Wheelchair Use Research Articles

The incidence, risk factors, and outcomes of symptomatic avascular necrosis of bone among Chinese pediatric patients with acute lymphoblastic leukemia

Avascular necrosis (AVN) of bone is a debilitating complication of pediatric patients with acute lymphoblastic leukemia (ALL). While it is extensively studied and reported in Western population, studies focused on Orientals are limited. This study aims to evaluate the incidence, risk factors, and clinical outcomes of AVN among Chinese children with ALL. This study is a retrospective, territory-wide population-based cohort study of pediatric patients with ALL enrolled on one of the three consecutive ALL study protocols (ALL-IC-BFM 2002, CCLG-ALL 2008, and CCCG-ALL 2015). A total of 24 out of 533 pediatric subjects with ALL (4.5%) had symptomatic AVN. Age was the single most important risk factor associated with the development of AVN. Only three patients were below age of 10 at the time of diagnosis of ALL. The incidences of AVN in patients aged above and below 10 years were 18.2% ± 3.6% and 0.8% ± 0.5%, respectively, and were significantly different (p < 0.005). Treatment protocol, immunophenotype, and gender were not predictive of AVN. Among the 24 patients, five required orthopedic interventions in view of progressive and severe disease. For subjects with hip joints involvement, follow-up assessments showed 12 of 22 hip joints had radiological progression over a median duration of 3.63 years. Seventeen of them did not have pain at the latest follow-up and among patients with pain (n=7), five did not experience any limitation on activities of daily living while two required use of walking aids or wheelchair. The incidence of symptomatic AVN in Chinese ALL patients was comparable to other studies in Western population. Adolescent age more than 10 years old was recognized to be the most important factor for development of AVN. Significant proportion of patients had radiological progression over time with a small percentage of subjects had daily activities affected.

Steering-by-leaning: Feasibility of Utilising Dynamic Backrests to Control Steering in Manual Wheelchairs

Steering-by-leaning is a promising innovation for manual wheelchairs. It may enable improved energy efficiency, one-handed manoeuvrability, and increased trunk activity during wheelchair use in daily life. To explore the feasibility of this concept, the lateral trunk function of active wheelchair users was assessed before comparing 3 preliminary dynamic backrest designs in a virtual steering exercise. Repeated measures, cross-over study. A convenience sample of 15 individuals who had been full-time users of manual wheelchair for at least 1 year. Active core strength and lateral leaning range of motion were captured while sitting freely. Participants subsequently tested 3 dynamic wheelchair backrest designs on an individually adjusted laboratory wheelchair prototype by performing a virtual steering exercise. Deviations from a target movement path were analysed using repeated measures analysis of variance and Pearson correlation coefficients. Functional leaning range of motion ranged from below 10° to almost 70°, but increased significantly with use of the simplest backrest design based on a 2-dimensional hinge joint. No correlation was found between functional levels and performance parameters in the virtual steering exercise. Using an individually fitted and calibrated design, upper body-actuated wheelchair steering using a laterally tilting backrest is accessible to wheelchair users across a wide spectrum of physical abilities.

A Goal-Directed Program for Wheelchair Use for Children and Young People with Cerebral Palsy in Uganda: An Explorative Intervention Study

In this exploratory study, we investigate whether goal-directed intervention for wheelchairs can increase the activities of daily living for children and young people with cerebral palsy (CP) when implemented in rural Uganda. Thirty-two children and young people with CP (aged 3-18 years) participated in a home-visit intervention program, which included donating wheelchairs and setting individual goals. Goal achievement, frequency of wheelchair use, condition of wheelchairs, and caregivers' perspectives were collected by interviews at 6-10 month after the start of intervention and the after three years. Our result show that most wheelchairs were in good condition and frequently used after 6-10 month with 83% goal achievement (132/158 goals; mean 4.3 (range 0-7). The caregivers reported several advantages (e.g., the child being happier) and few disadvantages (e.g., poor design and durability). At the three-year follow-up, only eleven wheelchairs were still used by 23 available participants (seven deceased and two moved). The children achieved 60% of their goals (32/53 goals mean 2.9; range 1-5). This demonstrates that the goal-directed intervention program for wheelchairs can be successfully implemented in a low-income setting with a high rate of goal achievement and frequent wheelchair use, facilitating participation. However, maintenance services are crucial to obtain sustainable results.

Is the figure-8 fatigue protocol a suitable tool to investigate shoulder muscle fatigue in wheelchair users with spinal cord injury?

Introduction&#x0D; Shoulder pain is common in persons with spinal cord injury (SCI) and has been associated with wheelchair use. Previous studies identified fatigue related compensation strategies that could impact the development of shoulder injury and pain (Bossuyt et al., 2020). The aim of this study was to determine the presence of performance and perceived fatigability during a figure-8 fatigue protocol (F8F; Collinger et al., 2010) and thereby validate the protocols suitability to assess fatigue in wheelchair users with SCI.&#x0D; Methods&#x0D; Wheelchair users with paraplegia (N = 43, age = 50.2 ±10.1 years, body weight = 72.1 ±13.3 kg, time since injury = 27.1 ±11.6 years) completed a F8F introduced by Collinger et al. (2010). The F8F consists of 3 bouts of 4 minutes maximum voluntary propulsion including turns and full stops with 90 seconds of rest between the bouts thereby simulating wheelchair propulsion during daily life. The surface EMG signal of the biceps brachii, pectoralis major (pars sternalis), deltoideus pars acromialis, lower and upper trapezius of the non-dominant shoulder was recorded. To analyse performance fatigability, root mean square (RMS) (expected to increase with fatigue) of the five muscles was calculated with a short-time Fourier transformation. RMS means were normalised to the starting RMS values. In addition, heart rate (HR) was measured using a heart rate monitor. To analyse perceived fatigability, rate of perceived exertion (RPE) was captured with a 20-point Borg scale. A one-way repeated measure ANOVA was used to analyse changes in the dependent variables RMS, HR and RPE over time (α = 0.05). Correlation coefficients (Spearman- or Pearson-Test) between changes in HR, RPE and RMS of muscles with significant effects for time, were calculated.&#x0D; Results and Discussion&#x0D; RPE as well as HR and RMS of pectoralis major and upper trapezius showed the expected increases at the end of the demanding parts of the protocol. The changes in RMS demonstrate a shift in the power of the EMG signal indicating fatigue. The presence of fatigue in only a subset of the muscles may lead to muscular imbalances and over time induce injury and/or pain. Weak to moderate correlations were found between changes in HR and RPE as well as between changes in RMS of pectoralis major and RMS of upper trapezius. The correlation of changes in HR and RPE further demonstrates the association of more global measures of performance and perceived fatigability. Nevertheless, these global measures of fatiguability did not correlate with the changes in RMS, a local measure of performance fatiguability. The lack of association between global and local parameters demonstrates the importance of recording local parameters like RMS and suggests the integration of local RPE-scores for future research. Exercise programs targeting the trapezius and pectoralis major may have a role in preventing fatigue during wheelchair propulsion.&#x0D; Conclusions&#x0D; The detected changes in markers of performance and perceived fatigability support F8F as an adequate choice to evaluate the effect of wheelchair propulsion induced fatigue in wheelchair users with paraplegia. Furthermore, these findings support the value of investigating biomechanical changes during fatiguing wheelchair propulsion that resembles daily life activities, when the neuromuscular system is prone to adaptations, as it may give us further insights into the development of shoulder injury and pain.&#x0D; References&#x0D; Bossuyt, F. M., Arnet, U., Cools, A., Rigot, S., de Vries, W., Eriks-Hoogland, I., Boninger, M. L., &amp; Group, S. S. (2020). Compensation strategies in response to fatiguing propulsion in wheelchair users: Implications for shoulder injury risk. American Journal of Physical Medicine &amp; Rehabilitation, 99(2), 91-98. https://doi.org/10.1097/PHM.0000000000001267&#x0D; Collinger, J. L., Impink, B. G., Ozawa, H., &amp; Boninger, M. L. (2010). Effect of an intense wheelchair propulsion task on quantitative ultrasound of shoulder tendons. PM&amp;R, 2(10), 920-925. https://doi.org/10.1016/j.pmrj.2010.06.007

Shoulder pain in persons with tetraplegia and the association with force application during manual wheelchair propulsion

Introduction&#x0D; Shoulder pain is highly prevalent in persons with spinal cord injury (Liampas et al., 2021) and restricts daily mobility and thus participation and quality of life. Shoulder loading activities, such as manual wheelchair propulsion or transfers, are seen as risk factors for shoulder pain. To minimize the risk for shoulder pain, clinical guidelines instruct persons with spinal cord injury to “use long, smooth strokes that limit high impacts on the pushrim”. Findings supporting this recommendation have been found for persons with paraplegia (Beirens et al., 2021). However, dependent on their lesion level, persons with tetraplegia do not have, full triceps function and are not able to grasp the hand rim properly, which will alter force application and may further impact shoulder pain. The aim of this study was to investigate the association between wheelchair propulsion biomechanics, including force application and spatio-temporal characteristics, and shoulder pain in persons with tetraplegia.&#x0D; Methods&#x0D; Sixteen community-dwelling, wheelchair dependent participants with tetraplegia (C7-C5, age 49.1 ±2.9 years, 23.4 ±2.4 years since injury, 94% male) were measured during wheelchair propulsion on a treadmill at two speed / power output conditions: 0.56 ms-1/10W and 0.83 ms-1/15W. A Smartwheel was fitted to the personal wheelchair to measure force application. The applied forces, their effectiveness (fraction of effective force) and smoothness (rate of rise of force, jerk), as well as push frequency, push angle and timing of the push cycles were analyzed. Based on the Wheelchair User Shoulder Pain Index (0-150), participants were stratified in groups with low (≤ 7), moderate (8-35) and high (≥ 36) shoulder pain. A mixed-effect multilevel analysis was used to identify the association between the dependent variables (propulsion biomechanics) and group of shoulder pain when controlling for sex, age, time since injury, lesion level, body weight and height.&#x0D; Results and Discussion&#x0D; The analysis showed that persons with high shoulder pain applied the force over a longer push angle (85.6°) and had a shorter recovery time (0.4s) and applied the force more effective (FEF = 40.7%) than persons with low pain (push angle = 81.2°, recovery time = 0.5s, FEF = 35.2%). In addition, persons with high shoulder pain applied less medial directed force (6.4 N) compared to persons with moderate pain (14.9 N). The results of this cross-sectional study on wheelchair propulsion in persons with tetraplegia are in contradiction to previously reported results in person with paraplegia (Beirens et al., 2021). Interestingly, tetraplegic persons with high shoulder pain are following clinical recommendation on how to propel the wheelchair optimally. These results support the importance of differentiating between lesions levels when further investigating force application as a risk factor for shoulder pain. In addition, the results ask for a close examination and possible adaptation of the clinical guidelines for persons with tetraplegia.&#x0D; References&#x0D; Beirens, B. J. H., Bossuyt, F. M., Arnet, U., van der Woude, L. H. V., &amp; de Vries, W. H. K. (2021). Shoulder pain is associated with rate of rise and jerk of the applied forces during wheelchair propulsion in individuals with paraplegic spinal cord injury. Archives of Physical Medicine and Rehabilitation, 102(5), 856-864. https://doi.org/10.1016/j.apmr.2020.10.114&#x0D; Liampas, A., Neophytou, P., Sokratous, M., Varrassi, G., Ioannou, C., Hadjigeorgiou, G. M., &amp; Zis, P. (2021). Musculoskeletal pain due to wheelchair use: A systematic review and meta-analysis. Pain and Therapy, 10, 973-984. https://doi.org/10.1007/s40122-021-00294-5

Comparison of Fractures Among Older Adults Who Are Ambulatory vs Those Who Use Wheelchairs in Sweden

Several diseases and conditions, such as cerebrovascular disease, arthritis, previous fractures, neurological diseases, or amputation, can result in severe immobility justifying wheelchair use for increased mobility. Immobility results in disuse osteoporosis and is considered a risk factor for fracture, although there are no large cohort studies that have investigated fracture risk in patients who use wheelchairs compared with an ambulatory control group. To investigate whether immobilized adults who used wheelchairs had a different risk of fracture and injurious falls compared with matched ambulatory controls. This retrospective cohort study compared patients who used wheelchairs and controls (propensity score matched 1:1 using 22 variables relating to anthropometrics, general condition, comorbidity, and fall and fracture risk), identified through a national database of adults 65 years or older who underwent a health evaluation (baseline) at Swedish health care facilities. Patients were followed up from January 1, 2007, to December 31, 2017, and data analysis was performed between June 1 and 30, 2022. Incident fracture, injurious falls without fracture, and deaths. A total of 55 442 adults using wheelchairs were included in the analysis (mean [SD] age, 83.2 [8.3] years; 60.5% women). Those who used wheelchairs and the 55 442 matched controls were followed up for a median of 2.0 (IQR, 0.5-3.2) and 2.3 (IQR, 0.8-3.6) years, respectively. Patients who used wheelchairs had a lower risk of any fracture (hazard ratio [HR], 0.43 [95% CI, 0.41-0.44]), major osteoporotic fracture (HR, 0.32 [95% CI, 0.31-0.33]), and hip fracture (HR, 0.30 [95% CI, 0.28-0.32]) compared with the ambulatory controls, associations that were only marginally affected by multivariable (same as the matching variables) adjustment. The risk of fall injury was lower among those who used wheelchairs than among ambulatory controls (unadjusted HR for Cox proportional hazards models, 0.48 [95% CI, 0.47-0.50]) and remained highly similar after adjustments. Patients who used wheelchairs had a significantly increased risk of death (HR, 1.35 [95% CI, 1.33-1.36]) compared with controls. Association between wheelchair use and fracture outcomes and injurious falls, calculated using a Fine and Gray model with death as a competing risk, was similar to associations obtained using Cox proportional hazards regression for all fracture outcomes. In this retrospective cohort study of older adults, wheelchair use was associated with a lower risk of fracture than observed in ambulatory controls. These findings suggest that immobility associated with wheelchair use should not be considered a risk factor for fracture.

A review on wheelchair and add-in devices design for the disabled

Owing to rapidly aging populations and rising road accidents, the daily use of wheelchairs, which has become necessary to aid mobility for the disabled, is growing globally. The patients with spinal cord injuries, cerebral palsy, and those inflicted with seizures need a wheelchair. The authors expect that the information gathered within this research will enhance the understanding of modern-day wheelchair requirements. This article presents the global research campaign, starting with a debut to the wheelchair and the communities they serve. Technological inventions focus on probably the most researched regions, creating one of the most interesting future research and development. This article reviews the role of wheelchairs for different disabilities by examining its respective merits and demerits. It highlights the gap between the associated technological features and capabilities, including the navigation and motion control methods, pros and cons of indoor-outdoor navigation on different surfaces such as standard, sandy, muddy and hilly terrain when using a wheelchair. Concerns related to the improvement the living conditions of the disabled have been concluded.

노인 뇌졸중 환자의 단속성 안구운동, 일상생활 수행능력 및 인지기능의 상관성

This study aimed to analyze the correlation between saccadic eye movement, activities of daily living, and cognitive function in elderly patients with stroke, that could help establish interventions in clinical settings.&#x0D; This study included 32 elderly patients with stroke who were admitted to a medical center. The King-Devick test (K-D test), Korean version of the Modified Barthel Index (K-MBI), and Korean version of the Montreal Cognitive Assessment (MoCA-K) were used as evaluation tools. The correlation between evaluation scores was analyzed using Pearson’s correlation coefficient.&#x0D; The correlations between the total scores of the K-D test, K-MBI, and MoCA-K were statistically significant (p&lt;0.01).&#x0D; In addition, the K-D test showed statistically significant correlations with personal hygiene, bathing, feeding, toilet, stair climbing, dressing, chair/bed transfer, ambulation, and wheelchair use in the K-MBI and visuospatial/executive, naming, delayed recall, and orientation in the MoCA-K.&#x0D; This study showed a correlation between saccadic eye movement, activities of daily living, and cognitive function in elderly patients with stroke. In the future, such studies with larger sample would help to establish interventions in clinical settings.

Age-based risk of end-stage kidney disease in patients with myelomeningocele

We aimed to quantify end-stage kidney disease (ESKD) risk after infancy in individuals with myelomeningocele (MMC) followed by urology in the modern medical era and to assess if ESKD risk was higher after surgery related to a hostile bladder. We retrospectively reviewed patients with MMC followed by urology at our institution born≥1972 (when clean intermittent catheterization was introduced) past 1 year of age (when mortality is highest, sometimes before establishing urology care). ESKD was defined as requiring permanent peritoneal/hemodialysis or renal transplantation. Early surgery related to hostile bladder included incontinent vesicostomy, bladder augmentation, detrusor Botulinum A toxin injection, ureteral reimplantation, or nephrectomy for recurrent urinary tract infections. Survival analysis and proportional hazards regression were used. Sensitivity analyses included: risk factor analysis with only vesicostomy, timing of surgery, including the entire population without minimal follow-up (n=1054) and only patients with≥5 years of follow-up (n=925). Overall, 1029 patients with MMC were followed for a median of 17.0 years (49% female, 76% shunted). Seven patients (0.7%) developed ESKD at a median 24.3 years old (5 hemodialysis, 1 peritoneal dialysis, 1 transplantation). On survival analysis, the ESKD risk was 0.3% at 20 years old and 2.1% at 30 years old (Figure). This was ∼100 times higher than the general population (0.003% by 21 years old, p<0.001). Patients who underwent early surgery for hostile bladder had higher ESKD risk (HR 8.3, p=0.001, 6% vs. 1.5% at 30 years). On exploratory analyses, gender, birth year, shunt status and wheelchair use were not associated with ESKD risk (p≥0.16). Thirty-year ESKD risk was 10% after early vesicostomy vs. 1.4% among children without one (p=0.001). Children undergoing bladder surgery between 1.5 and 5 years old had a higher risk of ESKD. No other statistically/clinically significant differences were noted. Patients with MMC remain at risk of progressive renal damage throughout life. We relied on the final binary ESKD outcome to quantify this risk, rather than imprecise glomerular filtration rate formulas. Analysis was limited by few people developing ESKD, inconsistent documentation of early urodynamic findings and indications for bladder-related surgery. While ESKD is relatively uncommon in the MMC population receiving routine urological care, affecting 2.1% of individuals in the first 3 decades, it is significantly higher than the general population. Children with poor bladder function are likely at high risk, underlining the need for routine urological care, particularly in adulthood.

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

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

Characterizing the Occurrence of Key Clinical Milestones in Duchenne Muscular Dystrophy in the United States Using Real-World Data.

Data on the clinical course of Duchenne muscular dystrophy (DMD) exist from well-characterized clinical cohorts but estimates from real-world populations are fewer. The objective was to estimate the prevalence of key clinical milestones by age, among real-world commercially-insured DMD patients in the United States. MarketScan claims (2013-2018) were used to identify males with DMD. The percentages with wheelchair use or experiencing scoliosis, neurologic/neuropsychiatric involvement, cardiomyopathy, and respiratory involvement were tabulated; as were the median (interquartile range [IQR]) ages at first observed occurrence within the claims data. Among DMD patients (n = 1,964), the median (IQR) baseline age was 15 (9-21) years, and median follow-up was 1.7 years. Wheelchair use was observed in 55% of those aged 8 to 13 years at cohort entry; scoliosis, among 38% of those 8 to 10 and 52% of those 11 to 13 years; neurologic/neuropsychiatric involvement, among 41-43% of those 8 to 13 years; respiratory involvement, among 45% of those 14 to 19 years; and cardiomyopathy, among 68% of those 14 to 16 and 58% of those 17 to 19 years. The prevalence of key clinical milestones across ages was broadly consistent with published findings. Variability in estimates reflect clinical heterogeneity; these contemporary estimates from real-world data help characterize clinical outcomes in DMD.

Impact of early mobilization on the duration of delirium in elderly hospitalized patients: A retrospective cohort pilot study.

Development of delirium during hospitalization impairs the activities of daily living in elderly hospitalized patients. In clinical practice, early mobilization from bed is recommended to reduce delirium incidence and hospitalization stay. However, the effects of early mobilization on elderly inpatients with delirium have not been established yet. The aim of this study was to investigate the association between early mobilization and the duration of delirium in elderly inpatients with delirium. This retrospective cohort pilot study examined 45 participants (23 males, 22 females; mean age: 84.5 ± 6.6 years), who developed delirium during hospitalization. Of the participants, 28 were surgically treated and 17 were non-surgically treated. We classified early or delayed mobilization based on the median number of days until the start of mobilization and compared after propensity score matching to adjust for baseline characteristics. Additionally, we examined the correlation between the number of days until the start of mobilization and the duration of delirium. The duration of delirium was significantly shorter in the early mobilization group, particularly in terms of sitting on the bed and wheelchair use than that in the delayed mobilization group {median: 4.0 [interquartile range (IQR): 2.0-6.0] vs 8.0 [IQR: 7.0-14.5] days, P = .013; median: 3.0 [IQR: 2.0-5.5] vs 11.0 [IQR: 7.5-14.5] days, P = .004, respectively}. Moreover, the duration of delirium significantly positively moderate correlated with the time until the start of sitting on the bed and wheelchair use (Spearman r = 0.527; P = .012, Spearman r = 0.630; P = .002, respectively). The results of this study suggest that early mobilization from sitting on the bed or wheelchair use after hospitalization or surgery may shorten the duration of delirium. Because the sample size of this pilot study is small, careful interpretation is needed, and further research is warranted.

Effect of power-assistance on upper limb biomechanical and physiological variables during a 6-minute, manual wheelchair propulsion test: a randomised, cross-over study

Purpose Use of a power-assistance wheelchair could reduce the risk of musculoskeletal disorders (MSDs), however, a comprehensive biomechanical evaluation of these systems has not been carried out. This study aimed to evaluate and compare biomechanical UL propulsion variables, and physiological exercise-related variables during the use of a wheelchair with rear drive power assist device (RD-PAD) and a standard manual wheelchair (MW). Materials and methods Twenty-two adults with spinal cord injury were recruited. RD-PAD (SmartDrive system) was fitted to their own MW. An instrumented wheel was used to measure handrim forces, and gas exchange and heart rate were monitored. Participants performed repeated out and back runs for 6 min on a straight outdoor course. Results Distance covered was significantly greater with the RD-PAD (538 ± 104 m versus 470 ± 124 m). Peak mechanical effort during the propulsion phase was significantly lower with the RD-PAD (p < 0.001). Heart rate, metabolic equivalent of task (MET), tidal volume, minute volume, oxygen consumption, and peak oxygen consumption were all significantly lower with the RD-PAD (p < 0.001). Conclusions The results showed that use of RD-PAD increased the distance covered by MW users and reduced the energy costs of propulsion. The biomechanical results indirectly suggest that RD-PAD may reduce the risk of MSD. Implications for Rehabilitation Using the SmartDrive system as propulsion assistance increases the travel autonomy. The SmartDrive system reduces the biomechanical constraints propelling the wheelchair on a slope and low slope. SmartDrive the system reduces the physiological solicitation related to the propulsion of wheelchair.

Analyzing the Impact of Multimorbidity on Long-Term Outcomes after Emergency General Surgery

INTRODUCTION: Many older patients with multiple comorbidities require emergency general surgery (EGS). Little is known about the impact of specific combinations of comorbidities (ie multimorbidity) on long-term outcomes for older EGS patients. METHODS: Medicare beneficiaries age 65 and older who presented to an acute care hospital and underwent EGS were identified using Medicare claims data (100% sample, 2015 to -2018). Patients were classified as multimorbid based on the presence of a Qualifying Comorbidity Set (a specific combination of comorbid conditions associated with increased risk of in-hospital mortality after general surgery) and compared with those without multimorbidity. Risk-adjusted outcomes through 180 days after discharge from index hospitalization were calculated using mixed-effects linear and logistic regression. RESULTS: Of 174,891 patients, 48.4% were identified as multimorbid. Multimorbid patients had higher rate of mortality and readmission through 180 days and higher rate of discharge to a rehabilitation/nursing facility or hospice (see Table). Compared with nonmultimorbid patients, multimorbid patients experienced longer index hospitalization (1.4 additional days, p < 0.001), higher cost through 180 days ($5,324 additional, p < 0.001), and greater than double the use of home oxygen (3.6% vs 1%, p < 0.001), walker (11.4% vs 4.2%, p < 0.001), wheelchair (1.9% vs 0.3%, p < 0.001), bedside commode (3.6% vs 1.1%, p < 0.001), and hospital bed (1.2% vs 0.2%, p < 0.001). Table. - Unadjusted and Adjusted Outcomes for Multimorbid and Nonmultimorbid Patients Outcomes metric Unadjusted proportion of multimorbid patients Unadjusted proportion of nonmultimorbid patients Adjusted odds ratio comparing multimorbid with nonmultimorbid patients p Value Died in hospital 5.8% 0.5% 3.75 <0.001 Died within 30 d 9.2% 1.2% 3.09 <0.001 Died within 90 d 13.5% 2.1% 2.7 <0.001 Died within 180 d 16.7% 3.1% 2.48 <0.001 Readmitted within 30 d 21.7% 10.9% 1.54 <0.001 Readmitted within 90 d 35.1% 13.2% 1.52 <0.001 Readmitted within 180 d 33.3% 15.3% 1.5 <0.001 Discharged to rehabilitation or nursing facility 29.7% 10.7% 1.72 <0.001 Discharged to hospice 2.2% 0.3% 2.6 <0.001 CONCLUSION: Among older patients, multimorbid patients experience worse outcomes after EGS than nonmultimorbid patients. Beyond survival, multimorbid patients experience greater loss of independence. This information is important for setting recovery expectations for high-risk patients to improve shared decision making.

Folic acid fortification of flour to prevent neural tube defects in Europe – A position statement by the European Board and college of obstetrics and gynaecology (EBCOG)

Neural tube defects are disabling birth defects developing during the very early stages of conception. Children born with spina bifida face significant physical, psychological and social consequences. They may have bowel and urinary dysfunction, and no lower limb muscle control, resulting in lifelong wheelchair use. There is robust evidence that periconceptual folic acid supplementation prevents neural tube defects, when compared with no intervention. However, approximately 40% pregnancies in Europe are unplanned, and women may therefore not be taking prophylactic folic acid at the time of conception. There is evidence that low dose folic acid consumption via flour fortification provides further benefits in prevention of neural tube defects.

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

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

Exploring the Influence of a Community-Based Peer-Led Wheelchair Skills Training on Satisfaction with Participation in Children and Adolescents with Cerebral Palsy and Spina Bifida: A Pilot Study.

Background: Peer-led approaches improve satisfaction with participation, wheelchair skills and wheelchair use self-efficacy in adults, but the evidence is limited in children. This pilot study aimed to explore the influence of community-based, peer-led, group wheelchair training program (i.e., Seating To Go) on satisfaction with participation (primary outcome), wheelchair skills, and wheelchair use self-efficacy in children and adolescents with cerebral palsy and spina bifida. Methods: A single group pre-post design was used. Invitations were shared online and diffused by clinicians and advocacy and provider groups to recruit a convenience sample of eight pediatric wheelchair users. Participants completed the Seating To Go program in groups that were facilitated by adult wheelchair users. Satisfaction with participation (Wheelchair Outcome Measure-Young People), wheelchair skills (Wheelchair Skills Test), wheelchair use self-efficacy (Wheelchair Use Confidence Scale), and perceived wheelchair skills capacity (Wheelchair Skills Test Questionnaire; proxy rating: parents) were evaluated before and after the Seating To Go program. Descriptive statistics and nonparametric longitudinal data analysis were conducted to explore changes in all outcomes from baseline to post-intervention. Results: Pediatric wheelchair users (ranging in age from 5 to 15 years) and their parents reported statistically significant improvements in satisfaction with participation. The improvements in wheelchair skills and wheelchair confidence were also statistically significant, but not the parents’ perception of their children’s wheelchair skills. Conclusions: A community-based peer-led approach to wheelchair skills training seems promising for improving wheelchair outcomes in pediatric wheelchair users. Further controlled studies with larger samples are warranted.

The Hidden Risk of Wheelchair Use

Not knowing how to unfold or even sit in a wheelchair the right way can cause a catastrophic injury to patients, visitors, volunteers, and staff of a healthcare facility. Wheelchairs are one of the most common assistive devices used in healthcare facilities, from admission to discharge. They are often found at the entrance of a facility for use by both patients and visitors with mobility issues. Hospital volunteers, transport staff, and clinical staff use wheelchairs to take patients to different care areas to have tests performed. Many facilities require that patients be transported in a wheelchair upon discharge. However, not knowing the proper method of unfolding a wheelchair or where to place your hands when sitting down in the seat can cause injuries, specifically to fingers, ranging from lacerations to amputations. An analysis of reports from the Pennsylvania Patient Safety Reporting System (PA-PSRS*) over the past decade identified 12 adverse events related to finger injuries involving wheelchairs in both inpatient and outpatient settings. Additionally, the U.S. Food and Drug Administration’s Manufacturer and User Facility Device Experience (MAUDE) reporting system, which “houses medical device reports submitted to the FDA by mandatory reporters (manufacturers, importers and device user facilities) and voluntary reporters such as health care professionals, patients and consumers,” contains hundreds of reports involving wheelchair injuries dating back to 2012. These reports indicate different kinds of wheelchairs (e.g., manual, bariatric, transport, and motorized) from myriad manufacturers are associated with these injuries. Although the type of injury and mechanism of injury reported varies from a head injury sustained from tipping over the wheelchair to a laceration from a screw, numerous reports of adverse events involved finger injuries, which are the focus of this safety announcement.

Illness Perceptions and Illness Identity in Adolescents and Emerging Adults With Neuromuscular Disorders.

Neuromuscular disorders (NMD) are intrusive medical conditions with implications for psychosocial development. This paper explores illness perceptions and illness identity dimensions of youth with NMD. First, we compare illness identity outcomes and illness perceptions of NMD patients with a comparison group of adolescents with type 1 diabetes mellitus (DM). Second, we report about the relationships between NMD-related variables and illness perceptions and illness identity. Scores on the Brief Illness Perception Questionnaire and the Illness Identity Questionnaire were compared between a group of NMD patients (N = 59; 12-22years) and an age- and gender-matched group of DM patients (N = 118). NMD-related variables included time since diagnosis, prognosis, wheelchair use, and physical limitations. Youth with NMD scored significantly higher on two of the four illness identity dimensions than youth with DM. NMD patients reported significantly less positive illness perceptions, experienced more physical symptoms, and had a lower score on understanding of their illness. Within the NMD group, wheelchair-users have a better understanding of their disease than those who are not wheelchair-bound. The present study is the first to investigate illness identity and illness perceptions in NMD. More research is needed to provide insight in the identity formation process of the growing group of adolescents with NMDs.

Outcomes and Health Care Service Use in Adults 50 Years or Older With and Without Multiple Sclerosis: A 6-Year Observational Analysis.

Multiple sclerosis (MS) typically presents in young adulthood. Recent data show the highest prevalence of MS in people aged 55 to 64 years; however, there are limited studies of this population. Administrative US claims data from IBM-Truven MarketScan commercial and Medicare databases (2011-2017) were analyzed. People with MS 50 years or older were assigned to the aging MS cohort (n = 10,746). The matched controls were people 50 years or older without MS (n = 10,746). Multivariable models compared outcomes between groups. Infections were more frequent in the aging MS cohort vs matched controls (61% vs 45%; P < .0001); urinary tract, acute upper respiratory tract, and herpes zoster were the most frequent infection types. Malignancy rates were 20% for both groups (P = .8167); skin, breast, and prostate malignancies were the most frequent types. Skilled nursing facilities (aging MS cohort, 12%; matched controls, 3%; P < .0001) and MRI (aging MS cohort, 87%; matched controls, 37%; P < .0001) were used more frequently in the aging MS cohort; brain and spine were the most frequent types of MRI in the aging MS cohort. Time to first cane/walker or wheelchair use was shorter in the aging MS cohort (cane/walker use: HR, 2.1; 95% CI, 1.9-2.3; P < .0001; wheelchair use: HR, 6.9; 95% CI, 6.0-8.1; P < .0001). In people 50 years or older, measures typically associated with worse health primarily resulted from having MS rather than being a consequence of aging alone.