Wheelchair Circuit Research Articles

Handgrip Strength Cutoff Points for Functional Independence and Wheelchair Ability in Men With Spinal Cord Injury.

To determine optimal handgrip strength (HGS) cutoff points for greater functional independence and wheelchair skills in men with spinal cord injury (SCI), and to establish predictive equations for functional independence and wheelchair ability in men with SCI, based on demographic characteristics, HGS, and functionality. In this cross-sectional study conducted at a rehabilitation hospital, 54 men with SCI were recruited and stratified into high and low paraplegia groups. All participants performed a maximum HGS test to determine cutoff points for the Spinal Cord Independence Measure (SCIM-III) and Adapted Manual Wheelchair Circuit (AMWC). The primary outcomes were the SCIM-III, AMWC, and HGS. Demographic characteristics obtained from participants' electronic medical records were the secondary outcomes, used as predictor variables of functional independence. The SCIM-III scale, performance score, and 3-minute overground wheeling test presented significant regression equations (R = 0.45, R = 0.69, and R = 0.72). The HGS showed a cutoff point of 102.5 kilogram force (kgf) to achieve a score of 70 on the SCIM-III and a 3-minute overground wheeling distance of 270 m. The HGS cutoff point to obtain a performance score of 23.7 seconds was 93.0 kgf. The HGS was a significant predictor for the SCIM-III score, AMWC performance score, and 3-minute overground wheeling test. Three significant predictive equations were established based on HGS. The cutoff points could be adopted as parameters for optimal functional independence and wheelchair skills.

Muscle Strength Cutoff Points for Functional Independence and Wheelchair Ability in Men With Spinal Cord Injury

ObjectiveDetermine trunk and shoulder muscle strength cutoff points for functional independence and wheelchair skills, and verify the predictive capacity of relative and absolute peak torque in men with spinal cord injury (SCI). DesignCross-sectional study. SettingRehabilitation hospital setting. ParticipantsMen (N=54) with SCI were recruited and stratified into high and low paraplegia groups. InterventionsAll participants performed maximum strength tests for shoulder abduction or adduction (isokinetic) and trunk flexion or extension (isometric) to determine relative and absolute peak torque cutoff points for the Spinal Cord Independence Measure version III (SCIM-III) and Adapted Manual Wheelchair Circuit (AMWC). Main outcome measuresThe primary outcome measures were SCIM-III, AMWC-Brazil test, and strength variables (peak torques). Demographic characteristics obtained from participants’ electronic medical records were the secondary outcomes used as predictor variables of functional independence. ResultsThe best predictive model for SCIM-III (R=0.78, P≤.05) used the sum of trunk flexion and extension relative peak torque values to determine the cutoff points (1.42 N·m/kg for a score of 70). Relative shoulder abduction peak torque was used in the predictive models for AMWC outcomes: performance score (R=0.77, P≤.05, cutoff points of 0.97 N·m/kg for 300.0m) and 3-minute overground wheeling (R=0.72, P≤.05, cutoff points of 0.96 N·m/kg for 18.5s). ConclusionsRelative peak torque showed better predictive capacity compared to absolute peak torque. Cutoff points were established for relative muscle strength and could help health professionals set appropriate goals for individuals with SCI to achieve high functional independence and wheelchair ability.

Motor learning outcomes of handrim wheelchair propulsion during active spinal cord injury rehabilitation in comparison with experienced wheelchair users

Purpose To investigate changes in wheelchair propulsion technique and mechanical efficiency across first five weeks of active inpatient spinal cord injury rehabilitation and to compare the outcomes at discharge with experienced wheelchair users with spinal cord injury. Methods Eight individuals with recent spinal cord injury performed six weekly submaximal exercise tests. The first and last measurement additionally contained a wheelchair circuit and peak graded exercise test. Fifteen experienced individuals performed all above-mentioned tests on one occasion. Results Mechanical efficiency and propulsion technique did not change during the five weeks of inpatient rehabilitation. Peak power output during peak graded test and performance time on the wheelchair circuit improved between the first and the last week. No difference in propulsion technique, peak power output, and performance time was found between the persons with a recent injury and the experienced group. Mechanical efficiency was higher after the correction for the difference in relative power output in the experienced group. Conclusion The group with a recent injury did not improve mechanical efficiency and propulsion technique over the period of active rehabilitation, despite significant improvements on the wheelchair circuit and in work capacity. The only significant difference between the groups was found in mechanical efficiency. Implications for rehabilitation The lack of time-dependent changes in mechanical efficiency and propulsion technique in the group with a recent spinal cord injury, combined with the lack of differences in technique, work capacity and on the wheelchair circuit between the groups, suggest that important adaptations of motor learning may happen even earlier in rehabilitation and emphasize that the group in active rehabilitation was relatively skilled. Standardized observational analyses of handrim wheelchair propulsion abilities during early spinal cord injury rehabilitation provide detailed understanding of wheelchair technique, skill as well as wheelchair propulsion capacity. Measurement of external power output is critical to interpretation of gross efficiency, propulsion technique, and capacity. Wheelchair quality and body weight – next to wheelchair fitness and skill – require careful consideration both in early rehabilitation as well as in the chronic phase of spinal cord injury.

Low-intensity wheelchair training in inactive people with long-term spinal cord injury: A randomized controlled trial on fitness, wheelchair skill performance and physical activity levels.

To investigate the effects of low-intensity wheelchair training on wheelchair-specific fitness, wheelchair skill performance and physical activity levels in inactive people with long-term spinal cord injury. Randomized controlled trial. Inactive manual wheelchair users with spinal cord injury for at least 10 years (n = 29), allocated to exercise (n = 14) or no exercise. The 16-week training consisted of wheelchair treadmill-propulsion at 30-40% heart rate reserve or equi-valent in terms of rate of perceived exertion, twice a week, for 30 min per session. Wheelchair-specific fitness was determined as the highest 5-s power output over 15-m overground wheelchair sprinting (P5-15m), isometric push-force, submaximal fitness and peak aerobic work capacity. Skill was determined as performance time, ability and strain scores over a wheelchair circuit. Activity was determined using a questionnaire and an odometer. Significant training effects appeared only in P5-15m (exercise vs control: mean +2.0 W vs -0.7 W, p = 0.017, ru=0.65). The low-intensity wheelchair training appeared insufficient for substantial effects in the sample of inactive people with long-term spinal cord injury, presumably in part owing to a too-low exercise frequency. Effective yet feasible and sustainable training, as well as other physical activity programmes remain to be developed for inactive people with long-term spinal cord injury.

Wheelchair skills performance between discharge and one year after inpatient rehabilitation in hand-rim wheelchair users with spinal cord injury

To study possible changes in wheelchair skills in participants with spinal cord injury between discharge and 1 year after rehabilitation, and to determine whether changes in wheelchair skills performance are related to lesion and personal characteristics, self-efficacy, and wheelchair satisfaction. Prospective cohort study. Eight rehabilitation centres with spinal cord injury units in the Netherlands. A total of 111 participants performed the Wheelchair Circuit twice: at discharge (t1) and 1 year after discharge (t2). Personal/lesion characteristics, self-efficacy, and wheelchair satisfaction were measured. Normalized ability score and performance time score were analysed with a linear multilevel regression analysis for possible associations with wheelchair skills. No statistically significant changes were found in the ability and performance time scores of the Wheelchair Circuit over the first year after discharge. Younger persons, those with paraplegia, and those with a better self-efficacy score showed higher ability scores and faster performance time scores on both test occasions. Wheelchair skills performance, measured with the Wheelchair Circuit, did not change during the first year after discharge from inpatient rehabilitation. Wheelchair skills performance was associated with age, lesion level and self-efficacy perceptions.

From “Wheelchair Circuit” to “Wheelchair Assessment Instrument for People With Multiple Sclerosis”: Reliability and Validity Analysis of a Test to Assess Driving Skills in Manual Wheelchair Users With Multiple Sclerosis

Vereecken M, Vanderstraeten G, Ilsbroukx S. From “Wheelchair Circuit” to “Wheelchair Assessment Instrument for people with Multiple Sclerosis”: reliability and validity analysis of a test to assess driving skills in manual wheelchair users with multiple sclerosis. ObjectivesTo assess the reliability and validity of the Wheelchair Assessment Instrument for people with Multiple Sclerosis (WAIMS), a test to measure driving skills in manual wheelchair users with multiple sclerosis (MS). DesignThree test trials per subject were conducted by 2 raters to examine reliability (inter- and intrarater) and validity (concurrent and construct). SettingA national multiple sclerosis rehabilitation center. ParticipantsConvenience sample of manual wheelchair users with MS (n=50), participating in an inpatient or outpatient rehabilitation program in a national multiple sclerosis center. InterventionsNot applicable. Main Outcome MeasuresThe WAIMS consists of 8 items and results in 3 final test scores: ability sum score, performance time sum score, and covered distance. These 3 scores are used to calculate inter- and intrarater reliability, concurrent validity, and construct validity. Concerning validity, the test scores on the WAIMS are compared with (1) the Belgian medical prescription of a wheelchair on the item d445 (hand and arm use), based on the International Classification of Functioning, Disability and Health, (2) the Expanded Disability Status Scale, and (3) the mobility (wheelchair) item of the FIM. ResultsIntrarater reliability was found to be higher than interrater reliability. Except for the interrater reliability of the ability sum score, all intraclass correlation coefficients met our standard of 0.80. Concurrent validity was rather low, but construct validity showed that the WAIMS is a valid instrument to assess driving skills in manual wheelchair users with MS. ConclusionsThe WAIMS is a promising tool to assess driving skills in manual wheelchair users with MS, but it needs some refinements and future studies to confirm this statement.

Adapted Manual Wheelchair Circuit: Test-Retest Reliability and Discriminative Validity in Persons With Spinal Cord Injury

Cowan RE, Nash MS, de Groot S, van der Woude LH. Adapted manual wheelchair circuit: test-retest reliability and discriminative validity in persons with spinal cord injury. Objective To assess the test-retest reliability and discriminative validity of a 14-item manual wheelchair circuit adapted from previous research (AMWC). Design Two AMWC trials per subject completed within 15 days. Setting Two clinical research and 3 rehabilitation centers. Participants Convenience sample of individuals with spinal cord injury (N=50) from centers in the United States (n=38) and the Netherlands (n=12). Mean age ± SD was 46±13 years, and mean injury duration ± SD was 12±11 years. Fifteen had cervical injuries, and 42 were men. Interventions An existing 8-task manual wheelchair circuit was modified to remove the need for a wheelchair treadmill and expanded to 14 tasks to attenuate floor and ceiling effects: 5 original tasks—figure-of-8, .012-m doorstep crossing, .10-m platform, 15-m sprint, and making a level transfer; 3 modified tasks—3% and 6% ramp, and 3-minute overground wheeling; and 6 new tasks—.04-m doorstep crossing, propelling over artificial grass, opening/closing a door, 3% side slope, holding a wheelie for 10 seconds, and propelling in a wheelie. Main Outcome Measures Reliability of the primary outcomes, sum ability score (sum of all tasks; 0–14 [no.]) and sum performance time (figure-of-8 + sprint + grass; 0–360 [s]), was determined by intraclass correlation coefficients (ICCs) for the whole sample and paraplegia (PP) and tetraplegia (TP) subsets. Independent t tests compared PP and TP trial 1 sum ability score and sum performance time. Results Sum ability and sum performance time ICCs exceeded .90 for the full sample and the PP/TP subsets. Sum ability was higher for PP than TP (PP, 12.9±1.2; TP, 9.8±2.8; P<.00), and sum performance times were lower for PP than TP (20.0±4.0s vs 32.0±1.97s, P<.00). Conclusions AMWC primary outcomes, sum ability score and sum performance time, are reliable and discriminate between TP and PP.

Correlation of shoulder range of motion limitations at discharge with limitations in activities and participation one year later in persons with spinal cord injury

To study the correlation between limited shoulder range of motion in persons with spinal cord injury at discharge and the performance of activities, wheeling performance, transfers and participation one year later. Multicentre prospective cohort study. A total of 146 newly injured subjects with spinal cord injury. Shoulder range of motion was measured at discharge. One year later, Functional Independence Measure (FIM), transfer ability, wheelchair circuit and Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) were assessed. Corrections were made for possible confounding factors (age, gender, level and completeness of injury, time since injury and shoulder pain). All subjects with limited shoulder range of motion at discharge had a lower FIM motor score and were less likely (total group 5 times, and subjects with tetraplegia 10 times less likely) to be able to perform an independent transfer one year later. Subjects with limited shoulder range of motion in the total group needed more time to complete the wheelchair circuit. No significant associations with the PASIPD were found in either group. Persons with spinal cord injury and limited shoulder range of motion at discharge are more limited in their activities one year later than those without limited shoulder range of motion.

Subject- and Injury-Related Factors Influencing the Course of Manual Wheelchair Skill Performance During Initial Inpatient Rehabilitation of Persons With Spinal Cord Injury

Kilkens OJ, Dallmeijer AJ, Angenot E, Twisk JW, Post MW, van der Woude LH. Subject- and injury-related factors influencing the course of manual wheelchair skill performance during initial inpatient rehabilitation of persons with spinal cord injury. Objectives To study changes in wheelchair skills in subjects with spinal cord injury (SCI) during rehabilitation; to determine whether changes in wheelchair skill performance are related to the subject, lesion characteristics, secondary complications, and upper extremity pain; and to investigate if wheelchair skill performance at discharge can be predicted from these features. Design Longitudinal. Subjects performed the Wheelchair Circuit 3 times during rehabilitation: at admission (t1), 3 months later (t2), and at discharge (t3). Setting Eight rehabilitation centers in the Netherlands. Participants One hundred twenty-one subjects with SCI. Interventions Not applicable. Main Outcome Measures The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores: ability, performance time, and physical strain. Results All the scores of the Wheelchair Circuit improved significantly between t1 and t2, and between t2 and t3. The scores were related to age and lesion level, whereas changes in scores were related to age, sex, lesion level, and secondary complications. The variables age, body mass index, sex, lesion level, motor completeness, and secondary complications contributed significantly to the prediction of the scores at t3. Conclusions Wheelchair skill performance improved during rehabilitation. Personal and lesion characteristics are most important for improving wheelchair skill performance and predicting wheelchair skill performance.

The Longitudinal Relation Between Physical Capacity and Wheelchair Skill Performance During Inpatient Rehabilitation of People With Spinal Cord Injury

Kilkens OJ, Dallmeijer AJ, Nene AV, Post MW, van der Woude LH. The longitudinal relation between physical capacity and wheelchair skill performance during inpatient rehabilitation of people with spinal cord injury. Objective To study the longitudinal relation between physical capacity and wheelchair skill performance in subjects with spinal cord injury (SCI) during rehabilitation. Design Observational prospective cohort study. Measurements were taken 3 times during subjects’ rehabilitation. Setting Eight rehabilitation centers in the Netherlands. Participants Ninety-seven subjects with SCI. Interventions Not applicable. Main Outcome Measures Parameters of physical capacity were upper-extremity muscle strength (manual muscle test [MMT] sum score), peak oxygen uptake, and peak power output (POpeak). The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores: ability, performance time, and physical strain. Results POpeak was related to all 3 scores of the Wheelchair Circuit, and the MMT sum score was related to the ability score and the performance time score. The results indicate that (1) subjects with higher values of POpeak and/or the MMT sum score had better scores on the Wheelchair Circuit than subjects with lower values and (2) when a subject increased his/her POpeak and/or MMT sum score, this was associated with better wheelchair skill scores. Conclusions There is a significant longitudinal relation between wheelchair skill performance and POpeak and MMT sum score during the rehabilitation of people with SCI. To optimize wheelchair skill performance, attention should be directed toward manual wheelchair exercise training and strength training of the upper body.

The wheelchair circuit: construct validity and responsiveness of a test to assess manual wheelchair mobility in persons with spinal cord injury

Kilkens OJ, Dallmeijer AJ, de Witte LP, van der Woude LH, Post MW. The Wheelchair Circuit: construct validity and responsiveness of a test to assess manual wheelchair mobility in persons with spinal cord injury. Arch Phys Med Rehabil 2004;85:424–31. Objective To assess the validity and responsiveness of the Wheelchair Circuit, a test to assess manual wheelchair mobility in persons with spinal cord injury (SCI). Design Longitudinal. Subjects performed the Wheelchair Circuit at the start (T1) and at the end (T3) of inpatient functional rehabilitation. Construct validity and responsiveness were assessed. Setting Eight rehabilitation centers in the Netherlands. Participants Seventy-four subjects with SCI admitted for inpatient rehabilitation. Interventions Not applicable. Main outcome measures The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores: ability, performance time, and physical strain. The construct validity of the Wheelchair Circuit was assessed by testing whether the test scores were significantly related to the subjects’ functional status, physical capacity, lesion level, motor completeness of the lesion, and age. To prove the test’s responsiveness, it was assessed whether the test scores had significantly improved between T1 and T3. Results For construct validity, 4 of the 5 hypotheses were confirmed. For test responsiveness, all 3 test scores had significantly improved during rehabilitation, and the standardized response mean values ranged from 0.6 to 0.9. Conclusions The Wheelchair Circuit is a valid and responsive instrument with which to measure manual wheelchair mobility in subjects with SCI.

Relationship between manual wheelchair skill performance and participation of persons with spinal cord injuries 1 year after discharge from inpatient rehabilitation

This cross-sectional study describes the level of manual wheelchair skill performance and participation of persons with spinal cord injuries (SCIs) 1 year after discharge from inpatient rehabilitation and tests the hypothesis that wheelchair skill performance is positively related to participation. Participants included 81 persons with SCI from eight rehabilitation centers in the Netherlands. The Wheelchair Circuit consists of eight wheelchair skills and results in three test scores: ability, performance time, and physical strain. Participation was assessed with the sum of the subscales Mobility Range and Social Behavior of the 68-Item Sickness Impact Profile (SIPSOC). SIPSOC was moderately related to the ability score (the Spearman rank correlation [rS] = -0.49), the performance time score (rS = 0.54), and the physical strain score (rS = 0.38). The regression analyses showed that, after controlling for lesion and personal characteristics, manual wheelchair skill performance is positively related to participation, with the strongest association for the performance time score. In persons with SCI who are manual wheelchair users, wheelchair skill performance is moderately associated to participation. Training of wheelchair skills has to be an important goal of rehabilitation, and persons should be stimulated to maintain their wheelchair skills after discharge from rehabilitation.

The wheelchair circuit: Reliability of a test to assess mobility in persons with spinal cord injuries

Kilkens OJ, Post MW, van der Woude LH, Dallmeijer AJ, van den Heuvel WJ. The wheelchair circuit: reliability of a test to assess mobility in persons with spinal cord injuries. Arch Phys Med Rehabil 2002;83:1783-8. Objective: To assess the reliability of a 9-task wheelchair circuit. Design: Three test trials per subject were conducted by 2 raters. Inter- and intrarater reliability were examined. Setting: Eight rehabilitation centers in the Netherlands. Participants: Convenience sample of 27 patients (age, ≥18y) with spinal cord injury (SCI), all of whom were in the final stage of their inpatient rehabilitation. Intervention: A wheelchair circuit was developed to assess mobility in subjects with SCI. The circuit consisted of 9 tasks: figure-of-8 shape, doorstep crossing, mounting a platform, sprint, walking, driving up treadmill slopes of 3% and 6%, wheelchair driving and transfer. Main Outcome Measures: Task feasibility, task performance time, and peak heart rates. Results: The number of tasks that subjects could perform varied from 3 to 9. Feasibility intrarater reliability was .98, and the interrater reliability intraclass correlation coefficient (ICC) was .97. Performance time ICCs ranged from .70 to .99 (mean, .88) for intrarater reliability and from .76 to .98 (mean, .92) for interrater reliability. Heart rate ICCs ranged from .64 to .96 (mean, .81) for intrarater reliability and from .82 to .99 (mean, .89) for interrater reliability. Conclusions: The reliability of the wheelchair circuit was good. More research is needed to assess test validity and responsiveness. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation