Wheelchair Selection Research Articles

Development and Evaluation of Evidence Based Patient Education Booklet in Hindi Language for Prevention of Shoulder Pain in Paraplegia

Background: Shoulder pain is one of the most frequent complaints of Paraplegia with a prevalence reported to range from 50% to 60%.It has been attributed to the increase in upper extremity (UE) weight bearing following lower extremity paralysis. Purpose of the study: To develop and Evaluate an Evidence Based Patient Education Booklet in Hindi Language for Prevention of Shoulder Pain in Paraplegia along with pictorial presentation. Design: A methodological study Method: It consist of 4 steps. 1) Literature review and informal interview of 2 doctors, 7 physiotherapists, 5 occupational therapists and 10 patients were used to determine the domains of the education booklet. 2) Development of content of the evidence based patient education booklet according to domains found in step 1 and develop a rough draft of booklet in Hindi Language. 3) Evaluation of the evidence based booklet by expert panel using SAM and to modify the booklet to produce the final booklet draft. 4) Pilot study on patients to take their views regarding the booklet developed. Results: The domains found in step 1 were: Education about pain, Education about the treatment options, Ergonomics modifications, Positioning, Wheel chair selection and transfer techniques, Exercises, General precautions. The content was developed in step 2. In step 3 the SAM score is- 88.13% and final booklet was produced after modification. In step 4 the patient rated the booklet easy to read and understand with an overall rating of 9/10 Conclusion: The developed patient education booklet came out to be easy to read and understand and of superior quality according to Suitability assessment of material questionnaire and hence should be made a part of patient education. Keywords: Patient education booklet, Shoulder pain in paraplegia, Suitability assessment of material questionnaire, booklet in Hindi language, Pain prevention and management, Health education material

Analysis of Body-Slip and Buttock Pressure Characteristics during Operation of a Double-Sliding Reclining Wheelchair in Patients with Spinal Cord Injury

To minimize body collapse due to repetitive reclining and repositioning when using a reclining wheelchair, reclining wheelchairs with a sliding backrest function have been developed. This study compared the differences in body-slip and buttock pressure according to the presence or absence of the sliding function of the backrest during reclining and repositioning motions in 10 patients with spinal cord injury. When reclining from 100° to 130°, backrest sliding and total body-slip in the double-sliding wheelchair were significantly decreased by 21.4 mm and 16.4 mm, respectively, compared to a non-sliding wheelchair, and the peak pressure on the ischial tuberosity was significantly decreased by 8.7 kPa. Upon comparison of the buttock pressure between the initial upright position before reclining and the return upright position after repositioning, the force and mean pressure with the double-sliding wheelchair were significantly reduced compared with those with the non-sliding wheelchair. It was confirmed that the double-sliding system improved body-slip and buttock pressure more effectively than the non-sliding system. This study’s results are expected to provide the basic data necessary for the prescription and selection of wheelchairs in clinical practice and to be utilized in the development of related devices.

Creating a consumer-friendly resource to assist persons with Amyotrophic Lateral Sclerosis (ALS) in navigating the power wheelchair selection process

ABSTRACT Persons living with Amyotrophic Lateral Sclerosis (ALS), a fatal neurodegenerative disease, are often asked to make important decisions regarding power wheelchair (PWC) selection soon after receiving a diagnosis. There is currently a paucity of consumer-friendly information to aid clients living with ALS in better understanding the long-term functional implications of decisions made during the PWC selection process. The purpose of this action research project was to identify the specific considerations and choices required during the PWC selection process to use as the basis for creating a concise, educational video tool that emphasizes functional independence and self-advocacy for clients living with ALS. Semi-structured interviews of a panel of expert stakeholders were conducted to isolate important considerations for PWC selection in clients living with ALS. Qualitative data were collected through coded interviews and used to prioritize themes that were incorporated into an educational video. Once the draft video was created, the expert panel was provided time to review and critique the video prior to the creation of a professional quality video. Major themes identified and analyzed included environmental considerations, PWC component options, self-advocacy, and transportation. The video resource aims to be a resource for beginning a conversation about PWC options to make the PWC evaluation and selection process less daunting for clients and their caregivers.

Parental experiences on the role of wheelchairs in the lives of their children with mobility impairments: a qualitative exploration in Dubai

Purpose To explore parental experiences on the role of wheelchairs in the lives of their children with mobility impairments in Dubai. Methods Seven participants were recruited through purposive sampling and their experiences were explored by conducting semi-structured interviews. The audio recordings were transcribed and thematically analysed. Results The findings showed that wheelchairs were an essential part of the children`s lives, which enabled their participation in the home, the school and the community. Procurement processes were difficult owing to a lack of assessment and prescription processes as well as insurance companies providing little assistance with payment. The participants described Dubai as a wheelchair friendly city and two overarching themes emerged; firstly, The wheelchair: “It is her life”, and, secondly, Participation: Isolation versus inclusion. Conclusion The study is the first of its kind in Dubai and indicated that the wheelchair played an important role in the children’s lives and allowed participation in life roles that brought joy and fulfilment. Without wheelchairs, children would be isolated and frustrated. However, some of the participants were not satisfied with their child’s current wheelchair and felt the chair was not appropriate. Recommendations to specific stakeholders included: the development of policies to guide wheelchair service provision by government. In addition, insurance providers could collaborate with the government to adhere to the policy to ensure healthy lives and promote well-being for all. IMPLICATIONS FOR REHABILITATION The wheelchair provided children the mobility to participate in life roles instead of being isolated. Not all children had appropriate wheelchairs. Service providers and medical insurance did not give sufficient support during wheelchair selection and procurement.

Significance of social factors for efficient provision of assistive devices and technologies for the disabled persons. Automating the process of customized selection of a wheelchair

Objective: to develop an algorithm for customized selection of a wheelchair for the disabled persons with limited mobility followed by design of a software allowing to automate the process of wheelchair selection. Materials and methods. Analytical review of English literature was performed to address the issues in prescription and utilization of the assistive devices and technologies (ADT). The regulatory documents governing the ADT prescription in the Russian Federation (RF) were studied. Russian market of the wheelchairs for the disabled persons was analyzed. Ten disabled persons with traumatic spinal cord injury to the department of medical rehabilitation of the Centre were examined to pilot the software for automated wheelchair selection. Results. After the literature review results were structured, the major groups of factors that should be considered when selecting a wheelchair were identified: 1) anthropometric measurement, 2) physical and functional capabilities of the disabled person, 3) level of everyday activity, 4) availability and physical capabilities of the caregivers, 5) particularities of the environmental factors. The algorithm for customized selection of wheelchair was designed. The database comprising the technical characteristics of 141 wheelchair models that are taken as a basis of the software was developed. IBM-compatible computer was used to develop the software. Programming language: Delphi, data base management system: Microsoft Access 2013. Piloting results showed the effectiveness of the software. In all cases appropriate wheelchairs were selected. Conclusion. Within current study the software for automated process of customized wheelchair selection was piloted. The software takes into consideration the level of activities and participation of the disabled persons and significant environmental factors which allows to customize the ADT prescription.

Kinematics and pushrim kinetics in adolescents propelling high-strength lightweight and ultra-lightweight manual wheelchairs

Purpose: The purpose of this study is to describe and compare pushrim forces, propulsive work cost, and upper body kinematics in adolescents propelling (1) a standard high strength lightweight wheelchair, and (2) an ultra-lightweight wheelchair with adjustable main axle positioning, on a level tiled floor (“Tile”), ascending a ramp (“Ramp”), and across a foam mat (“Mat”).Methods: A within-subjects repeated measures study design was used. Eight adolescent manual wheelchair users propelled the standard and ultra-lightweight wheelchairs across the three conditions. Average pushrim tangential force, propulsive power and work per unit distance travelled, as well as upper body kinematic angles, were analyzed.Results: Average pushrim tangential force (1.80 ± 0.7 N, p = .042) and propulsive work per unit distance travelled (8.3 ± 1.7 J·m− 1, p = .002) were higher for the standard lightweight wheelchair, whereas average speed was lower (0.12 ± 0.03 m/s, p = .006). Maximum shoulder (9.2 ± 2.0°, p = .003) and elbow flexion (8.0 ± 2.2°, p = .009) were higher for the ultra-lightweight wheelchair. Compared with Tile, propulsion on Mat and Ramp was associated with higher average tangential force, work per unit distance, power, and maximum flexion of the neck and trunk, whereas shoulder extension and average speed were lower for Mat and Ramp.Conclusions: Compared with the standard lightweight wheelchair, ultra-lightweight wheelchair propulsion was associated with lower pushrim forces, lower energy costs, higher self-selected speeds, and increased shoulder and elbow flexion. These variables have been linked to injury risk and mobility efficiency, and the results provided evidence that differences in weight and configuration options are both contributors. Findings can inform decision-making in the prescription of manual wheelchairs for pre-adult populations.Implications for RehabilitationA significant proportion of manual wheelchair users are children and adolescents, and due to the early onset of use they may be especially predisposed to the development of chronic overuse injuries.The study reports differences in energy costs, pushrim forces, and upper body kinematics measured when adolescents propelled standard and ultra-lightweight wheelchairs across three trial conditions.In the ultra-lightweight wheelchair, reduced energy cost is linked to more efficient mobility, and lower forces may be linked to lower risk of chronic injury.Significant differences in elbow and shoulder kinematics are also reported, and the findings support the importance of both weight and setup options in the selection of manual wheelchairs.

Test-retest reliability and construct validity of the Aspects of Wheelchair Mobility Test as a measure of the mobility of wheelchair users.

BackgroundThe Aspects of Wheelchair Mobility Test (AWMT) was developed for use in a repeated measures format to provide comparative effectiveness data on mobility facilitated by different wheelchair types. It has been used in preliminary studies to compare the mobility of wheelchairs designed for low-resource areas and is intended to be simple and flexible enough so as to be used in low-technology settings. However, to reliably compare the impact of different types of wheelchairs on the mobility of users, a measure must first be a reliable and valid measure of mobility.MethodsThis study investigated the test–retest reliability and concurrent validity for the AWMT 2.0 as a measure of mobility. For reliability testing, participants in a low-resource setting completed the tests twice in their own wheelchairs at least one week apart. For concurrent validity, participants also completed the Wheelchair Skills Test Questionnaire (WST-Q), a related but not identical validated assessment tool.ResultsConcurrent validity was indicated by a significant positive correlation with an r value of 0.7 between the WST-Q capacity score and the AWMT 2.0 score. Test–retest reliability was confirmed by an intraclass correlation coefficient greater than 0.7 between the two trials.ConclusionResults support the preliminary reliability and validity of the AWMT 2.0, supporting its effectiveness in comparing the mobility provided by different wheelchair types. This information can be used to enable effective use of limited funds for wheelchair selection at individual and organisational scales.

Classification of gait pathologies in hemiplegia: Does it change with running?

To test the hypotheses that people with hemiplegia using arms and legs to propel their wheelchairs perform better backward than forward and prefer the backward direction.Within-participant cross-sectional design.Manual wheelchair users (N=18) with hemiplegia caused by stroke, a sample of convenience.Rehabilitation center.Participants each performed 9 skills from the Wheelchair Skills Test (WST 4.1)—4 low-rolling-resistance skills (rolls 10m, turns 90° while moving, rolls 2m across 5° side slope, descends 5cm level change) and 5 high-rolling-resistance skills (ascends 5° incline, rolls 2m on soft surface, gets over 15-cm pothole, gets over 2-cm threshold, ascends 5cm level change)—in both the forward and backward directions, in random order.Total percentage capacity scores from the modified WST 4.1, success rates for individual skills, and responses from an orally administered questionnaire regarding direction preferences.The mean ± SD total WST 4.1 capacity scores were 53%±26% in the forward direction and 76%±30% in the backward direction (P<.001). For the 4 low-rolling-resistance skills, there were no clinically significant differences (≥20%) between forward and backward success rates. For the 5 high-rolling-resistance skills, the success rates were 33% to 50% higher in the backward direction. Participants preferred the forward direction for low-rolling-resistance skills and the backward direction for high-rolling-resistance skills.Wheelchair skills that involve high rolling resistance are performed more successfully in the backward than the forward direction, and participants prefer the backward direction for such skills. These findings have implications for wheelchair selection and skills training.

Editorial: Wheeled Mobility Biomechanics

Editorial: Wheeled Mobility Biomechanics

Evidence-Based Strategies for Preserving Mobility for Elderly and Aging Manual Wheelchair Users.

Elderly and aging manual wheelchair (MWC) users have increased risk for accelerated loss of function and mobility that greatly limits independence and affects quality of life. This review paper addresses important issues for preserving function and mobility for elderly and aging individuals who use a MWC by presenting the current available evidence and recommendations. These include recommendations for maximizing function, by decreasing pain, improving the ability to self-propel, and prolonging mobility and endurance through ergonomics, individualized wheelchair selection and configuration, and adaptations for increasing the capacity to handle the daily mobility demands through training, strengthening, and exercise. Each recommendation is supported by current research in each relevant area.

Using the International Classification of Functioning, Disability and Health (ICF) to address facilitators and barriers to participation at work.

The International Classification of Functioning, Disability and Health (ICF) was approved by the World Health Assembly in 2001. Ten years later, strong arguments have arisen regarding the added value of ICF to the policies on employment and the outcomes at the workplace. As a conceptual framework, ICF has universality because of its inclusive and comprehensive view of human functioning. At a practical level ICF can be used to quantify the impact of impairment on an individual's ability to act in his/her environment and to assess interventions to minimize the impact of disability and maximize functioning. To explore key indicators of social participation (life habits) of persons with disabilities, particularly related to work, among environmental and personal factors. Data were collected by self-administered questionnaires from a convenience sample of 149 working-age persons with disabilities. Social participation is a construct composed by multiple components and employment domain is the strongest indicator of participation. Correlations between social participation and personal factors, such as self-efficacy and attitudes towards disability were moderate. Those who are employed scored higher quality of life in terms of satisfaction with life, more positive attitudes toward disabilities and higher self-efficacy than the ones who are retired or unemployed. Persons using adapted wheelchair and those who were involved in wheelchair selection scored higher in social participation in general, performance at work, and quality of life. Age and disability duration were not associated with participants' employment status. These findings suggest that rehabilitation and vocational agents, like physiotherapists and other professionals, should have knowledge and understanding of the multiple factors that influence persons with disabilities' participation at work. Programs should provide appropriate wheelchairs, skills training, empowerment and problem-solving strategies in labour activities and occupational environment to promote employment of working-age persons with disabilities.

Manual Wheelchair Propulsion by People With Hemiplegia: Within-Participant Comparisons of Forward Versus Backward Techniques

ObjectiveTo test the hypotheses that people with hemiplegia using arms and legs to propel their wheelchairs perform better backward than forward and prefer the backward direction. DesignWithin-participant cross-sectional design. ParticipantsManual wheelchair users (N=18) with hemiplegia caused by stroke, a sample of convenience. SettingRehabilitation center. InterventionParticipants each performed 9 skills from the Wheelchair Skills Test (WST 4.1)—4 low-rolling-resistance skills (rolls 10m, turns 90° while moving, rolls 2m across 5° side slope, descends 5cm level change) and 5 high-rolling-resistance skills (ascends 5° incline, rolls 2m on soft surface, gets over 15-cm pothole, gets over 2-cm threshold, ascends 5cm level change)—in both the forward and backward directions, in random order. Main Outcome MeasuresTotal percentage capacity scores from the modified WST 4.1, success rates for individual skills, and responses from an orally administered questionnaire regarding direction preferences. ResultsThe mean ± SD total WST 4.1 capacity scores were 53%±26% in the forward direction and 76%±30% in the backward direction (P<.001). For the 4 low-rolling-resistance skills, there were no clinically significant differences (≥20%) between forward and backward success rates. For the 5 high-rolling-resistance skills, the success rates were 33% to 50% higher in the backward direction. Participants preferred the forward direction for low-rolling-resistance skills and the backward direction for high-rolling-resistance skills. ConclusionsWheelchair skills that involve high rolling resistance are performed more successfully in the backward than the forward direction, and participants prefer the backward direction for such skills. These findings have implications for wheelchair selection and skills training.

Participatory Action Research to Determine Essential Elements of a Wheelchair Assessment

Nearly 3 million people in the Unites States utilize a wheelchair for mobility. Yet, there is no standardized assessment or procurement process for wheelchair provision. Thus, practitioners have limited guidance in the essential elements of a wheelchair assessment. End users may have no or limited experience in determining the best choice of wheelchairs to meet their needs and often rely on the knowledge of the practitioner in the decision-making process of wheelchair selection. The author explored the current state of practice and the essential elements in the wheelchair assessment and procurement process. Obtaining the correct wheelchair is a complex process, involving the client, family, practitioners, suppliers, manufacturers, policy makers and insurers. This study utilized a qualitative research approach using Participatory Action Research (PAR) and a Delphi consensus approach to garner input from 155 individuals who have experience in or with wheelchair assessments. Participants in this study included representation from wheelchair manufacturers, suppliers, educators, occupational and physical therapists, end users, policy makers, and government affairs personnel. The findings of this study suggest that the wheelchair assessment include a wide range of elements, be client specific, and reflect a client-centered process.

Commentary on “Development of Items That Assess Physical Function in Children Who Use Wheelchairs”

“How should I apply this information?” The use of a blended model of both qualitative- and quantitative-data collection to guide clinical decision making is the strength of the paradigm underlying this research. Information in this article is relevant for all pediatric physical therapists working with children who use wheelchairs and also for those participating in the wheelchair selection process. This article reminds us that as rehabilitation professionals, relying on our expertise in evaluation and assessment of a child's physical function is not sufficient. In addition to clinical expertise of pediatric physical therapists, a child's self-reported outcome measure can be a useful method for children to actively engage in their own health care decision making and effective self-advocacy. The challenge is finding an appropriate outcome measure that allows self-reporting to be relayed accurately. This is especially true in the case of assessing physical function in children who use wheelchairs, since the research in this area is limited.1 The Patient Reported Outcomes Measurement Information System pediatric physical function related to mobility appears to be easily applied for children who use wheelchairs to assess their physical function. “What should I be mindful about in applying this information?” Although the physical function related to mobility was easily applied in this study and the children were able to respond to the test items, the individual test items might not have adequately reflected their true capabilities. The authors indicated that the children revealed that some items were vague, with multiple ways of interpreting the question, and the questions were based on the assumption that the child was ambulatory. In addition, the Patient Reported Outcomes Measurement Information System pediatric physical function related to mobility item bank was developed through focus groups and cognitive interview of children with asthma and children without medical conditions or disabilities. Although the sample size is small, with a limited age range (8-12 years), and is also limited in diagnostic categories addressed, the importance of refinement and expansion of this outcome measure for the pediatric population is encouraged. Outcome measures greatly enhance documentation. As precision of clinical documentation is increasingly requested by third-party payers, the use of reliable outcomes instruments is emerging as a necessary part of clinical practice decision making. Ana Carolina Mieres, PT, PhD eQHealth Solutions-Florida Tampa, Florida Jennifer Lam, PT, DPT All Children's Hospital, eQHealth Solutions-Florida St Petersburg, Florida

RESNA's Position on Wheelchairs Used as Seats in Motor Vehicles

ABSTRACT This position paper is based on the premise that those who ride seated in wheelchairs are entitled to equivalent occupant safety when they are traveling in motor vehicles. The document summarizes research and best practice for safety and selection of crashworthy wheelchairs with the requisite features required by the WC19 safety standard when it is necessary for individuals to use a wheelchair as a seat in a motor vehicle. Recommendations are based on data from accident and injury databases, prior research and a synopsis of the design, testing, performance and labeling requirements of ANSI and ISO voluntary industry standards for wheelchair transportation safety. This paper is intended for an audience of consumers, rehabilitation and health care professionals, manufacturers of wheelchairs and wheelchair transportation equipment and those who make reimbursement and public policy decisions. Content reviewed by the RESNA SIG on Wheeled Mobility and modified in accordance with SIG reviewers comments—January 2010. Approved by the RESNA Board of Directors—April 2010.

Remote decision support for wheeled mobility and seating devices

Current wheelchair selection and evaluation processes are time-consuming, often requiring cumbersome review and re-review of frequently changing wheelchair products and manufacturers. Telerehabilitation (TR) is an emerging field that complements the current in-person assessment for selecting an appropriate wheeled mobility and seating device in underserved areas. One of TR’s core functions is remote wheelchair selection (RWS), which requires detailed information on wheelchair characteristics and specifications, policy knowledge, and patient medical conditions including mobility limitation. Stakeholders currently have limited means to access comprehensive, reliable, monitored, and up-to-date information relative to wheeled mobility and seating devices, including performance, coverage criteria, or research evidence as to their benefits and short-comings. Centers for Medicare and Medicaid Services (CMS) implemented significant changes to the Healthcare Common Procedures Coding System (HCPCS) for wheeled mobility devices (WMDs) that includes expansion from 4 to 64 unique codes to identify different types of physical mobility devices (PMDs). This 16-fold increase can make it difficult to fully understand where a given product falls within the new structure. In our work we review the current TR research, wheelchair coverage policy issues, and the modern remote wheelchair selection paradigm. We introduce a framework for a web-based decision support system for remote wheelchair selection. These outcomes improve the wheelchair selection and evaluation processes through the capabilities of remote investigation of in-person assessment process, appropriated wheelchair alternatives, advanced wheelchair query and selection, a reusable wheelchair information repository, and systematic wheelchair evaluation. We also discuss lessons learned from a focus group study regarding the user acceptance of RWS-Advisor and the future direction of research on remote wheelchair selection.

Decisions and Dilemmas in Everyday Life: Daily Use of Wheelchairs by Individuals with Spinal Cord Injury and the Impact on Pressure Ulcer Risk.

Individuals with spinal cord injury (SCI) use wheelchairs for mobility and for full participation in their daily activities. The use of wheelchairs, however, can increase the risk of pressure ulcers. This study focused on wheelchair users' perceptions of the interplay between their wheeled mobility and the development of pressure ulcers by performing a secondary analysis of data gathered during a 2-year ethnographic study of 20 community-dwelling adults with SCI. Data from a subset of these individuals are described; each of these stories contains a pressure ulcer risk episode related to wheeled mobility or cushion use. Identified risk episodes were associated with wheelchair selection, wheelchair adjustment, habituation to new equipment, lifestyle choices, and challenging life contexts. Examples highlighted the crucial relationship between individuals' minute-to-minute decision-making and pressure ulcer risk.

919 車椅子選定エキスパートシステムの開発(設計工学・システムII)

919 車椅子選定エキスパートシステムの開発(設計工学・システムII)

Utilizing Research In Wheelchair and Seating Selection and Configuration For Chiloren With Injury/ Dysfunction Of The Spinal Cord

Objective: To determine how research regarding wheelchair and seating selection and configuration could be applied to the pediatric population with spinal cord injury (SCI) and dysfunction.Methods: Extensive Iiterature reviews were completed on (a) powered mobility options and age-appropriateness for training; (b) manual wheelchair configuration, pushrim biomechanics, and propulsion ergonomics; and (c) cushion selection and use of pressure-mapping devices. The findings in the Iiterature review then were compared with clinical observations from Shriners Hospitals for Children, Philadelphia’s Seating and Wheelchair Clinic.Results/Discussion: A significant amount of research is published on propulsion ergonomics and pushrim biomechanics in adults with SCI. However, this Iiterature review noted that there was limited research available on cushion selection and power mobility configuration. Many of the conclusions drawn from these publications are applied to pediatric patients and used during the decision-making process of wheelchair and cushion selection. However, it is critical to tailor the assessment to the pediatric population to meet their medical and functional needs.Conclusion: Although some of the findings can be correlated to the pediatric population, there is a Iack of research on wheelchair and seating selection and configuration as it specifically relates to the young person with SCI and dysfunction. Future studies need to be completed.

Factors influencing the decision to abandon manual wheelchairs for three individuals with a spinal cord injury

Purpose : This study was conducted to identify factors which influence individuals with a spinal cord injury to abandon their first wheelchair before five years of use. It aims to provide prescribing therapists and manufacturers with insights which may assist in facilitating better outcomes for wheelchair users, thereby reducing abandonment rates and containing replacement costs. Method : A descriptive, qualitative design was used to gather the perceptions of three individuals with a spinal cord injury. Results : Thematic analysis yielded five themes: 'Participants' experience of the first prescription'; 'The physical issues with the wheelchair have functional implications'; 'Gaining experience is so important'; 'Participants' experience of the second prescription'; and 'Participants' suggestions'. Conclusions : Factors influencing manual wheelchair abandonment for these participants were consistent with findings from the literature concerning dissatisfaction and abandonment of assistive technology. For these three individuals the lack of experience in wheelchair use and selection, the functional limitations encountered with the design of the wheelchair and the manner and timing of the prescription process combined to lead to dissatisfaction and ultimately abandonment. Suggestions for changes to wheelchair prescription practices were made.