Measurement reliability of functional tasks for persons who self-propel a manual wheelchair

OBJECTIVE: To evaluate the reliability of 4 functional tasks relevant to wheelchair seating. DESIGN: Within-subject and between-rater comparisons. SETTING: Rehabilitation center in Canada. PARTICIPANTS: Two separate convenience samples of 10 male wheelchair users. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The 4 functional tasks were timed forward wheeling, ramp ascent, forward vertical reach distance, and ramp descent, scored by an ordinal performance scale. To determine test-retest reliability, the participants performed each task twice on the same day. To determine interrater reliability, 5 experienced therapists independently scored each participant. The ramp descent task was replaced with a 1-stroke push distance task due to difficulties with the interpretation of the ordinal performance scale. RESULTS: Testing of all tasks was completed within 45 minutes, allowing for rest periods. There were no adverse incidents. One individual with C6 quadriplegia 4 months after spinal cord injury was unable to complete the ramp ascent. Estimates for test-retest reliability of all 4 functional tasks were excellent (r=.99). Interrater reliability was calculated for all tasks except the 1-stroke push and found to be excellent (intraclass correlation coefficient=.99). CONCLUSIONS: The final 4 functional tasks are practical, safe, and reliable tests that may be used for clinical evaluation of wheelchair seating. Further research involving comparative assessments of wheelchair seating options is required to determine the discriminative ability of the tests.     

Outcomes of Wheelchair Systems Intervention With Residents of Long-Term Care Facilities

This pilot study was designed to measure the effects of individually prescribed wheelchair systems on posture and reach, mobility, quality of life, and satisfaction with technology for residents of long-term care facilities. Thirty persons 60 years of age or older who resided permanently in a long-term care facility and who used seating and mobility systems for 6 hours or more each day were recruited for this project. Outcomes included timed independent mobility, forward and lateral reach, quality of life, and satisfaction with assistive technology. The study used semicrossover design with participants measured three times. Measurements were first made in the existing seating and mobility system and a second time immediately after participants were provided with individually prescribed seating and mobility systems. The final measurement was 3 months after the delivery of the individually prescribed system. Results indicated that individually fitted wheelchair systems for elderly residents of long-term care facilities are beneficial. Participants had less difficulty independently propelling their systems and increased forward reach, quality of life, and satisfaction with assistive technology. The study used semicrossover design with participants measured three times. Measurements were first made in the existing seating and mobility system and a second time immediately after participants were provided with individually prescribed seating and mobility systems. The final measurement was 3 months after the delivery of the individually prescribed system. Results indicated that individually fitted wheelchair systems for elderly residents of long-term care facilities are beneficial. Participants had less difficulty independently propelling their systems and increased forward reach, quality of life for social function and physical role, and satisfaction with the new wheelchair technology. Persons residing in extended care facilities benefit from receiving individually prescribed wheelchair systems. The individual systems enhance elderly persons' independent mobility, functional reach, feeling of well-being, and satisfaction with their assistive technology.     

Outcomes of wheelchair systems intervention with residents of long-term care facilities

This pilot study was designed to measure the effects of individually prescribed wheelchair systems on posture and reach, mobility, quality of life, and satisfaction with technology for residents of long-term care facilities. Thirty persons 60 years of age or older who resided permanently in a long-term care facility and who used seating and mobility systems for 6 hours or more each day were recruited for this project. Outcomes included timed independent mobility, forward and lateral reach, quality of life, and satisfaction with assistive technology. The study used semicrossover design with participants measured three times. Measurements were first made in the existing seating and mobility system and a second time immediately after participants were provided with individually prescribed seating and mobility systems. The final measurement was 3 months after the delivery of the individually prescribed system. Results indicated that individually fitted wheelchair systems for elderly residents of long-term care facilities are beneficial. Participants had less difficulty independently propelling their systems and increased forward reach, quality of life for social function and physical role, and satisfaction with the new wheelchair technology. Persons residing in extended care facilities benefit from receiving individually prescribed wheelchair systems. The individual systems enhance elderly persons' independent mobility, functional reach, feeling of well-being, and satisfaction with their assistive technology.     

C5和C6脊髓损伤患者与正常人在伸肘活动中上肢的角位移及角速度比较

目的研究C5和C6脊髓损伤（SCI）患者在伸肘活动中上肢的运动策略。方法采用Peak Motus运动解析系统对15例C5和C6水平SCI患者和15例正常人在抓取杯子、触摸开关、驱动轮椅和利用上肢负重4项伸肘动作中肩、肘、腕关节的角位移及角速度进行分析。结果与正常人相比，SCI患者在抓取杯子、触摸开关、驱动轮椅动作中的运动时间明显延长（P〈0．05）；在触摸开关和驱动轮椅动作中的角速度明显减慢（P〈0．05）；在前3项伸肘活动中，SCI患者主要依靠增加或减小肩关节的角位移来完成运动任务，而在利用上肢负重的动作中，则通过改变肩、肘关节在矢状面上的运动方向来代偿其功能缺陷。结论C5和C6水平SCI患者采用与正常人不同的运动模式和策略来完成伸肘活动。     

Assessing the influence of wheelchair technology on perception of participation in spinal cord injury

OBJECTIVE: To investigate factors related to the wheelchair, impairment, and environment that affect perception of participation of persons with spinal cord injury (SCI) in activities performed in 3 settings: in the home, in the community, and during transportation. DESIGN: Cross-sectional study. SETTING: Research centers and a specialized assistive technology (AT) clinic in Pittsburgh (Pitt). Research centers and community-based rehabilitation technology suppliers in Saint Louis (SL). PARTICIPANTS: Seventy wheelchair users with SCI. INTERVENTIONS: Subjects from Pitt and SL completed a written survey of AT usage in daily activities. MAIN OUTCOME MEASURES: Subjects were asked 5 questions within each setting (home, community, transportation) related to their perceived reason for functional limitations. RESULTS: The wheelchair was the most commonly cited factor limiting participation, followed by physical impairment and physical environment. Twenty-one percent of subjects with paraplegia reported pain as a limiting factor for their transportation use, significantly more (P=.047) than subjects with tetraplegia (3%). A trend (P=.099) was seen toward a higher percentage of subjects with tetraplegia (tetraplegia, 7%; paraplegia, 3%) reporting lack of equipment as a limiting factor for use of transportation. Differences were also seen across sites. CONCLUSIONS: The wheelchair was the most commonly cited limiting factor, followed by physical impairment and physical environment. The wheelchair is the most important mobility device used by persons with SCI and the one that users most associate with barriers.     

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

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, >or=18 y) 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 MEASURE: 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.     

Functional tasks exercise versus resistance exercise to improve daily function in older women: a feasibility study

OBJECTIVE: To evaluate the feasibility of a new functional tasks exercise program, designed to improve functional performance of community-dwelling older women, by comparing it with a resistance exercise program. DESIGN: A 12-week, randomized, single-blind pilot study. SETTING: A community leisure center. PARTICIPANTS: Twenty-four community-dwelling, medically stable women (mean age, 74.6+/-4.8 y) were randomized to the functional tasks exercises (function group) or the resistance exercises (resistance group). Three participants withdrew from the study. INTERVENTIONS: Exercises were given 3 times weekly for 12 weeks. The functional tasks exercise program aimed to improve daily tasks in the domains first affected in older adults, whereas the resistance exercise program focused on strengthening the muscle groups that are important for functional performance. MAIN OUTCOME MEASURES: Participant satisfaction with the exercises, Assessment of Daily Activity Performance (ADAP), and, as a secondary outcome, muscle strength and power. RESULTS: Exercise adherence was 81% in the function group and 90% in the resistance group. Participants reported greater satisfaction with the resistance exercises than with the functional exercises. The ADAP total score improved with time (P =.001; mean change function group, 7.5 U; 95% confidence interval [CI], 2.1-12.8; resistance group, 2.8 U, 95% CI, -0.4 to 5.9), as did isometric knee extensor strength (P =.001; mean change function group, 6.4%; 95% CI, -1.6 to 14.5; resistance group, 14.4%; 95% CI, 6.4-22.2). Testing for differences in outcomes between the 2 groups showed no statistically significant differences. CONCLUSIONS: The functional tasks exercise program is feasible and shows promise of being more effective for functional performance than a resistance exercise program. A randomized controlled trial with a larger sample size is needed to test the difference between the 2 programs.     

Correlations among trunk impairment,functional performance,and muscle activity during forward reaching tasks in patients with chronic stroke

[Purpose] This study aimed to investigate the relationships among trunk impairment, functional performance, and muscle activity during forward reaching tasks in patients with chronic stroke. [Subjects and Methods] Twenty-three chronic stroke patients participated in this study. Trunk impairment and functional performance were evaluated using the Trunk Impairment Scale, Berg Balance Scale, Timed Up and Go Test, and 10-Meter Walk Test. All subjects were asked to perform 3 different forward reaching tasks (affected side reaching, forward reaching, and less-affected side reaching), and measurements were taken during these 3 tasks by using surface electromyography. Correlation analyses were performed to assess the relationships among trunk impairment, functional performance, and muscle activity during the forward reaching tasks. [Results] Spearman’s correlation analysis revealed a strong, significant correlation between the Trunk Impairment Scale and functional performance, that was associated with balance and gait ability. During the 3 different forward reaching tasks, muscle activities of the less-affected lower extremity were significantly correlated with functional performance. [Conclusion] This study revealed the correlations among trunk impairment, functional performance, and muscle activity during forward reaching tasks in patients with chronic stroke and emphasized the importance of trunk rehabilitation.Key words: Electromyography, Postural balance, Stroke     

Clinical trial of exercise for shoulder pain in chronic spinal injury

BACKGROUND AND PURPOSE: The high prevalence of shoulder pain in wheelchair users may be related to the repetitive use of the upper limbs during self-care and wheelchair-related activities. The purpose of this study was to determine the effects of a controlled 8-week, scapula-focused exercise intervention on pain and functional disability in people with spinal cord injury (SCI) and shoulder impingement symptoms. SUBJECTS: Forty-one manual wheelchair users (with SCI and spina bifida), both with (n=21) and without (n=20) shoulder impingement symptoms, participated. METHODS: The study design was a clinical trial with an asymptomatic control group. Subjects completed the Wheelchair User's Shoulder Pain Index (WUSPI) and the Shoulder Rating Questionnaire (SRQ) and provided patient satisfaction scores at initial and 8-week visits. Subjects in the intervention group were instructed in a home exercise program consisting of stretching and strengthening exercises. Subjects in the asymptomatic control group received no intervention. An analysis of variance model was used to test for group and time effects for the WUSPI, SRQ, and satisfaction scores. RESULTS: Subjects in the intervention group showed significant improvements in all measures as a result of the intervention, whereas asymptomatic control group subjects remained stable. DISCUSSION AND CONCLUSION: A selective 8-week home exercise program is effective in reducing pain and improving function and satisfaction in this population of wheelchair users.     

A pilot study of functional access to public buildings and facilities for persons with impairments

Purpose: To compare functional access to public buildings and facilities for persons with and without impairments.

Method: This is a cross-sectional pilot study with a survey design. A four-member participant team representing three impairment types: mobility impaired person using a wheelchair, mobility impaired person who was not a wheelchair user, visually impaired person, and a control with no known impairments, challenged a stratified random sample of 30 public buildings in Greater Boston. Using a task oriented data collection instrument, functional access was determined in terms of percentage of tasks performed, time, distance, barriers and facilitators.

Results: Overall, task performance was high for the team. However, the wheelchair user reported a lower task performance (81%) in comparison to the control (100%) and persons with mobility and visual impairments (97 - 98%). There was little variation in mean values for time and distance to complete tasks. More barriers were reported by the persons with mobility impairments, wheelchair user and non-wheelchair user, and; highest facilitators by the person with visual impairment and the wheelchair user. The control reported the lowest barriers and facilitators. The types of barriers and facilitators varied for the three impairments and the control - structural for wheelchair and mobility impairments, wayfinding for visual impairment and interpersonal for control.

Conclusions: Task performance by itself may not be a good predictor of functional access. Barriers and facilitators are critical to understanding issues related to functional access for persons with impairments. Knowledge of how these differ for different impairments can be useful for improving environmental access and rehabilitation.     

A pilot study of functional access to public buildings and facilities for persons with impairments

Purpose: To compare functional access to public buildings and facilities for persons with and without impairments.

Method: This is a cross-sectional pilot study with a survey design. A four-member participant team representing three impairment types: mobility impaired person using a wheelchair, mobility impaired person who was not a wheelchair user, visually impaired person, and a control with no known impairments, challenged a stratified random sample of 30 public buildings in Greater Boston. Using a task oriented data collection instrument, functional access was determined in terms of percentage of tasks performed, time, distance, barriers and facilitators.

Results: Overall, task performance was high for the team. However, the wheelchair user reported a lower task performance (81%) in comparison to the control (100%) and persons with mobility and visual impairments (97?–?98%). There was little variation in mean values for time and distance to complete tasks. More barriers were reported by the persons with mobility impairments, wheelchair user and non-wheelchair user, and; highest facilitators by the person with visual impairment and the wheelchair user. The control reported the lowest barriers and facilitators. The types of barriers and facilitators varied for the three impairments and the control – structural for wheelchair and mobility impairments, wayfinding for visual impairment and interpersonal for control.

Conclusions: Task performance by itself may not be a good predictor of functional access. Barriers and facilitators are critical to understanding issues related to functional access for persons with impairments. Knowledge of how these differ for different impairments can be useful for improving environmental access and rehabilitation.     

Exploiting interlimb coupling to improve paretic arm reaching performance in people with chronic stroke

OBJECTIVE: To determine whether paretic arm reaching performance is improved in bilateral compared with unilateral conditions. DESIGN: Cohort study. SETTING: University human performance laboratory. PARTICIPANTS: Thirty-two subjects with chronic stroke (57+/-14y; on Fugl-Meyer Assessment arm score, 37+/-14). INTERVENTION: Unilateral and bilateral reaching. Bilateral tasks included varying levels of weight on the nonparetic hand. MAIN OUTCOME MEASURES: An electromagnetic tracking system recorded hand peak acceleration, velocity, and movement time. A 2-way repeated-measures analysis of variance and Tukey-adjusted pairwise comparisons were used to analyze the results (alpha=.05). RESULTS: Paretic differed significantly from nonparetic peak acceleration and velocity in unilateral reaching but not bilateral reaching. Within limbs, the paretic arm attained a higher peak acceleration (P<.001) and velocity (P=.03) in the bilateral compared with the unilateral task, but movement time was unchanged between tasks. Nonparetic peak acceleration was higher (P=.015), velocity was unchanged, and movement time increased (P=.005) in the bilateral compared with the unilateral task. The addition of a weight to the nonparetic arm during bilateral reaching did not result in further improvement in paretic arm performance. CONCLUSIONS: Interlimb coupling effects during bilateral reaching are retained even after chronic stroke and can be used to produce an immediate improvement in paretic arm reaching performance.     

Reaching upward is more challenging to dynamic balance than reaching forward

BACKGROUND: Older adults have less confidence in their ability to reach upward compared to reaching forward. The forward reach test may, therefore, not be ideally suited for detecting functional deficits that directly affect daily activities. METHODS: A new test of upward reach and forward reach (along a 50-degree track) were administered to young and older adults. Reach distance was adjusted for foot length and normalized to stature. The anterior safety margin was calculated by relating the center of pressure to the base of support. The extent to which age, sex, balance confidence, anthropometric, and center of pressure parameters contribute to forward and upward reach performance was assessed. FINDINGS: Reach and anterior safety margin scores were well-correlated between forward and upward reaching, but the upward reach test posed a greater challenge to dynamic balance - eliciting a smaller anterior safety margin from both older and younger subjects. Further, compared to young adults, older adults showed greater limitations in reach distance and balance parameters during upward reach compared with forward reach. An observational measure of reach strategy (whether or not the heels were raised from the platform during the test) differentiated between higher and lower reach performance for older adults. Anthropometric variables accounted for much of the variance in reach performance that would otherwise have been attributed to an age-related loss of functional capacity. Balance confidence scores also contributed to regression models predicting upward - but not forward - reach performance in older adults. INTERPRETATION: Though upward and forward reach performances were well related in this sample, a test of upward reach may be better suited to reveal early signs of functional decline in older adults than a test of forward reach.     

Article 14: Effect of a wheelchair-mounted robotic arm on functional outcomes in persons with spinal cord injury

Objective: To determine the effect of a wheelchair-mounted robotic arm (WMRA) on function in persons with spinal cord injury (SCI). Design: Participants enrolled in the 2-week protocol. Setting: Veterans Affairs medical centers in Houston and Pittsburgh. Participants: 11 men (mean age, 42±12y) with cervical SCI (C3-4 to C6-7). All used power wheelchairs with joystick controls. Intervention: Training took place for 6 hours over 3 days. Subjects practiced activities of daily (ADL) tasks for 14 hours over 7 days. Tasks were timed and subjects were classified functionally as dependent (0), needs assistance (1), or independent (2). After 2 weeks, they were reevaluated for functional improvement with the WMRA. Main Outcome Measures: Number and time to complete tasks were calculated. Results: Mean ADL scores (independence) at reevaluation were significantly higher (P<.02) than at baseline. Average ADL performance times decreased from 226 to 171 seconds, a statistically significant reduction in time (P<.0001). Data revealed significant differences in subjects’ functional independence and time to complete tasks with the WMRA in 7 activities (P<.05). Conclusions: The WMRA has the potential to enable persons with SCI to perform functional tasks that would otherwise be impossible for them. However, design problems (ie, added wheelchair width when WMRA is installed) interfered with maximum utilization and satisfaction.     

Utilization and user satisfaction with alternating pressure air cushions: a pilot study of at-risk individuals with spinal cord injury

Purpose: An appropriate wheelchair cushion is integral to pressure ulcer (PU) prevention for the wheelchair user with SCI. For users who find it difficult to remember or perform weight shifts, an alternating pressure air cushion (APAC) may off-load pressure to minimize PU risk. APACs are considered mobility assistive technology (AT). Effective AT delivery includes consideration of the AT consumer as a unique individual. The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) is a structured and standardized method to measure user satisfaction with AT. Method: Twelve full time wheelchair users with SCI were provided with an APAC six times for 2 weeks daily home use every 3 months. At the completion of the 18-month study period, the 8-variable QUEST 2.0b questionnaire was applied to evaluate satisfaction with APAC use. Results: Users were generally quite satisfied with APAC weight (p?<?0.01 relative to neutral). Durability was more likely to be an area of concern. Overall, 92% of participants considered themselves quite satisfied or very satisfied with APAC use (p?<?0.001). Conclusions: Users with SCI were satisfied with the overall performance of the APAC tested after repeated periods of use. The majority of user's were very satisfied with APAC comfort overall.

• Implications for Rehabilitation

• Abandonment of AT may be reduced if user satisfaction is evaluated.

• The QUEST 2.0b is a useful and valid measure of user satisfaction with alternating pressure air cushions.

• In the current study cohort, users with SCI were satisfied with the performance and comfort of the APAC tested after repeated periods of use.

     

The comparison of motor performance between part and whole tasks in elderly persons.

OBJECTIVE: When teaching clients a multistep functional task, therapists tend to break down the task into part tasks with discrete movements. The purpose of this study was to compare the kinematic performance between part and whole tasks in elderly persons. METHOD: A counterbalanced repeated-measures design was used. Twenty elderly persons without motor problems (7 men, 13 women) performed a signature task in two conditions. For the part-task condition, the participants did the task in a step-by-step manner: (a) reach for a pen, (b) bring the pen to the paper, and (c) sign the name. For the whole-task condition, the participants performed the task in an integrated continuous flow. Kinematic performances for two movement segments (i.e., reaching for the pen, bringing the pen to the paper) were compared between conditions. RESULTS: Generally, the whole-task condition elicited a more efficient, more forceful, and smoother movement than the part-task condition. CONCLUSION: The results suggest the importance of keeping a multistep functional task whole.     

The usability of six physical performance tasks in a rehabilitation population with chronic low back pain

OBJECTIVE: To examine the influence of task experience on the difference between test and retest and to assess test-retest reliability and limits of agreement of six performance tasks in chronic low back pain patients. These measures will be used to define the clinical usability. DESIGN: Test-retest of six performance tasks in a group of patients with no experience and a group of patients after previous experience with these tasks. SETTING: Three rehabilitation centres. SUBJECTS: Fifty-three patients with non-specific chronic low back pain. MAIN MEASURES: Five-minute walking, 50-ft (15 m) fast walking, sit-to-stand, loaded forward reach, 1-min stair-climbing and Progressive Isoinertial Lifting Evaluation (PILE). To assess the influence of task experience, differences between test and retest between both groups were tested using Mann-Whitney test. For both groups together, intraclass correlation coefficients (ICCs) and the limits of agreement using Bland and Altman plots were calculated. RESULTS: Thirty patients with no task experience and 23 patients who had already undertaken the tasks on at least two occasions participated. Both groups showed similar differences between test and retest. The test-retest reliability for the total study population was good to very high: ICC varied from 0.74 to 0.99. For the total study population, the limits of agreement expressed as percentage of the mean score of each task was low to moderate for 5-min walking and 1-min stair-climbing (21% and 20% respectively), moderate for 50-ft (15 m) fast walking, sit-to-stand and forward reach (33%, 29% and 36% respectively) and high for the PILE (48%). CONCLUSIONS: Task experience did not significantly influence test-retest differences. All tasks showed sufficient test-retest reliability. Based on the natural variability of the tasks, the 5-min walking and stair-climbing task, and to a lesser degree the 50-ft (15 m) walking, sit-to-stand and loaded forward reach, seem clinically useful. There are major concerns about the usability of the PILE.     

Chair configuration and balance control in persons with spinal cord injury

OBJECTIVE: To study whether chair configuration influences sitting balance in persons with spinal cord injury (SCI). DESIGN: Cross-sectional group study. SETTING: Rehabilitation centers and hospital rehabilitation departments. PATIENTS: Ten complete high thoracic SCI (level T2-T8) patients, 10 complete low thoracic SCI (T9-T12) patients, and 10 matched able-bodied controls. SCI participants had completed their active rehabilitation at least 6 months before the study. INTERVENTIONS: A balance-changing (forward) reaching task while seated in four differently configured chairs. Tilt angle (7 degrees and 12 degrees) and reclination angle (22 degrees) were varied relative to a standard chair configuration (10 degrees reclination). MAIN OUTCOME MEASURES: Maximal unsupported reaching distance, center-of-pressure displacement and muscle activity. RESULTS: Although no significant difference in actively controllable reach was found in controls or in subjects with low SCI, sitting balance improved in all chairs relative to the standard chair. Ability to control displacement of arms and trunk during reaching improved. No apparent need for additional postural muscle activity was found. Persons with high SCI did not improve their sitting balance. They were unable to control a shift in body mass larger than the one induced by arm movement. However, they had less muscle activity after backrest reclination or tilting the chair backwards. CONCLUSIONS: The tested chairs had an overall positive effect. However, for individually tailored chair configurations factors other than those investigated should be considered.