Manual Wheelchair Users Research Articles

Effects of the SmartDrive on mobility, activity, and shoulder pain among manual wheelchair users with spinal cord injury – a prospective long-term cohort pilot study

Purpose to investigate long-term effects of SmartDrive on mobility, everyday activity, and shoulder pain among spinal cord injured manual wheelchairs users. Material and methods A prospective pilot intervention study was conducted at Spinalis/Aleris Rehab Station, Sweden. Participants were consecutively invited when evaluated for SmartDrive prescription. Assessments were done at baseline, intervention (use of SmartDrive), and after six months. A smartwatch registered wheelchair utilization including push intensity and pushes/day. Wheelchair Outcome Measure, pain rating instruments including Wheelchair User’s Shoulder Pain Index, a wheelchair test, and semi-structured interviews were used. Descriptive statistics and content analysis approach were used. Results Twenty-five persons were screened, six of 14 included completed the study. Drop-out reasons were not related to SmartDrive for five of the eight persons. After intervention, there was a tendency of decreased pain (median (IQR) 5/10 (2.6–6.6) vs 2.5 (2–3.2). All participants reported increased satisfaction of performance when “taking a walk”, from median (IQR) 45/100 (27–70) at baseline to 95 (80–100) at 6 months. Two persons who could not ascend a slope at baseline could manage using the SmartDrive. Interviews revealed that the in general positive response persisted at six months. Also, with the SmartDrive the participants could go out despite pain, providing a sense of freedom and independence. Three incidents were reported. Conclusion This long-term pilot study indicates that a SmartDrive might be a valuable assistive device to promote mobility despite of shoulder pain. All participants considered it easy to use and experienced increased independence, however skills training and follow-ups are necessary. IMPLICATIONS FOR REHABILITATION A Rear Drive Power Assist Device (RD-PAD) could increase satisfaction with self-selected activities. A RD-PAD could increase functional mobility by facilitating propelling longer distances and steeper slopes. A RD-PAD could improve perseverance of daily activities in spite of shoulder pain. A RD-PAD could be a valuable assistive aid for persons with paraplegia with different level of wheelchair skills but with good self-awareness regarding their abilities. Thorough assessment of initial wheelchair skills, training, and follow-up are important to enhance safety and maximize performance when using the RD-PAD.

Correlation between physical activity, respiratory muscle strength and heart rate indexes in spinal cord injured wheel chair users

Objective: To find out the correlation between physical activity, respiratory muscle strength, heart rate indexes and heart rate variability in spinal cord injured manual wheelchair users. Also compare the physical activity, respiratory muscle strength, heart rate indexes and heart rate variability of spinal cord injured manual wheelchair users with the normal healthy controls. Patients and Methods: A convenient sample that included 50 SCI and 50 normal healthy controls with age 22-35 years was recruited. Individuals with chronic traumatic SCI of C6 to T12 (AIS A or B)4 and are trained with basic wheelchair skills4 . While those on medication, having any comorbidity other than SCI and current smokers were excluded. The SCI propelled their wheelchair for 5 mins at a self-selected and comfortable pace around a 41m circular track. Static mouth pressures and physical activity was recorded. Healthy individuals performed the 6-minute walk test. Results: A significant correlation between the respiratory muscle strength, heart rate indexes and heart rate variability was seen. PCCI was the most correlated followed by THBI and PCI did not showed any correlation.

Manual wheelchair biomechanics while overcoming various environmental barriers: A systematic review.

During manual wheelchair (MWC) locomotion, the user's upper limbs are subject to heavy stresses and fatigue because the upper body is permanently engaged to propel the MWC. These stresses and fatigue vary according to the environmental barriers encountered outdoors along a given path. This study aimed at conducting a systematic review of the literature assessing the biomechanics of MWC users crossing various situations, which represent physical environmental barriers. Through a systematic search on PubMed, 34 articles were selected and classified according to the investigated environmental barriers: slope; cross-slope; curb; and ground type. For each barrier, biomechanical parameters were divided into four categories: spatiotemporal parameters; kinematics; kinetics; and muscle activity. All results from the different studies were gathered, including numerical data, and assessed with respect to the methodology used in each study. This review sheds light on the fact that certain situations (cross-slopes and curbs) or parameters (kinematics) have scarcely been studied, and that a wider set of situations should be studied. Five recommendations were made at the end of this review process to standardize the procedure when reporting materials, methods, and results for the study of biomechanics of any environmental barrier encountered in MWC locomotion: (i) effectively reporting barriers' lengths, grades, or heights; (ii) striving for standardization or a report of the approach conditions of the barrier, such as velocity, especially on curbs; (iii) reporting the configuration of the used MWC, and if it was fitted to the subject's morphology; (iv) reporting rotation sequences for the expression of moments and kinematics, and when used, the definition of the musculoskeletal model; lastly (v) when possible, reporting measurement uncertainties and model reconstruction errors.

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

Come Roll with Me: Integrating Disability Awareness and Interprofessional Learning into a Medical Musculoskeletal Course

One in four Americans are affected by a disability making people with disabilities (PWD) the largest minority group in the United States. PWD experience a variety of social, economic and structural barriers that limit access to medical care and create significant health care disparities. While PWD visit health care providers at a higher frequency than those without disabilities, half of U.S. medical schools lack a disability awareness program, and 58% of medical school deans reported that a curriculum for patients with disabilities was not a high priority. These factors have led to a sense of unpreparedness amongst medical students in providing care for this population. In order to address these deficiencies, a new educational activity, Come Roll with Me (CRWM), was integrated into the Musculoskeletal & Skin course within a Southeastern allopathic medical school in 2021. Authors hypothesized that CRWM would increase disability awareness amongst medical students and enhance attitudes towards interprofessional practice. Come Roll with Me paired PWD, specifically power and manual wheelchair users, with small groups of second‐year medical and Doctor of Physical Therapy (DPT) students for a two‐hour session. Groups rotated through four stations including (1) a self‐propelled wheelchair course within the students’ educational building, (2) a discussion about accessible parking and transportation at the wheelchair users’ vehicles, (3) a skill‐development session on transfers taught by DPT students, and (4) an open dialog regarding barriers to healthcare experienced by PWD. Come Roll with Me was assessed via course evaluations and student reflection essays. Additionally, students were invited to complete the Interprofessional Attitudes Scale (IPAS) before and after the course. The study was approved by the UAB Institutional Review Board. CRWM was the highest rated instructional session in the Musculoskeletal and Skin course with a mean Likert‐scale score of 4.59/5.0 (N=109). Thematic analysis of reflection essays revealed newfound awareness of difficulties navigating a building in a wheelchair and lack of accessibility in doors, bathrooms, etc. Students expressed increased comfort in engaging with PWD and a desire for advocacy on their part. Medical students’ attitudes towards interprofessional collaborative practice improved with significant increases in the mean Teamwork, Roles, Responsibilities (39.3 vs. 42.0) and Interprofessional Biases (8.5 vs. 8.9) IPAS subscales (p<0.01). Come Roll with Me represents a novel interprofessional and patient‐centered method of embedding disability awareness and health care disparities within the preclinical medical curriculum. Integration of the basic sciences with patient encounters and social aspects of medicine are essential in the training of physicians who are competent to care for a diverse patient population.

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.

Association between individual wheelchair skills and fitness in community-dwelling manual wheelchair users with spinal cord injuries

Purpose Wheelchair skills are a key component to promotion of community participation among persons with spinal cord injury (SCI). The objective of this secondary analysis was to examine the association between individual wheelchair skills from the Wheelchair Skills Test Questionnaire (WST-Q) and fitness among community-dwelling adults with SCI. Materials and methods Twenty-six adults were recruited to complete the WST-Q and a standard graded aerobic wheelchair exercise test on a motorized treadmill for assessing peak power output (POpeak). Results Spearman Rho rank-order correlation (ρ) analyses indicated statistically significant correlations between POpeak and six basic (ρ = 0.41–0.57), eight intermediate (ρ = 0.44–0.59), and nine advanced (ρ = 0.42–0.80) WST-Q skill scores. After controlling for sex and injury level (Partial Spearman Rho rank order) significant correlations persisted for four advanced skills (i.e., descends high curb, turns in place in wheelie position, descends steep incline in wheelie position, descends high curb in wheelie position; ρ = 0.46–0.59) and one additional skill (i.e., ascends high curb ρ = 0.51). Conclusions More advanced wheelchair skills are significantly associated with fitness in persons with SCI. The directionality of the skills-fitness relationship, specifically whether wheelchair skills facilitate greater fitness or fitness is a prerequisite for certain wheelchair skills needs to be determined in future, larger studies. However, results from this study provide a comprehensive list of wheelchair skills that are associated with fitness that can be directly applied to guide further research and practice promoting community participation among persons with SCI. Implications for Rehabilitation Significant positive associations exist between advanced wheelchair skills (i.e., descends high curb, turns in place in wheelie position, descends steep incline in wheelie position, descends high curb in wheelie position and ascends high curb) and fitness in manual wheelchair users with spinal cord injury (SCI). This study provides a list of skills associated with fitness to guide clinical practice and areas for further rehabilitation research assessing the directionality of the relationship between fitness and wheelchair skills.

Physical activity levels and shoulder pain in wheelchair users during COVID-19 restrictions

BackgroundManual wheelchair users are at high risk of developing shoulder pain. However, it is not known if restrictions to limit the spread of the COVID-19 virus affected physical activity, wheelchair use and shoulder pain. ObjectiveThe aim of the study is to determine whether COVID-19 related restrictions caused changes in physical activity levels and the presence of shoulder pain in persons who use a wheelchair. MethodsManual wheelchair users completed a survey about the presence and severity of shoulder pain in a cross-sectional study design. Participants completed the Leisure Time Physical Activity Questionnaire and were asked about daily wheelchair activity before and during lockdown. A logistic regression examined the relationship between increase in shoulder pain severity and change in activity levels. ResultsSixty respondents were included for analysis. There was no significant change in physical activity during lockdown. There was a significant reduction in number of hours of daily wheelchair use and number of chair transfers during lockdown. Of the respondents, 67% reported having shoulder pain and 22% reported their shoulder pain becoming more severe during lockdown. No significant relationship was observed between the change in activity levels and increasing severity of shoulder pain. ConclusionRestrictions to reduce the spread of the COVID-19 virus resulted in no changes in physical activity levels in a sample of adult manual wheelchair users; however, there was a reduced time using a wheelchair each day and fewer chair transfers. The changes in wheelchair activities were not related to the worsening of shoulder pain.

Effect of Haptic Training During Manual Wheelchair Propulsion on Shoulder Joint Reaction Moments.

BackgroundManual wheelchair propulsion remains a very ineffective means of locomotion in terms of energy cost and mechanical efficiency, as more than half of the forces applied to the pushrim do not contribute to move the wheelchair forward. Manual wheelchair propulsion training using the haptic biofeedback has shown an increase in mechanical efficiency at the handrim level. However, no information is available about the impact of this training on the load at the shoulders. We hypothesized that increasing propulsion mechanical efficiency by 10% during propulsion would not yield clinically significant augmentation of the load sustained at the shoulders.MethodsEighteen long-term manual wheelchair users with a spinal cord injury propelled a manual wheelchair over a wheelchair simulator offering the haptic biofeedback. Participants were asked to propel without the Haptic Biofeedback (HB) and, thereafter, they were subjected to five training blocks BL1–BL5 of 3 min in a random order with the haptic biofeedback targeting a 10% increase in force effectiveness. The training blocs such as BL1, BL2 BL3, BL4, and BL5 correspond, respectively, to a resistant moment of 5, 10, 15, 20, and 25%. Pushrim kinetics, shoulder joint moments, and forces during the propulsive cycle of wheelchair propulsion were assessed for each condition.ResultsThe tangential force component increases significantly by 74 and 87%, whereas value for the mechanical effective force increases by 9% between the pretraining and training blocks BL3. The haptic biofeedback resulted in a significant increase of the shoulder moments with 1–7 Nm.ConclusionIncreases in shoulder loads were found for the corresponding training blocks but even though the percentage of the increase seems high, the amplitude of the joint moment remains under the values of wheelchair propulsion found in the literature. The use of the HB simulator is considered here as a safe approach to increase mechanical effectiveness. However, the longitudinal impact of this enhancement remains unknown for the impact on the shoulder joint. Future studies will be focused on this impact in terms of shoulder risk injury during manual wheelchair propulsion.

Design refinement and evaluation of a mobile manual standing wheelchair

Purpose There are no manually propelled wheelchairs on the market that are mobile in both seated and standing positions. In response to this product gap, our group formerly designed a mobile manual standing wheelchair (MMSW) and gathered stakeholder feedback. The purpose of this study was to refine the MMSW based on feedback, including weight and width reduction, and evaluate its performance. Materials and methods The MMSW was subjected to ANSI/RESNA stability testing, and three male participants completed a subset of the wheelchair skills test, including a 100-m roll test in the MMSW (seated and standing) and in their ultralight wheelchair. Results The MMSW met ANSI/RESNA stability safety standards. During the 100-m roll test, participants reached speeds with the MMSW in both the standing and sitting postures similar or greater than those typical of moving in the home environment (1.11 m/s seated; 0.79 m/s standing). Mobility speeds in the MMSW in the standing position were about three times faster than average walking speeds in exoskeletons (0.26 m/s exoskeletons). With the addition of chain drive bracing to the MMSW, one user was able to reach speeds in the standing position similar to average neurotypical walking speeds indicating the possibility for wheelchair users to be able to move in pace with family and friends. Conclusion All participants expressed interest in the MMSW to facilitate improved quality of life. Further work is needed to test the utility of the MMSW in home and community settings, and its potential effects on standing time and health outcomes. Implications for rehabilitation Manual standing wheelchairs with standing mobility may increase functional utility and length of standing time for manual wheelchair users Increased standing time may lead to several health benefits for manual wheelchair users

The presence of pain in community-dwelling South African manual wheelchair users with spinal cord injury.

BackgroundPain after spinal cord injury (SCI) is common and is likely to continue throughout life with varying levels of severity.ObjectiveTo determine the presence of pain, the sociodemographic and injury profile of community-dwelling manual wheelchair users.MethodThis quantitative correlational study used a sociodemographic and injury profile sheet and the Douleur Neuropathique 4 Questions (DN4) questionnaire to document demographic, SCI profiles as well as pain characteristics. Pain severity was determined using the Numeric Rating Scale. Data were analysed using the Statistical Package for the Social Sciences (SPSS) v27 at 0.05 level of significance.ResultsThe pain rate was 104; 85% of 122 participants and mainly in those with complete SCI (77.9%). Neuropathic pain was more common (76; 62.5%) and significantly associated (p < 0.05) with higher pain severity. Pain was mainly in one area of the body (59; 48.4%) but occurring in up to five areas. The most painful area had a mean severity of 6.7/10; was more common in the lower limbs below the injury level (48; 39.4%); and was burning in nature (40; 32.7%).ConclusionsPain after SCI is as problematic in the South African context as it is globally. With the rising SCI prevalence in the country, understanding pain and its presentation is important for holistic management of a person with SCI.Clinical implicationsIn-depth assessment of pain should be conducted and appropriate management interventions for specific pain types be prescribed to effectively reduce pain.

Detecting clinical practice guideline-recommended wheelchair propulsion patterns with wearable devices following a wheelchair propulsion intervention

ABSTRACT Wheelchair propulsion interventions typically teach manual wheelchair users to perform wheelchair propulsion biomechanics as recommended by the Clinical Practice Guidelines (CPG). Outcome measures for these interventions are primarily laboratory based. Discrepancies remain between manual wheelchair propulsion (MWP) in laboratory-based examinations and propulsion in the real-world. Current developments in machine learning (ML) allow for monitoring of MWP in the real world. In this study, we collected data from participants enrolled in two wheelchair propulsion interventions, then built an ML algorithm to distinguish CPG recommended MWP patterns from non-CPG-recommended patterns. Eight primary manual wheelchair users did not initially follow CPG recommendations but learned and performed CPG propulsion after the interventions. Participants each wore two inertial measurement units as they propelled their wheelchairs on a roller system, indoors overground, and outdoors. ML models were trained to classify propulsion patterns as following the CPG or not following the CPG. Video recordings were used for reference. For indoor detection, we found that a subject-independent model was able to achieve 85% accuracy. For outdoor detection, we found that the subject-independent model achieved 75.4% accuracy. These results provide further evidence that CPG and non-CPG-recommended MWP patterns can be predicted with wearable sensors using an ML algorithm.

Shoulder Pain, Function, and Ultrasound-Determined Structure in Elite Wheelchair-Using Para Athletes: An Observational Study.

This study aimed to determine the relationship between shoulder pain, physical examination, and tissue pathology in manual wheelchair users competing in elite sport. Eighty elite para athletes who used a manual wheelchair for daily mobility were recruited from international track (n = 40), field (n = 19), and powerlifting (n = 21) competitions. Athletes were surveyed regarding shoulder pain history and symptoms (Wheelchair User's Shoulder Pain Index (WUSPI)), whereas independent blind observers measured signs (Physical Examination of the Shoulder Scale (PESS)) and tissue pathology (Ultrasound Shoulder Pathology Rating Scale (USPRS)). Relationships between measures for the total cohort and for subgroups defined by sporting discipline were calculated. A large proportion of athletes reported a history of upper limb pain (39% dominant and 35% nondominant). For the total cohort, WUSPI score was 22.3 ± 26.9, PESS score was 7.4 ± 6.7, and USPRS score was 5.2 ± 4.0. There were no USPRS score differences between athlete subgroups; however, track athletes had lower WUSPI and PESS scores, especially compared with field athletes. The first principal component explained most of the variance in the WUSPI and PESS, which were strongly correlated (r = 0.71), and the second orthogonal component explained the USPRS, which did not correlate with either the PESS (r = 0.21) or WUSPI (r = 0.20). Subgroup analysis showed that track athletes had lower symptom scores for a given physical examination score. Elite para athletes who use manual wheelchairs for daily mobility have a high prevalence of shoulder symptoms, positive signs on physical examination, and ultrasound-determined tissue pathology. Ultrasound-determined tissue pathology does not correlate with symptoms or signs. This information can help to guide clinicians in managing shoulder problems in this athlete population at high risk of injury.

Effectiveness of resistance programs in wheelchair users shoulder function: A systematic review

Literature presents promising results regarding exercise programs to reduce shoulder pain in manual wheelchair users. However, there is a lack of systematization and specific usefulness of resistance training programs. Thus, the study objective was to analyze the effectiveness of resistance training programs in reducing shoulder pain, and to increase shoulder strength and function in manual wheelchair users (MWUs). A Boolean search strategy adapted for Pubmed, Ebsco, Scopus, Web of Science and Scielo Science databases was undertaken (up to February 2021) to identify all studies measuring changes in shoulder strength, pain, and/or function after implementing a resistance training program in MWUs. Two independent reviewers selected articles based on following criteria: MWUs, participants' age, study design and intervention types. Also, reviewers performed the study quality assessment, risk-of-bias analysis and data extraction. Of the 124 obtained publications, a total of 9 studies met the inclusion criteria, being evaluated through PEDro Scale (mean quality score in four or below) and uncertain risk of bias according to Cochrane Scale assessment. The studies shows that: one-repetition maximum (12-60%), isometric peak force (25-36%) and isokinetic muscle strength (10-30%) increased following resistance training interventions. Significant reductions (22-85%) in shoulder pain (WUSPI score) were found after resistance training interventions. In addition, shoulder function (evaluated by DASH questionnaire) improved (12-60%) following resistance training. The present review highlights the usefulness of resistance training programs to improve muscular strength and shoulder function and to reduce shoulder pain in MWUs. These results have significant practical applications to improve the quality of life of MWUs.

Lifestyle physical activity in manual wheelchair users - an overlooked public health opportunity.

Public health guidelines and health promotion efforts have traditionally focused on weekly accumulation of moderate to vigorous physical activity (MVPA) via structured exercise. There has been a recent paradigm shift towards the organic incorporation of MVPA in daily leisure and non-leisure time, termed "Lifestyle Physical Activity" (LPA). However, this paradigm shift and the underlying research has neglected manual wheelchair users (MWCUs) with spinal cord injury (SCI), who could benefit from LPA. This article argues for expanding the LPA paradigm shift into research and health promotion efforts involving MWCUs with SCI. We suggest a working definition of LPA for MWCUs and candidate metrics for quantifying LPA. This is followed by brief overviews of LPA correlates, outcomes/consequences, and interventions and the need for theory based approaches to study these domains. We lastly suggest an approach for mitigating potential negative outcomes of increased LPA in MWCUs and suggest a research agenda.

Chronic Shoulder Pain in Manual Wheelchair (MWC) Users with Spinal Cord Injury (SCI): The Lived Experience

Background: Existing research on the lived experience of those with spinal cord injury (SCI) resulting in paraplegia who use a manual wheelchair and experience shoulder pain is extremely limited. This research aimed to begin the process of understanding the lived experience of this population and to describe how chronic shoulder pain impacts occupational engagement and quality of life. Method: A phenomenological approach using a constant comparative method was used to analyze data and to construct and redefine themes throughout the research process. The qualitative data obtained from two semi-structured interviews with the four study participants is presented below. Results: Five overarching themes emerged. The themes of putting on the brakes, intrinsic factors, extrinsic factors, hope, and resilience emerged among the participants to describe their lived experience of shoulder pain as a manual wheelchair user with SCI. Conclusion: The themes presented increased the understanding of the lived experience of shoulder pain in this population. Though the experience was unique to each participant, many similarities emerged from the themes, such as the benefit of having a strong support network including others wheelchair users with SCI and demonstrating a resilient spirit.

The influence of shoulder pain and fear of falling on level and non-level transfer technique

Background Level and non-level transfers are essential tasks of daily living for wheelchair users. Minimal research has examined the role of shoulder pain and fear of falling on transfer quality. The purpose of this study is to (1) examine the association between shoulder pain, fear of falling (FoF) and transfer quality and (2) explore the feasibility of assessing non-level transfers to-and-from the floor. Methods Cross-sectional design was used to explore shoulder pain, FoF, and transfer quality in 30 manual wheelchair users (aged 18-42; 15 males). Participant demographic information (age, sex, race, disability, and years using wheelchair), Spinal Cord Injury-Fall Concern Scale (SCI-FCS), and Wheelchair User Shoulder Pain Index (WUSPI) was collected. Three types of transfers: (1) level, (2) uphill, and (3) floor-to-table were graded by a trained researcher using the Transfer Assessment Instrument (TAI) 3.0. Kruskal–Wallis test was used to determine differences in transfer quality based on condition. Spearman correlation was used to determine associations between demographic data, WUSPI, SCI-FCS, and transfer quality scores. Results All participants safely completed the uphill non-level transfer; 27 safely completed the floor-to-table non-level transfer. Statistical analysis revealed no difference in TAI score across transfer conditions. Spearman correlation revealed a significant correlation between WUSPI and SCI-FCS scores (r = .68, P = .01) and WUSPI and uphill TAI scores (r = -.45, P = .01). Conclusion Increases in shoulder pain are related to decreased uphill transfer quality and increased FoF. Non-level transfers to-and-from the floor are feasible within clinical or laboratory settings.

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.

Effect of Wheels, Casters and Forks on Vibration Attenuation and Propulsion Cost of Manual Wheelchairs.

Manual wheelchair users are exposed to whole-body vibrations as a direct result of using their wheelchair. Wheels, tires, and caster forks have been developed to reduce or attenuate the vibration that transmits through the frame and reaches the user. Five of these components with energy-absorbing characteristics were compared to standard pneumatic drive wheels and casters. This study used a robotic wheelchair propulsion system to repeatedly drive an ultra-lightweight wheelchair over four common indoor and outdoor surfaces: linoleum tile, decorative brick, poured concrete sidewalk, and expanded aluminum grates. Data from the propulsion system and a seat-mounted accelerometer were used to evaluate the energetic efficiency and vibration exposure of each configuration. Equivalence test results identified meaningful differences in both propulsion cost and seat vibration. LoopWheels and SoftWheels both increased propulsion costs by 12-16% over the default configuration without reducing vibration at the seat. Frog Legs suspension caster forks increased vibration exposure by 16-97% across all four surfaces. Softroll casters reduced vibration by 11% over metal grates. Wide pneumatic 'mountain' tires showed no difference from the default configuration. All vibration measurements were within acceptable ranges compared to health guidance standards. Out of the component options, softroll casters show the most promising results for ease of efficiency and effectiveness at reducing vibrations through the wheelchair frame and seat cushion. These results suggest some components with built-in suspension systems are ineffective at reducing vibration exposure beyond standard components, and often introduce mechanical inefficiencies that the user would have to overcome with every propulsion stroke.

Predicting physical activity intensity using raw accelerometer signals in manual wheelchair users with spinal cord injury.

Cross-sectional validation study. The performance of previously published physical activity (PA) intensity cutoff thresholds based on proprietary ActiGraph counts for manual wheelchair users (MWUs) with spinal cord injury (SCI) was initially evaluated using an out-of-sample dataset of 60 individuals with SCI. Two types of PA intensity classification models based on raw accelerometer signals were developed and evaluated. Research institutions in Pittsburgh PA, Birmingham AL, and Bronx NY. Data were collected from 60 MWUs with SCI who followed a structured activity protocol while wearing an ActiGraph activity monitor on their dominant wrist and portable metabolic cart which measured criterion PA intensity. Data was used to assess published models as well as develop and assess custom models using recall, specificity, precision, as well as normalized Mathew's correlation coefficient (nMCC). All the models performed well for predicting sedentary vs non-sedentary activity, yielding an nMCC of 0.87-0.90. However, all models demonstrated inadequate performance for predicting moderate to vigorous PA (MVPA) with an nMCC of 0.76-0.82. The mean absolute deviation (MAD) cutoff threshold yielded the best performance for predicting sedentary vs non-sedentary PA and may be used for tracking daily sedentary activity. None of the models displayed strong performance for MVPA vs non-MVPA. Future studies should investigate combining physiological measures with accelerometry to yield better prediction accuracies for MVPA.