a self-selected pace in a CMW and then again in the same chair fitted with the hand drive mechanism for a total of two trials. VO2 and HR were recorded using a portable device while distance, velocity and push frequency were measured manually. Velocity, distance traveled, push frequency, VO2 per meter, and heart rate were compared by wheelchair condition for the last 30 seconds of each trial using paired t-tests (α=0.05). RESULTS: The CMW condition resulted in more distance traveled (28.7±15.1 m vs. 20.0±8.7 m, p=0.049) as well as greater velocity (0.957±0.5 m/s vs. 0.667±0.3 m/s, p=0.049) than the EHDM condition. No significant differences were found between the two conditions for number of pushes (26.3±5.8 vs. 27.0±5.3, p=0.683), VO2 efficiency (0.24±0.1 ml/kg/min/m vs. 0.31±0.1 ml/kg/min/m, p=0.08), or HR (102.6±14.2 bpm vs. 105.5±15.7 bpm, p=0.635). CONCLUSION: The results demonstrate that participants avoided additional metabolic costs although performance (velocity and distance) was sacrificed with the EHDM. Modifications to the EHDM (e.g. addition of gearing) could rectify the performance decrement. Supported by the Clinical and Translational Science Institute Pilot & Collaborative Research Projects (NIH). The hand drive mechanism used in this study is the intellectual property of Shands Healthcare.

Système d’aide au choix et aux réglages du fauteuil roulant manuel

The manual wheelchair (MWC) is an effective renowned technical help to increase the mobility of persons with very diverse deficiencies, in various situations and activities. Catalogs and web sites describe ranges of very different MWCs to answer the variety of the users’ actual needs. The MWC is a mechanical device of rustic conception but however, a complicated object because it is composed of several hundreds of parts. It usually contains tens of adjustments and options. In this context, medical professionals have to recommend the use of MWC, prescribe a type of MWC, and also to specify the adjustments and the options, which will suit “at best” their patient. The distributors then have to find at their suppliers one or several MWCs that would meet these requirements. In scientific language, this approach of MWC prescription is called a problem of multicriteria choice. The reserved solution will necessarily be an acceptable or satisfying compromise. The objective of this project was to supply knowledge, an approach and software of “decision-making support” for all those who have to prescribe or to choose a MWC. The used knowledge arises from inquiries and from experiments realized in the fields of sociology, reeducation medicine and biomechanics. The obtained results are already been – or will soon be – published in scientific articles, a book is in the course of writing and will be published by Sauramps, and the software will be free of access.

Development and content validation of the Wheelchair Use Confidence Scale: a mixed-methods study

Background. Confidence in one's ability to perform a given task can be a stronger predictor of performance than skill itself. There are currently no measures to assess confidence with manual wheelchair use. The objective of this study was to develop and assess the content validity of the Wheelchair Use Confidence Scale (WheelCon-M).Method. A two-phase mixed-methods design was used. Semi-structured interviews were conducted to generate items, followed by a Delphi survey for item selection. Persons who use a wheelchair, health care professionals, and researchers participated in both phases of the study.Results. An 84-item WheelCon-M was developed based on the qualitative data. After the Delphi survey, a final 62-item WheelCon-M was composed of the following six areas (number of items per area): Negotiating the Physical Environment (33 items), Activities Performed using a Manual Wheelchair (11 items), Knowledge and Problem Solving (6 items), Advocacy (4 items), Managing Social Situations (5 items) and Managing Emotions (3 items).Conclusion. This article reports the development and content validation of the WheelCon-M. As a scale to measure confidence with wheelchair use was not available prior to this work, clinicians now have a method of identifying individuals who have low confidence with wheelchair use.

Association of Shoulder Pain With the Use of Mobility Devices in Persons With Chronic Spinal Cord Injury

To assess the prevalence of shoulder pain and its association with the use of assistive devices for mobility in persons with chronic spinal cord injury (SCI). Cross-sectional analysis conducted within a cohort study. SCI service in a hospital and the community. Between August 2005 and January 2008, 93 participants with chronic SCI completed a standardized health questionnaire and pain questionnaire. Shoulder pain in last 6 months elicited by use of the McGill Pain Questionnaire pain diagram. Of the 93 participants, 65 (69.9%) reported pain at any site in the 6 months before testing. Shoulder pain, reported by 39.8% of participants, was the third most common site of pain after the legs and back. When stratified by the use of assistive mobility devices, shoulder pain was reported by 46.7% of motorized wheelchair users, 35.4% of manual wheelchair users, 47.6% of participants using aids such as crutch(es) or canes, and 33.3% of participants walking without assistance (P = .7 for comparison of 4 groups). Shoulder pain is highly prevalent in SCI. The authors of previous studies have largely attributed shoulder pain in SCI to manual wheelchair use. However, our results provide evidence for similarly elevated prevalence of shoulder pain among motorized wheelchair users and those patients using crutches or canes. This finding suggests that in addition to overuse injury from cyclic wheelchair propulsion, the assessment of other mechanical and nonmechanical factors that lead to shoulder pain in SCI is an unmet research need that may have treatment implications.

Manual wheelchair-related mobility characteristics of older adults in nursing homes

Aim. Manual wheelchairs are commonly prescribed for older adults in nursing homes (NH). The extent of their utilisation being unknown may result in the prescription of standard wheelchairs. The purpose of this study was to quantify manual wheelchair use by nursing home residents.Methods. Seventy-two independent wheelchair users were recruited from four NH (two VA-affiliated and two private). A customised wheelchair data logger was attached to each participant's wheelchair for 1 month. Data were reduced and compared separately for VA- affiliated and private facilities by types of propulsion pattern (arms versus legs and the combination of arms and legs) using MANOVA.Results. Participants from the VA-affiliated facilities who used their arms were covering more distance (1451 m versus 806 m), with greater endurance (73 m versus 60 m) as compared to participants who used combination of arms and legs. However, no difference was observed between velocity of wheelchair propulsion between groups (0.48 m/s versus 0.58 m/s). For private facilities no notable difference was observed between the groups.Conclusion. Older adults who live in NH and use of wheelchairs represent a diverse cohort. The efficacy of using an objective assessment method to measure the extent of use of wheelchairs was demonstrated in this study.

Evaluation of Manual Wheelchair Performance in Everyday Life

Evaluation of wheelchair performance (capacity and skills) is crucial in the investigation of wheeled mobility in people with a spinal cord injury (SCI). Manual wheelchair use is a complex combination of skills, which together determine overall functioning, daily activities, participation, and quality of life. The evaluation of wheelchair performance requires a systematic biophysical approach that appreciates the importance of the individual elements of the wheelchair-user combination: the wheelchair, the wheelchair-user interface, and the user, as well as the environment. Measurement technologies and outcomes of experimental and observational studies will highlight the importance of a well-balanced individual wheelchair performance.

Effect of rear suspension and speed on seat forces and head accelerations experienced by manual wheelchair riders with spinal cord injury

Whole-body shocks and vibrations experienced during manual wheelchair use can decrease an individual's comfort, increase the rate of fatigue, result in injury, and consequently limit mobility and community participation. We used a wheelchair-vibration simulator to examine whether the seat reaction forces experienced by wheelchair users were differentially influenced by wheelchair suspension, trunk-muscle innervations, and ground speed. We used wheelchairs instrumented with load cells and accelerometers to determine the forces transmitted from the seat frame and the head accelerations experienced by riders. We determined that self-selected speed, seat force, and head accelerations differed between subjects with and without trunk-muscle innervations and between rigid and suspension wheelchairs. Seat force and head accelerations were greatest in the rigid-frame wheelchair and lowest in the spring-type suspension-frame wheelchairs. Those participants without trunk-muscle innervations preferred slower speeds than those with trunk-muscle innervations. Forward head accelerations were greater in those without than with trunk-muscle innervations. Wheelchair rear-suspension systems may improve wheelchair mobility function in terms of comfort at higher velocity by minimizing the seat forces and head accelerations experienced by the riders, especially those with higher level spinal cord injury and diminished postural control.

Wheelchair propulsion demands during outdoor community ambulation

Objective Quantify manual wheelchair propulsion effort during outdoor community ambulation. Design Case series. Subjects Thirteen individuals (12 with SCI, 1 with spina bifida) who were experienced manual wheelchair users and had no current upper extremity injury or pain complaints. Methods Measurements were obtained from instrumented wheelchair rims during steady-state propulsion as subjects traversed outdoor concrete sidewalk terrain that included smooth level, aggregate level, and a ramp with a smooth surface. Propulsion effort was assessed using the average propulsion moment, average instantaneous power, and work for both upper extremities. Results Propulsion effort, captured by the propulsion moment, work and power, varied across ground conditions ( p < 0.001). Propulsion effort was greater as the rolling resistance increased (i.e., smooth versus aggregate surfaces) and as the inclination angle progressed from level to inclined surfaces. There were no side-to-side differences across ground conditions for the propulsion moment or work. Power generation was significantly greater on the dominant compared to the non-dominant extremity during the more challenging aggregate surface and ramp conditions. Conclusions Propulsion effort varies with demands imposed by different ground conditions. Quantification of wheelchair propulsion demands provides rehabilitations specialists with objective information to guide treatment of patients adapting to manual wheelchair use.

Evidence-Based Strategies to Preserve Shoulder Function in Manual Wheelchair Users with Spinal Cord Injury

The increased demand on the upper limbs during manual wheelchair use results in a high prevalence of shoulder pathology in people with spinal cord injury (SCI). Because individuals with SCI are dependent on their upper extremities for mobility and daily activities, shoulder dysfunction can present a devastating loss of independence and decreased quality of life. Research on quantification of shoulder loading and muscular demands during wheelchair propulsion, self-transfers, weight-relief raises, and overhead activities is presented. This review examines evidence-based recommendations aimed at preserving shoulder function by addressing environmental factors related to ergonomics, equipment selection, and performance technique and personal factors related to enhancement of the load-bearing capacity of shoulder structure through strengthening and resistance training.

User satisfaction with mobility assistive devices: An important element in the rehabilitation process

Background. An assistive device often means an evident change in a person's ability, more easy to notice than the effects of most of other types of physiotherapy or occupational therapy intervention. In spite of this, there is very little evidence in this area.Purpose. The objective was to follow-up user satisfaction with and the use and usefulness of rollators and manual wheelchairs. The objective was also to determine any difference in satisfaction between users of the two different types of mobility assistive products.Methods. A random sample of 262 users participated in the study, 175 rollator users and 87 wheelchair users. The Quebec User Evaluation of Satisfaction with Assistive Technology—QUEST 2.0 and an additional questionnaire were used for data collection.Results. Overall satisfaction with both types of device was high and most clients reported use of their device on a daily basis. There was a difference in how the users estimated the usefulness and other characteristics as well as some service aspects related to prescription and use of the two types of device. Most users reported not having had any follow-up; however, most users had not experienced any need for one.Conclusions. A standardized follow-up will give rehabilitation professionals continuous and valuable information about the effect of and satisfaction with assistive devices.

Shoulder Muscular Demand During Lever-Activated Vs Pushrim Wheelchair Propulsion In Persons With Spinal Cord Injury

Background/Objective: The high demand on the upper limbs during manual wheelchair (WC) use contributes to a high prevalence of shoulder pathology in people with spinal cord injury (SCI). Leveractivated (LEVER) WCs have been presented as a less demanding alternative mode of manual WC propulsion. The objective of this study was to evaluate the shoulder muscle electromyographic activity and propulsion characteristics in manual WC users with SCI propelling a standard pushrim (ST) and LEVER WC design.Methods: Twenty men with complete injuries (ASIA A or B) and tetraplegia (C6, n = 5; C7, n = 7) or paraplegia (n = 8) secondary to SCI propelled STand LEVER WCs at 3 propulsion conditions on a stationary ergometer: self-selected free, self-selected fast, and simulated graded resistance. Average velocity, cycle distance, and cadence; median and peak electromyographic intensity; and duration of electromyography of anterior deltoid, pectoralis major, supraspinatus, and infraspinatus muscles were compared between LEVER and ST WC propulsion .Results: Sign ificant decreases in pectoralis major and supraspinatus activity were recorded during LEVER compared with ST WC propulsion. However, anterior deltoid and infraspinatus intensities tended to increase during LEVER WC propulsion. Participants with tetraplegia had similar or greater anterior deltoid, pectoralis major, and infraspinatus activity for both ST and LEVER WC propulsion compared with the men with paraplegia.Conclusions: Use of the LEVER WC reduced and shifted the shoulder muscular demands in individuals with paraplegia and tetraplegia. Further studies are needed to determine the impact of LEVER WC propulsion on long-term shoulder function.

PR_256: Wheelchair-Related Falls in Veterans With Spinal Cord Injury

Objective: To describe the epidemiology of wheelchair-related falls in spinal cord injury (SCI). Design: Prospective cohort study with baseline data collection and monthly follow-up for 12 months. Setting: 3 Department of Veterans Affairs SCI centers and 1 SCI support clinic. Participants: Veterans with nonprogressive SCI or disorders who use a wheelchair as a primary form of mobility. Interventions: Not applicable. Main Outcome Measures: Wheelchair falls and tips and injurious falls. Results: Preliminary data from the initial 655 subjects enrolled in the study are reported, of whom 339 have completed the 12-month follow-up to date. 25% of the subjects have reported wheelchair falls during the follow-up period, and just under half of those reported multiple falls. 12% of all subjects reported injurious falls. Injuries ranged from minor cuts or abrasions to 1 fall-related death and 4 subjects with fall-related fractures. Factors typically associated with falls in ambulatory nonwheelchair users (eg, older age, greater limitations in physical activity, cognitive impairment, and environmental factors such as poor lighting) do not appear to be associated with wheelchair-related falls in our sample. In contrast, our preliminary data suggest that wheelchair-related falls in SCI are more common with younger age, higher activity level and surrogates for greater activity and/or wheelchair use (eg, paraplegia vs quadriplegia, higher FIM scores), and with use of manual versus power wheelchairs. Conclusions: This study provides epidemiologic data that should be valuable in future development of models for predicting wheelchair falls and fall-related injuries in people with SCI, and in suggesting health-related practices that could be modified to decrease wheelchair-related falls and associated injuries.

Poster 203: Manual Wheelchair Use by Community-Dwelling and Institutionalized Veterans

Objective: To describe the relationship between patient, environmental, and wheelchair characteristics and wheelchair use. Design: Cohort study. Setting: 1 Veterans Administration teaching hospital. Participants: 99 consecutive cognitively intact veterans newly prescribed a manual wheelchair. Interventions: Not applicable. Main Outcome Measures: Self-reported and study team measured sociodemographic, health, wheelchair, and environmental characteristics. Results: The sample was similar to the veteran population as a whole with an average age of 66, 59% white, and 58% with a high school education.

Shoulder pain in wheelchair users with tetraplegia and paraplegia

Objective: To compare the prevalence and intensity of shoulder pain experienced during daily functional activities in individuals with tetraplegia and individuals with paraplegia who use manual wheelchairs. Design: Self-report survey. Setting: General community. Participants: Fifty-five women and 140 men, 92 subjects with tetraplegia and 103 subjects with paraplegia who met inclusion criteria of 3 hours per week of manual wheelchair use and at least 1 year since onset of spinal cord injury. Main Outcome Measures: Respondents completed a demographic and medical history questionnaire and the Wheelchair User's Shoulder Pain Index (WUSPI), a measure of pain during typical daily activities. Results: More than two thirds of the sample reported shoulder pain since beginning wheelchair use, with 59% of the subjects with tetraplegia and 42% of the subjects with paraplegia reporting current pain. Performance-corrected WUSPI scores were significantly higher in subjects with tetraplegia than in subjects with paraplegia. Conclusions: Both the prevalence and intensity of shoulder pain was significantly higher in subjects with tetraplegia than in subjects with paraplegia. Efforts to monitor and prevent shoulder pain should continue after rehabilitation.

Wheelchair safety--adverse reports to the United States Food and Drug Administration.

Evidence has been accumulating that injuries related to wheelchair use are common and sometimes serious. The object of this study was to evaluate the databases of the Food and Drug Administration (FDA) for insights to the nature and causes of such problems. We analyzed 651 records that were received by the FDA between 1975 and 1993. There were 368 injuries, 21 of which were fatal, affecting 334 wheelchair users. Fractures were the most common (45.5%), with lacerations (22.3%) and contusions/abrasions (20.1%) accounting for most of the remainder. The proportion of incidents related to the use of scooters, powered wheelchairs, and manual wheelchairs were 52.8%, 24.6%, and 22.6%, respectively. Four broad classes of contributing factors, often acting in combination, were implicated: engineering (60.5%), environmental (25.4%), occupant (9.6%), and system (4.6%). Of the tips and falls, those in the forward direction were most common in incidents affecting manual or powered wheelchairs, but the sideways direction was most common in scooters. The FDA database provides a unique perspective on wheelchair safety, with implications for clinicians, users, manufacturers, and regulatory bodies.