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Ebook: Rehabilitation: Mobility, Exercise and Sports
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This book is a collection of summarized papers and poster presentations from the 4th International Congress Rehabilitation: Mobility, Exercise & Sports, which will be of interest to all those involved in the field of human movement sciences and the rehabilitation professions. Rehabilitation medicine is a relatively young discipline, as is the science of human movement, but both have progressed rapidly from their inception in the latter half of the 20th century to take their current place as important, multi-disciplinary, evidence based, academic and clinical research subjects. This congress, encompassing as it does the subject of assistive technology, brings together both local and international experts and practitioners for an exchange of current knowledge, experience and views, which will strengthen the collaboration between the rehabilitation profession and human movement and the social and engineering sciences worldwide. An individual’s mobility is crucial for function, participation and quality of life. Addressing questions such as rehabilitation diagnosis, treatment strategy and monitoring, as well as assistive technology and environmental optimization, the benefits of exercise and sport and the issues of risks for overuse and secondary impairment, this book is a major contribution to debate, knowledge provision and development in this important area.
1. Introduction
Rehabilitation medicine in the Netherlands was officially founded as a separate medical profession in 1955. Being a young multidisciplinary area of clinical practice and health care, rehabilitation medicine evolved from an initially clinically-founded discipline towards a more academic-based discipline at the start of this millennium. In 2008 clinical rehabilitation care was offered in 24 specialized rehabilitation centers, in university hospitals and in many of the larger general hospitals in the Netherlands.
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Human Movement Sciences has been intimately linked to rehabilitation from its inception as an academic discipline in Amsterdam in the early seventies. As distinct from other Western countries, in the Netherlands the professional training of paramedical and nursing staff is outside the university teaching program and part of a separate system of higher education that primarily offers professional bachelor and master programs. This is where physio-, occupational, vocational therapists, physical education and sports teachers are trained, also for rehabilitation practice. Human movement scientists follow a research-oriented university-based training program, focussed on the study of human movement, both with a fundamental and an applied connotation. ‘Human movement sciences’ (HMS) is an interdisciplinary study, encompassing a wide range of disciplines such as (exercise) physiology, psychology, anatomy, biomechanics, motor control & learning etc. It is offered as an independent scientific bachelor-master program at two universities (Amsterdam
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2. The Dutch rehabilitation–research situation
The academic or research performance of the rehabilitation discipline in the Netherlands and Europe has been described briefly by Stam [5]. The survey involved the input in 4 key-rehabilitation sciences journals (Archives of Physical Medicine and Rehabilitation, Clinical Rehabilitation, Journal of Rehabilitation Medicine and Disability and Rehabilitation) throughout the year 2004. All publications were ranked to country of origin of the research and authors. The Netherlands ranked 3rd, among a group of 12 countries, and was responsible for 8% of the total number of publications. At (31%) the USA headed the list. However, the list would be quite different if the population size of each country were taken into account, as is indicated by Coppen and Bailey for a similar ranking on clinical medicine [6], where the USA ranked 9 and the Netherlands 6 on the number of citations per 1000 population. The impact of the contribution of the Netherlands to the field of rehabilitation research in an international context is considerable and in part explains the active organization of the current congress.
With the 4th International congress we also in part celebrate the 2nd lustrum and the success of the Rehabilitation program of the Netherlands Organization for Health Research and Development (ZonMw)
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Many rehabilitation centers and university departments, and thus the rehabilitation field and the patients, benefit to this day from the success of the ZonMw funding program. It has boosted the scientific infrastructure of rehabilitation centers, both in personel as well as in technical facilities. It has – above all – stimulated the academic observation and thinking processes in rehabilitation practice and boosted the number of rehabilitation professionals with a research background. This is clearly of crucial importance for the quality of rehabilitation treatment and outcome. The importance of such a rehabilitation research and sciences agenda was very clearly stipulated recently by Frontera and colleagues with their analysis of the North American rehabilitation situation [8,9]; the bottom line of their statement being that: “…survival of the (…rehabilitation…) specialty, may depend, among other things on the quality of the knowledge base. Very few things could be more important for our patients.”
3. 4th International State-of-the-art-Congress ‘Rehabilitation: mobility, exercise & sports’
It is indeed in the context of this brief history that the 4th International Congress ‘Rehabilitation: Mobility, Exercise & Sports’ is taking place, as a multidisciplinary event and team effort, and as a natural outcome of the continued collaboration between (local and international) rehabilitation professionals, human movement, social and engineering sciences. The current congress program follows the preceding congresses in 1991 [10], 1998 [11] and 2004 [12–14] and the academic evolvement of the organizing team in a very natural way.
The theme ‘Rehabilitation: Mobility, Exercise & Sports’ of the 4th International Congress has also evolved from the continued research work in recent years in the (inter)national context. The program follows the intricate collaboration between human movement sciences and rehabilitation professionals and practice, which among others have evolved in the working group ‘Rehabilitation’ of the Netherlands Society of Human Movement Sciences (VvBN)
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4. Mobility, Exercise & Sports
The theme of the congress, mobility exercise and sports in the context of rehabilitation practice, is of extremely great interest to human movement scientists, and rehabilitation professionals. It is indicated to be of key importance in the process of recovery in persons with chronic disease and in the context of long-term health [1,16,18–21].
Mobility is defined in the ICF as ‘…the ability moving by changing body position or location or by transferring from one place to another, by carrying, moving or manipulating objects, by walking, running or climbing, and by using various forms of transportation.’[2]. Being a mobile individual is crucial for function, participation and quality of life. The extent of mobility will be dependent on the structures and functions and the capacities of the individual, availability and quality of assistive technology and environmental optimization, as well as the interfacing between these and the individual. Above all, personal qualities will impact the final outcome (Figure 1) [1,2,15].
Important questions revolve not only around the functions and structures of individuals with different diagnoses but also around how these impact activities, participation and quality of life. Beyond that the role of assistive technology, environmental barriers and questions of their fine-tuning to individuals in the light of daily functioning (and sports) are issues for technologists and ergonomists, as well as for rehabilitation professionals and human movement scientists.
Rehabilitation practice, and the individual, can and will try to affect mobility through exercise, training and learning of motor skills and overall functional and physical capacities. Sports introduce a natural environment of physical exercise and skill learning as well as a social context of participation and enjoyment. Yet, diagnosis-specific guidelines for exercise and training as well as motor learning are often still limited in their scientific evidence-base [16,17]. Optimal strategies for rehabilitation have to be established in the context of long-term preservation of function, health and quality of life. Moreover, exercise and sports are supposed to have benefits, but the combination of impairment, assistive technology and intensity of daily activities, exercise and sports must also be viewed in the context of risks of overuse and secondary impairment, as has been described for manual wheelchair use [14,22–24]. Fine-tuning between assistive technology and individual functions and structures as well as the regular supervision and feedback of exercise and training in rehabilitation, activities of daily living and sports require a thorough understanding of underlying mechanisms and processes in a wide range of individuals, with different diagnoses, and at different levels of expertise and performance, from daily practice to elite sports at the Paralympics.
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5. What we seek for…
The current and future congresses seek for the evidence-base of mobility, exercise and sports in the context of rehabilitation diagnosis, treatment and strategy and also of long-term functioning, participation, health and quality of life. The ICF [2] is the leading contextual framework in the development of research activities, the organization of knowledge, understanding and clinical practice. The importance of the congress lies in the exchange of the state-of-the-art knowledge, lively debates and the exchange of experiences among a diversity of clinical professionals and researchers from different disciplines, backgrounds and countries, leading to a continued cross-cultural debate and exchange, as has been recently advocated as a necessity to further the international field of physical medicine and rehabilitation [26].
The keynote speakers, the oral program and the poster sessions assure such a formal and informal debate, during exhibition time, breaks, the social program and in leisure time. The congress model of a ‘one-track event for all’ has proved to be effective in that perspective and will lead to international exchange and collaboration.
As previously [10,11], and apart from the 3 day program, the congress will provide a congress book with 3-page summaries of all oral and poster contributions, which you see here in front of you. A set of 10–12 highlights of the congress will also be published in the well-established journal ‘Disability and Rehabilitation’ as a special issue. This will support the outcome of the congress as a tool in the international communication of rehabilitation and human movement sciences.
References
[1] Van der Ploeg, H.P., et al., Physical activity for people with a disability: a conceptual model. Sports Med, 2004. 34(10): p. 639–49.
[2] WHO, International Classification of Functioning, Health and Disability. 2001, Geneva: WHO.
[3] Gutenbrunner, G., A.B. Ward, and M.A. Chamberlain, White book on Physical and Rehabilitation Medicine in Europe. J Rehabil Med, 2006. 39: p. 1–48.
[4] Fletcher, R.W. and S.W. Fletcher, Knowledge Management, in Clinical Epidemiology, the essentials. 2005, Lippincott Williams & Wilkins: Philadelphia. p. 221–231.
[5] Stam, H.J., Research in physical and rehabilitation medicine in Europe: how are we doing? J Rehabil Med, 2006. 38(1): p. 1–2.
[6] Coppen, A. and J. Bailey, 20 most-cited countries in clinical medicine ranked by population size. Lancet, 2004. 363(9404): p. 250.
[7] de Groot, S., et al., Patient monitoring during inpatient spinal cord injury rehabilitation: implementation experiences of periodical testing. Disability & Rehabilitation. submitted.
[8] Frontera, W.R., Research and the survival of physical medicine and rehabilitation. Am J Phys Med Rehabil, 2006. 85(12): p. 939–44.
[9] Frontera, W.R., et al., Rehabilitation medicine summit: building research capacity. Executive summary. Arch Phys Med Rehabil, 2006. 87(1): p. 148–52.
[10] Van der Woude, L., et al., eds. Ergonomics of Manual Wheelchair Propulsion, State of the Art. 1993, IOS press: Amsterdam. 366.
[11] Van der Woude, L.H.V., M.T.E. Hopman, and C.H. Van Kemenade, eds. Biomedical Aspects of Manual Wheelchair Propulsion: State of the Art II. 1999, IOS press: Amsterdam. 392.
[12] JRRD, S.I., 3rd International Congress Restiration on (wheeled) mobility in sci rehabilitation. J Reh Res & Dev, 2004. 41(2, supplement 2): p. 1–85.
[13] JRRD, S.i., Background on the 3rd International Congress. J Reh Res Dev, 2005. 42(3, supplement 1): p. 1–110.
[14] T&D, 3rd international Congress ‘Restoration of (wheeled) mobility in SCI rehabilitation, State of the art II’ I: its background. Technology and Disability, 1005. 17: p. 55–123.
[15] Rimmer, J.H., Use of the ICF in identifying factors that impact participation in physical activity/rehabilitation among people with disabilities. Disabil Rehabil, 2006. 28(17): p. 1087–95.
[16] Frontera, W.R., D.M. Slovnik, and D.M. Dawson, eds. Exercise in rehabilitation medicine. 2nd ed. 2006, Human Kinetics Publishers. 454.
[17] Durstine, J.L. and G.E. Moore, ACSM's Exercise management for persons with chronic diseases and disabilities. 2003, Chapaign: Human Kintecs, ACSM.
[18] Durstine, J.L., et al., Physical activity for the chronically ill and disabled. Sports Med, 2000. 30(3): p. 207–19.
[19] Cooper, R.A., et al., Research on physical activity and health among people with disabilities: a consensus statement. J Rehabil Res Dev, 1999. 36(2): p. 142–54.
[20] Nash, M., Exercise as a health-promoting activity following spinal cord injury. J Neurological Physical Therapy, 2005. 29(2): p. 87–93.
[21] Rimmer, J.H. and D. Braddock, Health promotion for people with physical, cognitive and sensory disabilities: an emerging national priority. Am J Health Promot, 2002. 16(4): p. 220–4, ii.
[22] Nichols, P.J., P.A. Norman, and J.R. Ennis, Wheelchair user's shoulder? Shoulder pain in patients with spinal cord lesions. Scand J Rehabil Med, 1979. 11(1): p. 29–32.
[23] van Drongelen, S., et al., Upper extremity musculoskeletal pain during and after rehabilitation in wheelchair-using persons with a spinal cord injury. Spinal Cord, 2006. 44(3): p. 152–9.
[24] van Drongelen, S., et al., Glenohumeral joint loading in tetraplegia during weight relief lifting: a simulation study. Clin Biomech (Bristol, Avon), 2006. 21(2): p. 128–37.
[25] Vanlandewijck, Y., Sports Science in the Paralympic movement. J Rehab Res & Devel, 2006. 43(7): p. XVII–XXIV.
[26] Negrini, S. and W.R. Frontera, The Euro-American rehabilitation focus: a cultural bridge across the ocean. Am J Phys Med Rehabil, 2008. 87(7): p. 590–1.
Department of Rehabilitation Science & Technology, University of Pittsburgh, Pittsburgh, USA and Human Engineering Research Laboratories, Department of Veterans Affairs Rehabilitation Research and Development Service, Pittsburgh, USA World-wide this is an interesting time to participate in wheeled mobility research. The population of people who could benefit from wheeled mobility is growing at a rate of 5% percent per year by some estimates and at a rate of 22% per decade by more conservative numbers. Currently, about 100 million people around the planet use or would use a wheelchair if one were available. To this end, the World Health Organization commissioned a report to clarify best practices for wheelchair design, service delivery, and outcome measurement for low-income countries. In many respects this report is a model for all countries. Globally, there are pressures to reduce the costs associated with providing wheeled mobility, which is stifling innovation in some respects, but fueling the drive for greater scientific evidence. This is coupled with greater participation of people with disabilities as designers, engineers, scientists, and clinicians as the impact of accessibility and human-rights egislation begins to take effect. The future likely will require a much higher degree of scientific and medical evidence in order for quality wheeled mobility to be reimbursed by insurance companies. Fortunately, forward thinking clinicians and scientists have already started incorporating greater instrumentation and outcomes data collection. Consumers are becoming more involved in designing and selecting wheeled mobility through web-based tools that allow for wide-spread democratization of information. More educated and engaged clinicians and wheelchairs users who are or who work closely with scientists will eventually lead to greater mobility, community participation, and higher quality designs.
Purpose: To determine whether pain, posture and satisfaction with life change in persons with spinal cord injury after improvement in sagittal plane alignment via customized orthotic wheelchair configuration. Methods: Prospective repeated measure study. Participants: Eleven men with T1-T10 motor complete spinal cord injury. Main Outcome Measures: Seated Height (SH), Wheelchair User's Shoulder Pain Index (WUSPI), Posture Scale for Wheelchair Users (PSWU), pain intensity, and Satisfaction with Life Scale (SWLS). Results: Increase in SH was significant (p=.03), mean change of 2.57 centimeters (1.01 inches); 95% C.I.: 0.33 to 4.82. At two weeks, participants reported significantly less pain (-9.6) on the WUSPI (p=.03); C.I.: -18.34 to -0.87, and significantly lower ‘worst pain’ intensity (-1.18) (p=.04); C.I.: -2.3 to -0.4. Remaining outcomes did not show significant change. Conclusion: The results of this study support the use of wheelchair configuration to provide orthotic stabilization in the sagittal plane to the paralyzed trunk. Improved postural alignment was shown to decrease shoulder pain and intensity of pain measured two weeks post intervention. Early orthotic postural support via wheelchair configuration may prevent the negative sequelae of postural deviations and promote improved health outcomes.
The purpose of this study was to investigate adaptations in gross mechanical efficiency during asynchronous hand-rim wheelchair propulsion of novice able-bodied participants following 4 weeks of practice. Twenty seven male participants performed a series of five, 4-minute sub-maximal exercise bouts at 1.7 m·s-1. Arm frequencies consisted of the freely-chosen frequency (FCF), followed by 4 counter-balanced paced trials pushing at 60, 80, 120, and 140% of the FCF. Gross efficiency (GE) was determined. Participants were divided into two experimental groups (FCF, N = 9; 80% FCF, N = 8) and a control group (N = 8). The experimental groups received a 4-week propulsion practice period (3·wk-1, 12 practice trials) at 1.7 m·s-1. Post practice period all groups repeated the five 4-minute sub-maximal exercise bouts. Over the practice period the mean GE for the FCF condition increased in both experimental groups (+1.0 & 0.9%) compared to the control group (+0.1%) (P = 0.001). Arm frequency decreased at FCF in both experimental groups (P = 0.001), however, larger changes were observed in the FCF experimental group. Four weeks practice had a beneficial effect on metabolic cost and GE in male novice participants. This improved GE associated to the resulting changes in the self-selected arm frequency in both experimental groups, as an overall indicator of propulsion technique.
For many wheelchair users, performing transfers is essential for achieving independence with daily activities. However, transfers are particularly straining on the upper limbs and may contribute to the development of pain and overuse injuries at the shoulder. The purpose of this study was to determine the muscular demands of seven bilateral muscles acting at the shoulder and elbow during level and non-level transfers with and without a gap separating the wheelchair and target surface. Fourteen men with spinal cord injury transferred from their own wheelchair to a 1) level bench, 2) level bench with a 10 cm gap, 3) higher bench (+10 cm), 4) higher bench with a 10 cm gap, 5) lower bench (-10 cm), and 6) lower bench with a 10 cm gap in a random order. The maximum surface EMG reached during transfers was normalized to the subject's maximum EMG value reached during maximum static contractions for each muscle. Gaps required greater recruitment of the biceps and anterior deltoid muscles (p < 0.05). The increased muscle activation observed with gaps is likely due in part to increased combined shoulder flexion and abduction and glenohumeral joint strain on the anterior wall. As a result, individuals with SCI should be advised to position their wheelchair as close as possible to the surface they intend to transfer.
The determination of propulsive and recovery phases of manual wheelchair propulsion are important in estimating the efficacy of manual propulsion. With the actual potential of collection of database by different research team, manual determination of propulsive and recovery phases of each wheelchair cycle represents a tremendous amount of time. Automatic detection with only a single threshold and low-pass filtering is insufficient to detect initial and terminal phases during propulsion. The purpose of this work is to present a new adaptive method based on short-time spectral analysis (STSA) of forces and moment acting at the handrim level. Eight able-bodied subjects were asked to propel on ergometer with 3 slopes, while forces and moments were recorded with an instrumented rear wheels. The STSA was applied to raw signal and automatic detection was based on priori and a posterior probability of absence and presence of propulsive signal. Better results are obtained with the new adaptive method when compared to the classical method with one single threshold and one cut-off frequency per signal. This method will prove useful when monitoring manual propulsion for a long term, and with different types of propulsion and classification of pattern of daily activities.
The purpose of this study was to evaluate the effectiveness of force application and the load on the glenohumeral joint during handrim wheelchair propulsion at two different seat heights. In a research laboratory able-bodied male subjects propelled a wheelchair fitted with a SmartWheel on a treadmill at 3 different speeds, while power output was kept constant at 25 W by a pulley system. There was no effect of seat height on the propulsion effectiveness and the glenohumeral joint load under the current experimental conditions.
The purpose of this study is to present an analysis of wheelchair's rolling resistance which can be explain by the two wheel's rolling resistance factor λ1/r1 and λ2/r2, of the back wheel and of the front wheel respectively. Deceleration tests of manual wheelchair allowed calculating λ1/r1 and λ2/r2 from accelerometer measurements. For a rigid ground, λ2/r2 is almost 8,5 times higher to λ1/r1; so, the value of the wheel's rolling resistance factor is higher on front wheels. In this case, for a velocity of 1m/s and a total weight of 1000N, the power rolling resistance could be 11watt. This information shows the importance of the wheel's rolling resistance factor and of the centre of gravity position to study wheelchair locomotion.
Purpose: In order to build a realistic manual wheelchair simulator, an accurate dynamic model of the wheelchair-user system is needed. Besides, the characterization of this model necessitates the continuous knowledge of each caster wheel's orientation (CWO). The aim of this work is to propose a method that predicts these orientations based on the rear wheels' kinematics. Methods: A standard wheelchair equipped with two instrumented wheels was moved following straight and curvilinear patterns. A first-order model expressing the variation rate of the CWOs with respect to the rear wheels' kinematics was developed. The numerical integration of the model leads to an estimate of the CWOs. Simultaneously, the orientation of a caster wheel was measured using a three-dimensional optoelectronic system. Results: The estimated and the observed orientation values were compared. The estimation error was very low (<5 deg) when the orientation does not abruptly change, and stayed below 10 degrees at all times. Conclusion: Based on our data, it is possible to predict the CWOs with a fairly good accuracy using only the geometrical parameters of the wheelchair and the data from the instrumented rear wheels. This method is promising since it will help characterizing the wheelchair-user dynamic model in the future.
The goal of this project is to analyze data from the tracking sheets of therapists of the Center for Assistive Technology (CAT) at the University of Pittsburgh Medical Center to determine how much time is taken for delivery of manual or power wheelchairs and scooters. Executing the process in a timely manner is a necessary part of client satisfaction and quality of service. The average total days taken for delivering the mobility device were calculated as 110.00 +/- 70.11 days, which conforms to the goal of 100 days set by CAT. A total of 257 out of 549 (46.8%) devices delivered in 2007 and 2008 were delivered in 51-100 days. The longest time period in the delivery process was the period between when the report was completed and final delivery of the device which consisted heavily of insurance review. Therapists seemed to be able to facilitate delivery time by shortening the time for report writing as well as shortening times of vendor responsibilities. Manual wheelchairs had the longest delivery time, likely due to the need for customization and fitting. More research is needed to determine how diagnosis, insurance type, and vendors may influence delivery time.
Purpose: To develop a multimodal procedure for evaluating pressure ulcer-preventing cushions and conduct a comparison of the biomechanics and tissue response induced by 4 pressure ulcer-preventing cushions most commonly prescribed to patients with spinal cord injury in our hospital. Methods: Firstly, the distribution of pressures at the user-cushion interface was analyzed (Xsensor), and secondly, tissue viability was assessed by transcutaneous oxygen pressure (TcPO2) (Radiometer TCM 400) in 22 people with thoracic complete spinal cord injury (T1-T2). The variables analyzed were related with the distribution of pressures and contact surface at the user-cushion interface (Pmax, Pm, Psd, Stot, S>60 and % S>60) and tissue response (TcPO2). Results: The dual-compartment air cushion produced the best Pmax, Pm, Psd and Stot results compared to the other cushions (P<0.05). TcPO2 values did not differ significantly between cushions. Conclusion: A method was developed for the multimodal evaluation of pressure ulcer-preventing cushions that enhances our understanding of how these cushions behave and can help to prevent pressure ulcers in both sports and rehabilitation.
The purpose of this study was to evaluate the implementation of standardized physical and functional tests to individually monitor patients with a spinal cord injury (SCI) in 8 rehabilitation centers and to analyze enablers and barriers of the implementation process. A prospective effect- and process evaluation was performed. Team members responded to mailed questionnaires at the start (n=115) and end (n=82) of the one-year implementation period. Furthermore, a questionnaire was administered to managers (n=8), coordinators (n=8) and 32 persons with SCI in 4 centers. Outcome of the effect evaluation was the phase of implementation of standardized testing in each center. The process evaluation analyzed enablers and barriers of the implementation process. After a year of implementation, half of the centers shifted to higher implementation phases. None of the centers was classified in the highest phase. Enablers were the positive attitude of the team members regarding standardized testing and an encouraging local coordinator. Most important barrier was lack of time to implement standardized testing. It can be concluded that there is a large support for implementing standardized tests to monitor functioning of patients with SCI. During a year a positive shift was visible in the extent of implementation. Successful implementation of patient monitoring requires substantial amounts of time and effort of the rehabilitation centers involved.
Manual wheelchair propulsion is a well known factor of upper limb musculoskeletal disorders risk (ULMDR). Through a large bibliographic review, movement amplitude and repetition, proximity of joints limits, user overweight and vertical forces are commonly admitted as the main risk factors of upper limb injuries in wheelchair propulsion. Thus, we propose a clinically usable method to quantify ULMDR according to wheelchair kinematics. Through a synthesis of literature information, for the three upper limb joints, ergonomic indexes were grouped in a general equation to quantify ULMDR. A case study has been realized. A 3D analysis of upper limb motion during propulsion was made using a Vicon 460 system. Four different wheelchair configurations were tested: two seat heights and two anterior-posterior wheel positions. For both seat heights, computed ULMDR are less important for backward position. For both antero-posterior wheel positions, computed ULMDR are less important for the highest seat position. The results showed good promises at quantifying the impact of sitting changes on ULMDR. These ergonomic indexes could be helpful in clinical settings when prescribing a wheelchair. To validate this method, a longitudinal study will be performed. Forces applied on hand rims will be added in further development.
Introduction: Approximately 155, 000 Canadians depend on manual wheelchairs for locomotion [1] and an estimated 31-73% of these people will experience shoulder pain as a result of manual wheeling [2]. Biomechanical research into the determinants of shoulder pain has been inconclusive. However, to date there has been very little research into the neural control of manual wheeling. One concept is that rhythmic upper limb movement (such as arm swing, swimming, and possibly manual wheeling) is regulated by a central pattern generator (CPG) and follows a similar pattern of sensory processing as described for walking. This study will explore this concept by investigating the modulation of cutaneous reflexes during manual wheeling. Purpose: The purposes of this study are to determine if the cutaneous reflex response to stimulation of the superficial radial nerve are phase-dependent during manual wheeling, to determine if there is evidence of task specificity between manual wheeling and upper arm cycling and to determine if manual wheeling experience changes the pattern of reflex modulation during wheeling. Methods: Subjects will include 15 manual wheelchair users (MWUs) with spinal cord injury and 15 non-MWUs. All subjects will complete two tasks in a randomized order including wheeling on a wheelchair treadmill at a self-selected speed and arm cycling using an arm ergometer. Electrical stimulation of the superficial radial nerve will be conducted pseudorandomly throughout the wheeling cycle eliciting cutaneous reflex responses. EMG responses will be measured in 6 muscles. The wheeling cycle will be broken up into phases using a custom made program utilizing SmartWheel and Optotrak data. Cutaneous reflex responses will be grouped and averaged depending on the phase of the wheeling cycle and be compared between MWUs and non-MWUs. Anticipated Results: It is anticipated that that the difference in cutaneous reflex amplitude between stimulated and un-stimulated EMG responses will vary dependending on the phase of the wheeling cycle. It is also anticipated that task-dependency will be evident by greater amounts of cutaneous reflex modulation of the wheeling task compared to the arm cycling task and that a greater amount of modulation will be observed in the MWU group compared to the non-MWU group.
This pilot study tested the hypothesis that exercising on a wheelchair accessible treadmill improves cardiovascular fitness for manual wheelchair users without adverse effects on propulsion biomechanics or shoulder pain. Three manual wheelchair users participated in 30 minute exercise sessions three times per week for six-weeks using self-selected programs on a wheelchair accessible treadmill. Exercise capacity and propulsion biomechanics were assessed before and after the six week program. On average, subjects displayed increases in maximum VO2 (22.9%) and maximum heart rate (9.6%), while resting heart rate decreased (14.7%). Propulsion biomechanics and shoulder pain did not change. There were no adverse effects associated with extended use of the treadmill. The results suggest that persons with paraplegia can improve cardiovascular fitness through the regular aerobic exercise with a wheelchair accessible treadmill.
A wheelchair undergoes vibrations while traveling over obstacles and uneven surfaces, resulting in whole body vibration of the person sitting in the wheelchair. According to clinicians, people with spinal cord injury (SCI) report that vibration evokes spasticity. The relatively new Spinergy wheelchair wheels (Spinergy, Inc; San Diego, California) are claimed to absorb more road shock then conventional steelspoked wheelchair wheels. If this claim is true, this wheel might also reduce spasticity in people with SCI. We hypothesized that Spinergy wheels would absorb vibration, reduce perceived spasticity, and improve comfort in individuals with SCI more than standard steel-spoked wheels. To test this hypothesis, 22 nondisabled subjects performed a passive ramp test so that we could more closely examine the dampening characteristics of the Spinergy versus traditional wheels. Furthermore, 13 subjects with SCI performed an obstacle test with both wheel types. Vibrations were measured with accelerometers, and spasticity and comfort were assessed with subject-reported visual analog scales. The results of the study showed that, within the current experimental setup, the Spinergy wheels neither reduced vibration or perceived spasticity nor improved comfort in people with SCI more than the conventional steelspoked wheels.
In this work we present the Leveraged Freedom Chair (LFC), a wheelchair-based mobility aid designed specifically for the developing world. People with disabilities in developing countries have needs that differ drastically from those of people in the developed world; they most often do not have access to public transportation and are forced to travel long distances on rough terrain. Existing mobility aids, such Western-styled wheelchairs, are inefficient to propel and difficult to use off-road. Hand-powered tricycles, although more efficient for long distance travel, are too large to use in the home. The LFC is designed to fully suit the needs of people with disabilities in developing countries by utilizing upper body power through a lever-drive system. The drivetrain, which is made from locally available bicycle components, enables the user to select different gear ratios by sliding his or her hand up and down the levelers. The levers are sized to optimally convert upper body power when traveling on the variety of terrains encountered in the developing world.
To evaluate the reliability and validity of the extended Wheelchair Circuit fifteen dependent subjects with Spinal Cord Injuries performed the extended Wheelchair Circuit two times with 9.3 ± 11.3 days between the trials. Test-retest reliability and validity were calculated for the three outcome measures: ability score, the performance time score and the physical strain score. Validity was assessed by analyzing the scores of the Wheelchair Circuit on age, lesion level and completeness of the lesion. The intraclass correlation coefficients of the Wheelchair Circuit were 0.94 for ability score, 0.99 for performance time score and 0.82 for physical strain score at confidence level p<0.05. Validity was good using lesion level on both ability and performance time scores: a significant difference between scores of persons with para- and tetraplegia was found (p<.05). Age did not correlate with any of the scores and also completeness of the lesion was no factor for wheelchair skill performance. Comparing the original Wheelchair Circuit with the ability score of the extended Wheelchair Circuit showed that the variability and discrimination between subjects and groups improved, but floor and ceiling effect remained. The Extended Wheelchair Circuit is a reliable research tool. The ability and performance time score are valid scores. Further research should focus on validity (especially of the physical strain score) and floor and ceiling-effect reducing tasks using a larger and more varied study population.
Introduction: The Segway Personal Transporter® is a self-balancing, electric-powered transportation device. While the Segway has not been marketed to individuals with mobility impairments, we wish to investigate the potential this technology offers to enhance quality of life in this population. Objectives: To determine the functional abilities that are necessary for successful use of the SegwayPT® as a personal mobility device and to asses how it compares to clients' current method of mobility. Methods: Participants (n=22) underwent three training sessions with the Segway to correlate their functional ability with their skill level on the device based on a Segway Task Assessment tool. Secondly, of the 22 subjects, 10 subjects navigated a 25m obstacle course with their current mobility devices and then the Segway. Outcome measures were the Wheelchair Outcomes Measure (WhOM) score and the difference in the time required to complete the obstacle course. Results: All participants successfully completed the Segway Task Assessment, regardless of scores on functional assessments. There was a significant increase in WhOM score between subjects' current mobility method and using the Segway for client specific goals. Interestingly, some subjects felt remarkable improvements with their spasticity after using the Segway. Conclusion: The Segway may be a useful device for a broad range of populations with functional disabilities to meet their mobility goals. We are now exploring possible therapeutic benefits of using the Segway with respect to spasticity and fatigue in SCI.
A 2-D model has been designed for solving the problem of the subject-and-wheelchair fore-and-aft stability, and implemented into a simulation program, which computes the seat height and fore-and-aft position from the wheelchair dimensions, the subject's anthropometry, his sitting posture in the wheelchair, and a stability index chosen according to the subject's ability to control his equilibrium. This program should greatly help the medical staff for quickly and precisely choosing the wheelchair settings fitted to the patient's characteristics.
The physical capacity of wheelchair users is usually evaluated by their power output, which is generally calculated from the mechanical work of the resultant braking force only. This method does not take into account the kinetic energy variations of the subject-and-wheelchair system. The purpose of this study was to verify if these variations could be neglected for estimating the subject's mechanical work. Three young wheelchair users performed a straightforward displacement with a Wireless Wheelchair Ergometer. According to the subjects, their total estimated mechanical work could be 2 to 5 times higher than the mechanical work of the resultant braking force applied on the system. These results showed that the system's kinetic energy variations should not be neglected for estimating the subject's mechanical work in real conditions.