Power Wheelchair Users Research Articles

Effectiveness of a Wheelchair Skills Training Program for Powered Wheelchair Users: A Randomized Controlled Trial

ObjectivesTo test the hypothesis that powered wheelchair users who receive the Wheelchair Skills Training Program (WSTP) improve their wheelchair skills in comparison with a control group that receives standard care, and secondarily to assess goal achievement, satisfaction with training, retention, injury rate, confidence with wheelchair use, and participation. DesignRandomized controlled trial. SettingRehabilitation centers and communities. ParticipantsPowered wheelchair users (N=116). InterventionFive 30-minute WSTP training sessions. Main Outcome MeasuresAssessments were done at baseline (t1), posttraining (t2), and 3 months posttraining (t3) using the Wheelchair Skills Test Questionnaire (WST-Q version 4.1), Goal Attainment Score (GAS), Satisfaction Questionnaire, injury rate, Wheelchair Use Confidence Scale for Power Wheelchair Users (WheelCon), and Life Space Assessment (LSA). ResultsThere was no significant t2–t1 difference between the groups for WST-Q capacity scores (P=.600), but the difference for WST-Q performance scores was significant (P=.016) with a relative (t2/t1 × 100%) improvement of the median score for the intervention group of 10.8%. The mean GAS ± SD for the intervention group after training was 92.8%±11.4%, and satisfaction with training was high. The WST-Q gain was not retained at t3. There was no clinically significant difference between the groups in injury rate and no statistically significant differences in WheelCon or LSA scores at t3. ConclusionsPowered wheelchair users who receive formal wheelchair skills training demonstrate modest, transient posttraining improvements in their WST-Q performance scores, have substantial improvements on individualized goals, and are positive about training.

Measuring wheelchair confidence among power wheelchair users: an adaptation of the WheelCon-M using focus groups and a think aloud process

Purpose: The aim of this study was to adapt the WheelCon-M, an outcome measure used to assess confidence with manual wheelchair use, into a version that is applicable for power wheelchair users (WheelCon-P). Methods: Adaptation of the WheelCon-M into the WheelCon-P occurred in two phases: (1) item modification was conducted using focus groups and (2) item refinement was done using a think aloud process. Results: The healthcare professionals (n = 12) were mostly female, mostly occupational therapists and practiced an average of 14 years. The power wheelchair users (n = 8) were 50% men with an average of 8 years of power wheelchair experience and a range of diagnoses. In phase 1, of the 63 WheelCon-M items, 6 remained the same, 18 were removed, 38 modified and 15 new items added to develop the WheelCon-P. In phase 2, 15 WheelCon-P items were refined. Conclusions: This study resulted in the modification of the WheelCon-M into the WheelCon-P, a 59-item, self-report outcome measure designed to assess confidence with power wheelchair use. The next step in the evolution of this promising new measure is the assessment of its measurement properties. Implications for Rehabilitation The WheelCon-P is a new outcome measure designed to assess confidence with power wheelchair use. This study suggests that the items in this measure will be interpreted as intended.

Power Wheelchair Use in Persons With Amyotrophic Lateral Sclerosis: Changes Over Time

The objectives of this study were to survey persons with Amyotrophic Lateral Sclerosis (ALS) at 1 and 6 months after receiving power wheelchairs to determine long-term use, comfort, and function as well as the power wheelchair’s impact on daily tasks and quality of life. A 33-question survey and Psychosocial Impact of Assistive Devices Scale (PIADS) were sent 1 month after getting a new power wheelchair; a follow-up survey was sent at 6 months. Based on satisfaction and feature use survey results, at 1 month, 81% of users found the power wheelchair overall comfort to be high, 88% found their overall mobility to be improved, and 95% found it easy to use. Their quality of life increased and pain decreased at 1 and 6 months. According to the PIADS, the power wheelchair gave users increased ability to participate and sense of competence. This study has important results for the ALS community, as it is the first to assess power wheelchair users at 1 and 6 months after power wheelchair procurement. The results demonstrate the impact the power wheelchair has on mobility, psychosocial issues, functional abilities, and quality of life for a person with ALS.

The power of power wheelchairs: Mobility choices of community-dwelling, older adults

Background: Power wheelchairs are purported to have a positive effect on health, occupation, and quality of life. However, there is limited knowledge about what factors shape power wheelchair use decisions. Aims/objectives: A study was undertaken to understand the mobility choices of community-dwelling, power wheelchair users. Methods: A series of semi-structured qualitative interviews was conducted with 13 older adult power wheelchair users. Participants were interviewed at enrollment and four months later. Data analysis was informed by Bourdieu’s theoretical constructs of habitus, capital, and field. Results: Three main styles of power wheelchair use were identified: reluctant use, strategic use, and essential use, and each type is illustrated using an aggregate case study. Conclusion/significance: These findings highlight the need to alter the power relationship that exists between prescribers and device users and to effect policy changes that enable people with physical impairments to make as wide a range of mobility choices as possible.

Developing a chairable computing platform to support power wheelchair users

Power wheelchair users often use and carry multiple mobile computing devices. Many wheelchair users experience motor impairments that affect their hands, arms, neck, and head. Additionally, a power wheelchair user's ability to interact with computing technology may be physically restricted by the wheelchair's frame, which can obstruct movement or limit reach. We believe these accessibility issues can be overcome by designing new systems to take advantage of the physical abilities of the user while leveraging the wheelchair's frame to create assistive systems. We also hope to make progress toward limiting social barriers that hinder technology adoption. This could potentially improve the overall benefit of emerging technologies for people with varying abilities. With this research I aim to develop an interactive wheelchair-based computing platform designed to support the unique and dynamic needs of power wheelchair users while also creating new interaction possibilities.

Effect of tilt and recline on ischial and coccygeal interface pressures in people with spinal cord injury.

Clinicians commonly recommend that power wheelchair users with spinal cord injury perform wheelchair tilt and recline maneuvers to redistribute seating loads away from the ischial tuberosities. However, ischial pressure reduction may be accompanied by coccygeal pressure increases. Although the coccyx is among the most common sites of pressure ulcers, few studies have reported coccygeal interface pressure. The purpose of this study was to investigate both ischial and coccygeal interface pressures in response to changes in wheelchair tilt and recline angles. Thirteen power wheelchair users were recruited into this study. Six combinations of wheelchair tilt (15, 25, and 35 degrees) and recline (10 and 30 degrees, corresponding to traditional recline conventions of 100 and 120 degrees, respectively) angles were tested in random order. Each combination was tested with 5 mins of upright sitting, 5 mins of tilt and recline, as well as 5 mins of maximal pressure relief recovery. Peak pressure indices were calculated at the ischial and coccygeal sites. Ischial pressures monotonically decreased in response to increasing combinations of tilt and recline. Increments of 15 degrees of tilt did not produce significant differences under either recline angle, whereas increments of 25 degrees of tilt produced significant differences under both recline angles. Coccygeal pressures increased in response to the four smallest (of six) combinations of tilt and recline, whereas they decreased in response to the largest two combinations. Ischial pressures seemed to be redistributed to the coccyx in response to the four smallest angle combinations and redistributed to the back support in response to the two largest angle combinations. Future work should confirm this pressure redistribution to the back support and determine the back support locations of redistribution.

Measurement properties of the Wheelchair Skills Test – Questionnaire for powered wheelchair users

Purpose: To evaluate the test–retest reliability, concurrent validity and responsiveness of the Wheelchair Skills Test – Questionnaire (WST-Q) Version 4.1 for powered wheelchair users. Methods: A volunteer sample of 72 community-dwelling, experienced powered wheelchair users, ranging in age from 50 to 77 years, participated in this study. Participants completed measures at baseline and 1 month later. Results: Mean ± standard deviation total percentage WST-Q scores at baseline and 1 month were 83.7% ± 10.9 and 86.3% ± 10.0 respectively. Cronbach’s alpha was 0.90 and the 1 month test–retest intraclass correlation coefficient (ICC1,1) was 0.78 (confidence interval: 0.68–0.86). There were no floor or ceiling effects. Percentages of agreement between baseline and 1 month for individual skills ranged from 72.2% to 100%. The correlations between the WST-Q and the objective Wheelchair Skills Test (WST), WheelCon and Life Space Assessment were r = 0.65, r = 0.47 and r = 0.47 respectively. The standard error of measurement (SEM) and smallest real difference (SRD) were 5.0 and 6.2 respectively. Conclusion: The WST-Q 4.1 has high internal consistency, strong test–retest reliability and strong support for concurrent validity and responsiveness.Implications for Rehabilitation:There is evidence of reliability, validity and responsiveness of the Wheelchair Skills Test – Questionnaire (WST-Q) among experienced older adult powered wheelchair users.The WST-Q can be used to measure powered wheelchair skills, guide intervention and measure change over time.

Problematic clinical features of powered wheelchair users with severely disabling multiple sclerosis

Purpose: The aim of this study is to describe the clinical features of powered wheelchair users with severely disabling multiple sclerosis (MS) and explore the problematic clinical features influencing prescription. Method: Retrospective review of electronic and case note records of recipients of electric-powered indoor/outdoor powered wheelchairs (EPIOCs) attending a specialist wheelchair service between June 2007 and September 2008. Records were reviewed by a consultant in rehabilitation medicine, data systematically extracted and entered into a computer database. Further data were entered from clinical records. Data were extracted under three themes; demographic, diagnostic, clinical and wheelchair factors. Results: Records of 28 men mean age 57 (range 37–78, SD 12) years and 63 women mean age 57 (range 35–81, SD 11) years with MS were reviewed a mean of 64 (range 0–131) months after receiving their wheelchair. Twenty two comorbidities, 11 features of MS and 8 features of disability were thought to influence wheelchair prescription. Fifteen users were provided with specialised seating and 46 with tilt-in-space seats. Conclusions: Our findings suggest that people with severe MS requiring an EPIOC benefit from a holistic assessment to identify problematic clinical features that influence the prescription of the EPIOC and further medical and therapeutic interventions.Implications for RehabilitationPeople with multiple sclerosis (MS), referred for an EPIOC, require a full clinical assessment to identify problematic clinical features that are potentially treatable and/or can be accommodated through specialised seating and tilt.The beneficial effects of TIS should be considered for all EPIOC users with MS and particularly for those with comorbidityPoorly controlled spasticity, when identified in people with MS, should be managed through positioning in the chair, pressure-relieving cushion and referral for medical management.

Measurement Properties of the Late Life Disability Index Among Individuals Who Use Power Wheelchairs as Their Primary Means of Mobility

ObjectiveTo examine the reliability, validity, and factor structure of the Late Life Disability Instrument (LLDI) in individuals who use power wheelchairs as their primary means of mobility. DesignA 4-week, test-retest study design. SettingFive Canadian cities. ParticipantsThe validity sample included 115 new and experienced power mobility users, and the reliability sample included 85 experienced users (N=115). These volunteer samples included individuals who were aged ≥50 years and independently used power mobility as their primary means of mobility. InterventionsNot applicable. Main Outcome MeasureThe LLDI measures participation in 2 dimensions of 16 life activities: frequency and perceived limitations. Validity measures included the Wheelchair Skills Test–power version, the Assistive Technology Outcomes Profile for Mobility, the Hospital Anxiety and Depression Scale, the Power Mobility Wheelchair Confidence Measure, and the Life Space Assessment. ResultsFor the reliability sample, raw intraclass correlational coefficients for limitation and frequency dimension scores ranged from .855 (95% confidence interval .781–.905) to .883 (95% confidence interval, .822–.924), respectively. For the validity sample, scores on the LLDI were correlated as hypothesized with scores on validity measures. The factor structure that was identified with the original sample was not replicated among power wheelchair users. For LLDI frequency, exploratory factor analysis indicated that 5 of the original 16 items did not perform similarly among power wheelchair users. For LLDI limitations, a 1-factor, rather than a 2-factor, solution was identified. ConclusionsThe study provides evidence in support of the reliability and validity of the measure but suggests that the original subscale scores may not be applicable to power wheelchair users.

Men’s and women’s perspectives on using a powered mobility device: Benefits and societal challenges

Objective: To describe how men and women experience their use of powered wheelchairs (PW) and powered scooters (PS) in everyday occupations, in the home and in society at large. Methods: A qualitative research approach with focus-group methodology was used. Four focus groups were created, with men and women as well as PW and PS users in different groups. Applying a descriptive approach, data were analysed according to the principles described by Krueger. Findings: Three categories emerged and revealed that even though use of PW and PS increased independence and enabled everyday occupations, participants struggled to be independent powered mobility device (PMD) users. They experienced many accessibility problems in dwellings and in society, described similarly by users of PW and PS. Men and women experienced their use of (PMD) differently, especially in relation to the service delivery process. Conclusions: The study contributes with new knowledge on accessibility for PW and PS users and related service delivery processes, stating that gender differences regarding provision and training must be taken into account. Occupational therapists can contribute to an enhanced understanding of PMD users’ challenges in person–environment–occupation transactions in the home and society, and thereby promote occupational justice for PMD users.

The potential impact of intelligent power wheelchair use on social participation: perspectives of users, caregivers and clinicians

Purpose: To explore power wheelchair users’, caregivers’ and clinicians’ perspectives regarding the potential impact of intelligent power wheelchair use on social participation. Methods: Semi-structured interviews were conducted with power wheelchair users (n = 12), caregivers (n = 4) and clinicians (n = 12). An illustrative video was used to facilitate discussion. The transcribed interviews were analyzed using thematic analysis. Results: Three main themes were identified based on the experiences of the power wheelchair users, caregivers and clinicians: (1) increased social participation opportunities, (2) changing how social participation is experienced and (3) decreased risk of accidents during social participation. Conclusion: Findings from this study suggest that an intelligent power wheelchair would enhance social participation in a variety of important ways, thereby providing support for continued design and development of this assistive technology.Implications for RehabilitationAn intelligent power wheelchair has the potential to:Increase social participation opportunities by overcoming challenges associated with navigating through crowds and small spaces.Change how social participation is experienced through “normalizing” social interactions and decreasing the effort required to drive a power wheelchair.Decrease the risk of accidents during social participation by reducing the need for dangerous compensatory strategies and minimizing the impact of the physical environment.

Power wheelchair driving challenges in the community: a users’ perspective

Purpose: There is limited information on the difficulties individuals experience in manoeuvring their power wheelchairs during daily activities. The aim of this study was to describe the nature and context of power wheelchair driving challenges from the perspective of the user. Methods: A qualitative design using semi-structured interviews with power wheelchair users. Qualitative content analysis was used to identify themes. Results: Twelve experienced power wheelchair users were interviewed. Findings revealed that power wheelchair driving difficulties were related to the accomplishment of activities of daily living, and the influence of environmental context. Four key themes emerged: (1) difficulties accessing and using public buildings-facilities, (2) outdoor mobility, (3) problems in performing specific wheelchair mobility tasks/manoeuvres and (4) barriers and circumstances that are temporary, unforeseen or specific to a particular context. Conclusion: This qualitative study furthers our understanding of the driving difficulties powered wheelchair (PW) users experience during daily activities. This knowledge will assist clinicians and researchers in two areas: in choosing assessment measures that are ecologically valid for power wheelchair users; and, in identifying and refining the content of training programs specific to the use of power wheelchairs.Implications for RehabilitationA better understanding of the everyday challenges individuals experience in driving their power wheelchair will assist clinicians and researchers in:Choosing assessment measures and identifying training programs for this population.Refining the content of power wheelchair training programs.

Exploring Powered Wheelchair Users and Their Caregivers’ Perspectives on Potential Intelligent Power Wheelchair Use: A Qualitative Study

Power wheelchairs (PWCs) can have a positive impact on user well-being, self-esteem, pain, activity and participation. Newly developed intelligent power wheelchairs (IPWs), allowing autonomous or collaboratively-controlled navigation, could enhance mobility of individuals not able to use, or having difficulty using, standard PWCs. The objective of this study was to explore the perspectives of PWC users (PWUs) and their caregivers regarding if and how IPWs could impact on current challenges faced by PWUs, as well as inform current development of IPWs. A qualitative exploratory study using individual interviews was conducted with PWUs (n = 12) and caregivers (n = 4). A semi-structured interview guide and video were used to facilitate informed discussion regarding IPWs. Thematic analysis revealed three main themes: (1) “challenging situations that may be overcome by an IPW” described how the IPW features of obstacle avoidance, path following, and target following could alleviate PWUs’ identified mobility difficulties; (2) “cautious optimism concerning IPW use revealed participants” addresses concerns regarding using an IPW as well as technological suggestions; (3) “defining the potential IPW user” revealed characteristics of PWUs that would benefit from IPW use. Findings indicate how IPW use may help overcome PWC difficulties and confirm the importance of user input in the ongoing development of IPWs.

Performance Metrics for Power Wheelchairs: A Pipe Dream?

Power wheelchair (PWC) users depend on their equipment to reliably transport them throughout daily activities and allow them to participate fully in community life. However, as reported by Worobey and colleagues, PWCs frequently require repairs and cause users a variety of problems, which can range from annoying to catastrophic. These authors suggest that comparing the performance of individual PWC makes and models—a PWC Consumer Reports—might be helpful to inform users and others about the relative quality of different products. Although a comparative report is an appealing idea, we suggest that producing meaningful comparisons of specific PWCs, especially complex rehabilitation PWCs, confronts significant methodologic and practical hurdles. Challenges include dealing with small sample sizes for individual products, risk-adjusting outcomes to account for systematic differences in patterns of use, specifying meaningful outcome metrics, distinguishing the contributions of manufacturers and PWC suppliers to suboptimal performance, and disentangling the myriad components of complex rehabilitation PWCs, which often carry parts from multiple manufacturers. In any case, most users have little control over their PWC selections, with the policies of health insurers and other factors largely dictating equipment choices. Considering these various concerns, we argue that producing a valid and useful Consumer Reports for PWCs will be difficult and, at least for complex rehabilitation chairs, will be of limited value.

Investigation of peak pressure index parameters for people with spinal cord injury using wheelchair tilt-in-space and recline: methodology and preliminary report.

The purpose of this study was to determine the effect of the sensel window's location and size when calculating the peak pressure index (PPI) of pressure mapping with varying degrees of wheelchair tilt-in-space (tilt) and recline in people with spinal cord injury (SCI). Thirteen power wheelchair users were recruited into this study. Six combinations of wheelchair tilt (15°, 25°, and 35°) and recline (10° and 30°) were used by the participants in random order. Displacements of peak pressure and center of pressure were extracted from the left side of the mapping system. Normalized PPI was computed for three sensel window dimensions (3 sensels × 3 sensels, 5 × 5, and 7 × 7). At least 3.33 cm of Euclidean displacement of peak pressures was observed in the tilt and recline. For every tilt angle, peak pressure displacement was not significantly different between 10° and 30° recline, while center of pressure displacement was significantly different (P < .05). For each recline angle, peak pressure displacement was not significantly different between pairs of 15°, 25°, and 35° tilt, while center of pressure displacement was significantly different between 15° versus 35° and 25° versus 35°. Our study showed that peak pressure displacement occurs in response to wheelchair tilt and recline, suggesting that the selected sensel window locations used to calculate PPI should be adjusted during changes in wheelchair configuration.

An interview study for developing a user guide for powered seating function usage

Purpose: Powered seating functions (PSFs) provide powered wheelchair users an independent means to adjust posture dynamically. To facilitate the best use of PSFs in daily living, we conducted this structured interview study to develop a preliminary user guide to provide “take-home” information to powered wheelchair users. Method: An internally developed questionnaire to assess clinical recommendations of PSF usage was administered in an interview format to clinical seating and mobility specialists. A qualitative analysis was applied to codify the recommendations, and the findings were transformed into a PSF user guide. Results: Specific but varied seating positions and temporal indications were recommended for performing pressure relief positioning. For several activities, appropriate seating positions should be determined according to the immediate physical condition of the user and/or the environmental settings. Conclusion: The methods and positions of using PSFs should be determined with consideration for individual preferences, physical condition, environmental setting, and desired tasks after thorough clinical seating assessments. Precautions about positioning and driving safety, and the importance of discussing with clinicians are emphasized in the user guide. This PSF user guide will be updated after more scientific evidence accumulates and be structurally evaluated for its face and content validity in the future.Implications for RehabilitationPowered seating functions (PSFs) can be used to assist with many daily activities and health management.The methods and positions of using PSFs should be determined with consideration for individual preferences, physical condition, environmental setting, and desired tasks after thorough clinical seating assessments.Precautions about driving safety and sitting stability affected by changes in the seating angles should be emphasized in user education and training.

Disparities in Wheelchair Procurement by Payer Among People With Spinal Cord Injury

To identify insurance provider-related disparities in the receipt of lightweight, customizable manual wheelchairs or power wheelchairs with programmable controls among community-dwelling people with spinal cord injury (SCI). Six Spinal Cord Injury Model System centers. A multicenter cross-sectional study. A total of 359 individuals at least 16 years of age or older and 1 year after SCI who use a manual or power wheelchair as their primary means of mobility. The subjects were stratified by payer, and payers were grouped according to reimbursement characteristics as follows: Medicaid/Department of Vocational Rehabilitation (DVR), private/prepaid, Medicare, Worker's Compensation (WC)/Veterans Affairs (VA), and self pay. Demographic, wheelchair, and payer data were collected by medical record review and face-to-face interview. There were 125 participants in the Medicaid/DVR group, 120 in the private/prepaid group, 55 in the Medicare group, 30 in the WC/VA group, and 29 in the self-pay group. For manual wheelchair users, the likelihood of having a lightweight, customizable wheelchair was 97.5% for private/prepaid, 96.3% for Medicaid/DVR, 94.1% for WC/VA, 87.5% for Medicare, and 82.6% for self pay. For power wheelchair users, those with WC/VA (100%) were most likely to receive a customizable power wheelchair with programmable controls, followed by private/prepaid (95.1%), Medicaid/DVR (86.0 %), Medicare (83.9%), and self pay (50.0%). The only payer group for which all beneficiaries received wheelchairs that met standard of care were power wheelchairs provided by WC/VA. Fewer than 90% of people whose manual wheelchair was paid for by Medicare and self pay, and whose power wheelchair was paid for by Medicaid/DVR, Medicare, and self pay did not meet standard ofcare. Although these findings need to be correlated with long-term risks, such as overuse injuries, breakdowns, and participation, this study demonstrates that disparities in wheelchair procurement by insurance provider persist.

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.

Recipients of Electric-Powered Indoor/Outdoor Wheelchairs Provided by a National Health Service: A Cross-Sectional Study

ObjectiveTo describe the characteristics across all ages of powered wheelchair users and the assistive technology prescribed by a regional specialist wheelchair service. DesignCross-sectional study. SettingRegional wheelchair service. ParticipantsElectric-powered indoor/outdoor wheelchair (EPIOC) users (N=544) with 262 boys and men (mean age ± SD, 41.7±20.7y; range, 8–82y) and 282 girls and women (mean age ± SD, 47.2±19.7y; range, 7–92y). InterventionsNot applicable. Main Outcome MeasuresDemographic, clinical/diagnostic details of EPIOC recipients, including pain, (kypho)scoliosis, and ventilators. Technical features, including specialized (adaptive) seating, tilt in space, and modified control systems. Factors were related to age groups: 1 (0–15y), 2 (16–24y), 3 (25–54y), 4 (55–74y), and 5 (≥75y). ResultsNeurologic/neuromuscular conditions predominated (81%) with cerebral palsy (18.9%) and multiple sclerosis (16.4%). Conditions presenting at birth or during childhood constituted 39%. Of the participants, 99 had problematic pain, 83 had (kypho)scoliosis, and 11 used ventilators. Specialized (adaptive) seating was provided to 169 users (31%); most had cerebral palsy or muscular dystrophy. Tilt in space was used by 258 (53%) participants. Younger people were more likely to receive tilt in space than older ones. Only 92 had specialized (adaptive) seating and tilt in space (mean age ± SD, 29±17.8y; range, 8–72y). Of the participants, 52 used modified control systems. ConclusionsThe diversity of EPIOC users across age and diagnostic groups is shown. Their complex interrelations with these technical features of EPIOC prescriptions are explored. Younger users were more complex because of age-related changes. This study provides outcomes of the EPIOC prescription for this heterogeneous group of very severely disabled people.

Reliability and validity of the French-Canadian Late Life Function and Disability Instrument in community-living wheelchair-users

Objective: To examine the test–retest reliability, standard error of measurement, minimal detectable change, construct validity, and ceiling and floor effects in the French-Canadian Late Life Function and Disability Instrument (LLFDI-F). Method: The LLFDI-F is a measure of activity (i.e. physical functioning of upper and lower extremities), and participation (i.e. frequency of and limitations with). The measure was administered over the telephone to a sample of community-living wheelchair-users, who were 50 years of age and older, in this 10-day retest methodological study. The sample (n = 40) was mostly male (70%), had a mean age of 62.2 years, and mean experience with using a wheelchair of 20.2 years. Sixty-five percent used a manual wheelchair. Results: The test–retest intraclass correlation coefficients (ICC2,1) for the participation component ranged from 0.68 to 0.90 and from 0.74 to 0.97 for the activity component. Minimal detectable changes ranged from 7.18 to 22.56 in the participation component and from 4.71 to 16.19 in the activity component. Mann–Whitney U-tests revealed significant differences between manual and power wheelchair-users in the personal and instrumental role domains, and all areas in the activity component. Conclusion: There is support for the test–retest reliability and construct validity of the LLFDI-F in community-living wheelchair-users, 50 years of age and older. However, because the majority of items in the lower-extremity domains of the activity component do not account for assistive device use, they are not recommended for use with individuals who have little or no use of their lower-extremities.