Wheelchair Skill Performance Research Articles

Wheelchair-skill performance: Controlled comparison between people with hemiplegia and able-bodied people simulating hemiplegia

Kirby RL, Adams CD, MacPhee AH, Coolen AL, Harrison ER, Eskes GA, Smith C, MacLeod DA, Dupuis DJ. Wheelchair-skill performance: controlled comparison between people with hemiplegia and able-bodied people simulating hemiplegia. ObjectiveTo test the hypothesis that able-bodied people simulating hemiplegia (using the hemiplegic-propulsion pattern [1 arm and 1 leg]) have as much difficulty performing wheelchair skills as people with hemiplegia. DesignSingle-blind, controlled comparison of 2 groups. SettingKinesiologic laboratory in a rehabilitation center. ParticipantsTwenty wheelchair users with hemiplegia (HP group) (median age, 68y; 80% men) and 20 able-bodied participants (AB group) (median age, 67y; 75% men). InterventionsThe participants in the AB group simulated hemiplegia and received a brief period of wheelchair skills training. Participants in both groups were asked to attempt the 50 skills of the Wheelchair Skills Test, version 2.4 (WST 2.4). Main outcome measuresTotal and subtotal percentage scores on the WST 2.4 and success rates for the 50 individual skills. ResultsThe mean percentage WST scores for the AB group were significantly greater than those for the HP group for the total WST scores (P<.001), the indoor skill level (P<.001), and the community skill level (P<.001), but the advanced skill level scores were 0% for both groups. On the individual skills, the AB group had success rates at least 25% higher than the HP group for 13 (26%) of the skills. Both groups were generally successful (≥75% success rate) on 21 skills (42%). Both groups experienced difficulties (≤50% success rate) on 13 skills (26%), notably those in which there was high rolling resistance (eg, incline ascent) or high balance demands (the wheelie skills). ConclusionsBoth people with hemiplegia and able-bodied people who are simulating hemiplegia experience similar difficulties when performing some wheelchair skills. This suggests that there are difficulties inherent in these tasks, a finding that holds promise for solutions based on new techniques and technologies.

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.

Wheelchair skills training program: a randomized clinical trial of wheelchair users undergoing initial rehabilitation

MacPhee AH, Kirby RL, Coolen AL, Smith C, MacLeod DA, Dupuis DJ. Wheelchair Skills Training Program: a randomized clinical trial of wheelchair users undergoing initial rehabilitation. Arch Phys Med Rehabil 2004;85:41–50. Objective To test the hypothesis that a brief, formalized period of additional wheelchair skills training is safe and results in significantly greater improvements in wheelchair skills performance than a standard rehabilitation program. Design Randomized controlled trial. Setting Rehabilitation center. Participants Thirty-five wheelchair users (20 with musculoskeletal disorders, 15 with neurologic disorders) admitted for initial rehabilitation. Subjects’ mean age ± standard deviation (SD) was 59±18.3 years. Intervention Subjects randomly allocated to the treatment group participated in the Wheelchair Skills Training Program (WSTP), averaging 4.5±1.5 training sessions, each 30 minutes long. Subjects in the control group did not receive any wheelchair skills training beyond that given in a typical rehabilitation stay. Main outcome measures Wheelchair Skills Test (WST), version 2.4, before and after training. Changes in total percentage WST score and individual skill scores were examined. Results There were no adverse incidents. The control group’s mean percentage score ± SD increased from 60.1%±14.4% to 64.9%±13.3%, an 8% improvement of the posttest relative to the pretest ( P=.01). The WSTP group’s mean score increased from 64.9%±9.4% to 80.9%±5.6%, a 25% improvement of the posttest relative to the pretest ( P<.000). The WSTP group showed significantly greater improvements than the control group ( P<.000). Among the specific skills, significantly greater improvements were seen in the WSTP group for the gravel and high-curb descent skills ( P<.001). Conclusions The WSTP is safe and practical and has a clinically significant effect on the independent wheeled mobility of new wheelchair users. These findings have implications for the standards of care in rehabilitation programs.

Wheelchair skills tests: a systematic review.

To describe and compare the content, feasibility, outcome parameters, and clinimetric properties of the manual wheelchair skills tests reported in the literature. A systematic literature search was conducted in MEDLINE, EMBASE, PsychINFO and Current Contents. Tests were selected if they were observational tests, designed for subjects using hand-rim wheelchairs and were intended to assess wheelchair skill performance at the activity level. The search resulted in 34 papers, in which 24 different wheelchair skills tests were described. The skill most frequently included was wheelchair propulsion, consecutively followed by transferring, negotiating kerbs, ascending slopes, traversing tracks, sprinting and performing a wheelie. The three most frequently used outcome parameters were task performance time, independency of task performance, and physical strain during skill performance. Sensitivity to change was evaluated in three tests, validity in 10 tests, and reliability in nine tests. Many tests are applied to measure wheelchair skill performance using different tasks and outcome measures. This makes it difficult to compare study results. Consensus among researchers as to which skills must be included as well as to standardization of the use of measurement instruments will reduce this problem and will additionally lead to a better insight in the quality of tests.