A new design for an old concept of wheelchair pushrim

Purpose: Report on the development of an ergonomic manual wheelchair pushrim and evaluate the user’s perception of the quality of the device. Method: Based on anthropometric features and ergonomic concepts, a new wheelchair pushrim was designed, and a prototype was manufactured in polyurethane, using the rapid prototyping technique and serial production of parts by molding. The prototype was tested by a sample of wheelchair users, who rated the perceived quality of the device after testing both the new and conventional pushrims in a wheelchair propulsion experimental protocol. Results: The new ergonomic pushrim was found to be, in general, better than the conventional round tube pushrim. Specifically, experienced wheelchair users found the new wheelchair pushrim better in terms of easy and comfortable propulsion, braking and maneuvering of the wheelchair, and appearance. Conclusions: The new wheelchair pushrim provides a proper fit for the hands due to its ergonomic design and its polyurethane composition, making wheelchair propulsion easier and more comfortable than the conventional wheelchair pushrim. Assistive technology devices should be design based on ergonomic concepts that involve less effort and offer greater comfort for the user.

Implications for Rehabilitation

• Manual wheelchair propulsion has been related with upper limb injuries that may potentially limit functionality.

• The conventional pushrim does not meet the need for a firm and stable grip, requiring further effort to hold the pushrim during manual propulsion that may cause discomfort, pain and contribute for developing upper limb injuries.

• In a relatively small sample of wheelchair users, this study shows that an ergonomically designed pushrim makes manual propulsion easier and more comfortable compared to the conventional pushrim.

     

Manual wheelchair propulsion on ramp slopes encountered when boarding public transit buses

Abstract

Objective: To compare the kinetics of manual wheelchair (MWC) propulsion on ramps of varying slopes that may be encountered when accessing large accessible transit vehicles (LATVs).

Design: Observational study.

Setting: Biomechanics research laboratory.

Participants: A convenience sample of able-bodied adults (n?=?7) having no propulsion experience propelled a MWC on ramps of slope 3.5°, 9.5° and 15°.

Interventions: Not applicable.

Main outcome measures: Resultant (F_res), radial (F_r) and tangential (F_t) forces applied to the wheelchair pushrim, rate of rise of resultant force (ROR), peak power output (P), temporal characteristics and thigh to trunk angle were analyzed across three ramp slopes.

Results: Pushrim forces and power output significantly increased with increasing slope, with peak F_res more than doubling from 107?N on a 3.5° slope to 230?N on a 15° slope. ROR was 1.76 times higher at 9.5° and 2.47 times higher at 15° compared to a 3.5° slope. Minimum thigh to trunk angle decreased sharply from 80° (3.5° slope) to 50° (9.5° slope) and then to 30° (15° slope) as ramp slope increased.

Conclusions: Ascending bus ramps require greater power and pushrim force on steeper ramp slopes, presenting a potential barrier to transportation accessibility. Given this finding, it is imperative that bus operators minimize ramp slope to assure MWC users are able to access LATVs.

• Implications for Rehabilitation

• Although transit bus ramps are intended to provide wheelchair access to public transportation, limitations in MWC user physical strength and function may prevent safe access.

• Transit bus ramp slopes encountered during ingress can present a challenge to MWC users given power output and pushrim force requirements to ascend the ramp.

• MWC users and therapists should be aware of ramp slopes that may be encountered when boarding transit buses; wheelchair training should incorporate skills needed to ascend transit bus ramps.

     

A review of manual wheelchairs

Purpose: To review the scientific literature published in the last 14 years on the different types of manual wheelchairs. Method: A systematic review of the literature was conducted to find the recent research on manual wheelchairs. Results: The findings of 77 references on pushrim-propelled wheelchairs, crank-propelled wheelchairs, lever-propelled wheelchairs, geared manual wheelchairs and pushrim-activated power-assist wheelchairs are reported. Conclusion: The pushrim-propelled wheelchair is light, easy to steer and has good indoor manoeuvrability but is very inefficient and causes serious upper body overloading so that long-term use leads to steadily deteriorating capability for the user and ultimately a transition to a powered chair. Whilst the latter is less physically demanding, the sedentary lifestyle and decreasing muscle use lead to several secondary health problems. Crank- and lever-propelled wheelchairs and geared pushrim wheelchairs are more efficient and less demanding and may improve the quality of life of the user by expanding the range of accessible environments, reducing upper body pain, increasing independence and avoiding or delaying the ‘debilitating cycle’. However, wheelchairs with these alternative modes of propulsion are often heavier, wider and/or longer and are less easy to steer, brake and fold than the pushrim wheelchair.

• Implications for rehabilitation

• Pushrim-propelled wheelchairs are difficult to drive on outdoor paths (grass and gravel/sand surfaces) and ramps so that users are confined to restricted environments and have limited participation in everyday activities.

• The repetitive strain imposed on the upper body by pushrim propulsion leads to very high prevalence of shoulder and wrist pain in manual wheelchair users.

• Crank-propelled and lever-propelled wheelchairs are more efficient and less straining than pushrim propelled wheelchairs, allowing users to access more challenging environments, prolong independence and improve the quality of life.

     

Design,testing and evaluation of angle-adjustable backrest hardware

Purpose: The purpose of this study was to design and evaluate a final design prototype of angle-adjustable backrest hardware. Methods: A traditional iterative design development protocol was undertaken and completed. Before evaluation by a focus group, testing of the prototype was performed in strict accordance with ISO standards. Focus group participants were between 18 and 80 years of age, used a manual wheelchair as their primary means of mobility, and transferred independently. Individuals with pressure sores or who required of the use of specialized or custom seating for trunk support were excluded from the study. A questionnaire was administered to elicit participants’ opinions on the adjustability, function and appearance of the angle-adjustable backrest device. Results: The prototype successfully met the ISO testing standards. Wheelchair users (n?=?8) who evaluated the device in a focus group had an overall positive response. Things they most liked about the prototype were comfort, support (function/activities) and adjustability, while things they most disliked about the prototype were problems with string and reaching back position to adjust. Conclusions: The prototype had a positive impression from participants, however, improvements on the operation method and usability were suggested.

• Implications for Rehabilitation

• The adjustable backrest is in need of development to provide function, comfort and support for manual wheelchair users.

• Manual wheelchair users will benefit by using the angle adjustment as they maintain their active lifestyles.

• Balance control while performing pressure relief in a wheelchair would be increased.

     

Comfort and stability of wheelchair backrests according to the TAWC (tool for assessing wheelchair discomfort)

Purpose: The goal of this study was thus to determine if people with different types of wheelchair backrests on their personal wheelchairs reported different levels of comfort as measured by the Tool for Assessing Wheelchair disComfort (TAWC). Methods: Participants were between 18 and 80 years of age and were manual wheelchair users. The TAWC was used to assess the participants’ wheelchair seating discomfort levels with the wheelchair and seating systems. Results: We surveyed 131 wheelchair users to assess the comfort of their backrests on their personal wheelchairs and found a trend suggesting that rigid backrests are were less comfortable as compared with sling backrests. This finding was statistically significant in a subgroup of participants with tetraplegia. Conclusions: Although many clinicians expect rigid backrests to be more comfortable because they may provide more support, the higher discomfort ratings among rigid backrest users with tetraplegia may be due to sub-optimal shape, fit, adjustment or user preferences.

• Implications for Rehabilitation

• Development of a measure for long-term seating discomfort is needed.

• Design and development of better rigid backrests that are functional but provide adequate comfort are in need.

     

Development of a wheelchair maintenance training programme and questionnaire for clinicians and wheelchair users

Purpose of state: The aims of this study were to develop a Wheelchair Maintenance Training Programme (WMTP) as a tool for clinicians to teach wheelchair users (and caregivers when applicable) in a group setting to perform basic maintenance at home in the USA and to develop a Wheelchair Maintenance Training Questionnaire (WMT-Q) to evaluate wheelchair maintenance knowledge in clinicians, manual and power wheelchair users.

Methods: The WMTP and WMT-Q were developed through an iterative process.

Results: A convenience sample of clinicians (n?=?17), manual wheelchair (n ∞ 5), power wheelchair users (n?=?4) and caregivers (n?=?4) provided feedback on the training programme. A convenience sample of clinicians (n?=?38), manual wheelchair (n?=?25), and power wheelchair users (n?=?30) answered the WMT-Q throughout different phases of development. The subscores of the WMT-Q achieved a reliability that ranged between ICC(3,1)?=?0.48 to ICC(3,1)?=?0.89. The WMTP and WMT-Q were implemented with 15 clinicians who received in-person training in the USA using the materials developed and showed a significant increase in all except one of the WMT-Q subscores after the WMTP (p?<?0.007).

Conclusion: The WMTP will continue to be revised as it is further implemented. The WMT-Q is an acceptable instrument to measure pre- and post-training maintenance knowledge.

• Implications for Rehabilitation

• The Wheelchair Maintenance Training Program can be used to educate rehabilitation clinicians and technicians to improve wheelchair service and delivery to end users.

• This training complements the World Health Organization basic wheelchair service curriculum, which only includes training of the clinicians, but does not include detailed information to train wheelchair users and caregivers.

• This training program offers a time efficient method for providing education to end users in a group setting that may mitigate adverse consequences resulting from wheelchair breakdown.

• This training program has significant potential for impact among wheelchair users in areas where access to repair services is limited.

     

The effects of four different stroke patterns on manual wheelchair propulsion and upper limb muscle strain

Purpose: To evaluate the effects of stroke pattern on handrim biomechanics and upper limb electromyography (EMG) in experienced wheelchair users. Method: Subjects propelled their own wheelchair on a level, motor-driven treadmill using each of four identified stroke patterns: arcing, double loop (DL), semi-circular (SC) and single loop (SL). Upper limb EMG and measurements taken from an instrumented wheelchair wheel were compared for each pattern. A one-way ANOVA with Bonferroni correction (p < 0.05) was used to check for significant differences. Results: The DL and SC patterns produced the best overall results. The DL pattern led to a significantly longer contact angle and significantly less braking moment than the SL and arcing patterns, and a significantly lower cadence than the SL pattern. The SC pattern led to a significantly longer contact angle than the SL pattern and the lowest peak force and impact of any pattern. There were no significant differences in integrated EMG (IEMG); however, the DL and arcing patterns produced lower combined IEMG values. Conclusions: When traversing level terrain, wheelchair users should push with either the DL or SC patterns. Between the two, the DL pattern required less muscle activity and may be a better choice for experienced wheelchair users.

Implications for Rehabilitation

• Manual wheelchair propulsion is essential for many individuals with lower limb impairments; however, it often leads to upper limb pain, which can limit mobility and quality of life.

• Stroke patterns that reduce upper limb demand can help users reduce their risk of pain.

• The double loop (DL) and semi-circular (SC) stroke patterns produced the best combinations of handrim biomechanics and are therefore recommended for use.

• Due to an observed increase in elbow muscle activity, individuals who use the DL pattern are not encouraged to switch to the SC pattern.

     

Effects of synchronous versus asynchronous mode of propulsion on wheelchair basketball sprinting

Abstract

Purpose: This study aimed to first investigate synchronous (SYN) versus asynchronous (ASY) mode of propulsion and, second, investigate the wheel camber effects on sprinting performance as well as temporal parameters. Method: Seven wheelchair basketball players performed four maximal eight-second sprints on a wheelchair ergometer. They repeated the test according to two modes of propulsion (SYN and ASY) and two wheel cambers (9° and 15°).

Results: The mean maximal velocity and push power output was greater in the synchronous mode compared to the asynchronous mode for both camber angles. However, the fluctuation in the velocity profile is inferior for ASY versus SYN mode for both camber angles. Greater push time/cycle time (Pt/Ct) and arm frequency (AF) for synchronous mode versus asynchronous mode and inversely, lesser Ct and rest time (Rt) values for the synchronous mode, for which greater velocity were observed. Conclusions: SYN mode leads to better performance than ASY mode in terms of maximal propulsion velocity. However, ASY propulsion allows greater continuity of the hand-rim force application, reducing fluctuations in the velocity profile. The camber angle had no effect on ASY and SYN mean maximal velocity and push power output.

• Implications for Rehabilitation

• The study of wheelchair propulsion strategies is important for better understanding physiological and biomechanical impacts of wheelchair propulsion for individuals with disabilities.

• From a kinematical point of view, this study highlights synchronous mode of propulsion to be more efficient, with regards to mean maximal velocity reaching during maximal sprinting exercises.

• Even if this study focuses on well-trained wheelchair athletes, results from this study could complement the knowledge on the physiological and biomechanical adaptations to wheelchair propulsion and therefore, might be interesting for wheelchair modifications for purposes of rehabilitation.

     

Interrater and intrarater reliability of the wheelchair skills test version 4.2 for power wheelchair users

Purpose: The purpose of this study is to estimate the interrater and intrarater reliability of the Wheelchair Skills Test (WST) Version 4.2 for powered wheelchairs operated by adult users.

Materials and methods: Cohort study with a convenience sample of occupational therapists (n?=?10). For the main outcome measure, participants viewed and scored eight videos of adult power wheelchair users completing the 30 skills of the WST Version 4.2 on two occasions, a minimum of two weeks apart. Using these scores, we calculated intraclass correlation coefficients to estimate interrater and intrarater reliability.

Results: The interrater reliability intraclass correlation coefficient was 0.940 (95%CI 0.862–0.985). Intrarater reliability intraclass correlation coefficients ranged from 0.923 to 0.998.

Conclusions: The WST Version 4.2 has excellent interrater and intrarater reliability and is a reliable tool for use in clinical and research practice to evaluate a power wheelchair user’s skill capacity.

• Implications for Rehabilitation

• The Wheelchair Skills Test for Powered Wheelchair Users (WST-P 4.2) is a useful addition to the clinical tools available for clinicians who assess and train for powered wheelchair use.

• The WST-P 4.2 has excellent reliability and potential for clinical use as a pre-post measure of powered wheelchair skills.

• Clinicians using the WST-P 4.2 should attempt to maintain consistent scoring procedures, particularly for those skills that may require subjective assessment of skill safety.

     

The potential impact of intelligent power wheelchair use on social participation: perspectives of users,caregivers and clinicians

Purpose: To explore power wheelchair users’, caregivers’ and clinicians’ perspectives regarding the potential impact of intelligent power wheelchair use on social participation. Methods: Semi-structured interviews were conducted with power wheelchair users (n?=?12), caregivers (n?=?4) and clinicians (n?=?12). An illustrative video was used to facilitate discussion. The transcribed interviews were analyzed using thematic analysis. Results: Three main themes were identified based on the experiences of the power wheelchair users, caregivers and clinicians: (1) increased social participation opportunities, (2) changing how social participation is experienced and (3) decreased risk of accidents during social participation. Conclusion: Findings from this study suggest that an intelligent power wheelchair would enhance social participation in a variety of important ways, thereby providing support for continued design and development of this assistive technology.

• Implications for Rehabilitation

• An intelligent power wheelchair has the potential to:

• Increase social participation opportunities by overcoming challenges associated with navigating through crowds and small spaces.

• Change how social participation is experienced through “normalizing” social interactions and decreasing the effort required to drive a power wheelchair.

• Decrease the risk of accidents during social participation by reducing the need for dangerous compensatory strategies and minimizing the impact of the physical environment.

     

Differences in outcomes between the JoyBar control and standard wheelchair joystick control on two maneuverability tasks: a pilot study

Purpose: To determine if older adult, novice wheelchair users who drive a power wheelchair with a JoyBar control complete maneuverability tasks in less time and with less error than those who drive a power wheelchair with a standard joystick control.

Materials and methods: A parallel randomized controlled trial design conducted at a medical rehabilitation and research centre with ambulatory older adults aged 60 and above (n?=?27). The intervention was the JoyBar alternative wheelchair control. The primary outcome measure was total time to complete each of the two maneuverability tasks. The secondary outcome measure was total number of errors during each of the maneuverability tasks.

Results: An independent, two sampled t-test was conducted and revealed that the JoyBar group took a greater amount of time to complete both maneuverability tasks than the control group (p?p?Conclusions: Maneuverability of a powered wheelchair by novice wheelchair users was not improved through the use of the JoyBar when compared to a standard wheelchair joystick, as measured by rates of error and time to complete maneuverability tasks.

• Implications for rehabilitation

• Clients who are new to powered wheelchair use may perform maneuverability tasks faster, with equivalent accuracy, using a standard joystick versus the JoyBar.

• Clients who use a JoyBar may require adjustments to the programming of their wheelchair to ensure optimal performance.

• Additional training may be required to achieve proficiency in maneuverability tasks with a JoyBar versus a standard joystick.

     

Manual wheelchair tilt-rest skill: a cross-sectional survey of awareness and capacity among wheelchair users

Abstract

Purpose: The tilt-rest skill consists of tipping the wheelchair back and allowing it to rest against a solid object with the wheel locks applied (e.g., for pressure redistribution, neck comfort or hands-free activities). The objective of this study was to determine the proportion of experienced manual wheelchair users who are aware of this skill and who can perform it.

Materials and methods: We conducted a cross-sectional survey of 49 manual wheelchair users using a questionnaire developed for the purpose. The tilt-rest skill was attempted by those who reported that they were capable of performing it.

Results: Participants’ mean (SD) age was 55.1 (18.2) years, 38 (77.6%) were male, their median (IQR) duration of wheelchair use was 2 (7.2) years and their mean (SD) daily time spent in the wheelchair was 9.5 (4.6) hours. Twenty-seven (55.1%) participants were aware of the skill, 19 (38.8%) reported being able to perform the skill and 16 of 47 (34.0%) were able to demonstrate the skill. Multivariate modelling with the question “Can you complete the tilt-rest skill?” as the dependent measure revealed an inverse relationship with age – Odds Ratio (95% Confidence Interval) of 0.476 (0.293, 0.774) (p?=?.0028) for each 10?year increase in age.

Conclusions: Only just over half of manual wheelchair users are aware of the tilt-rest skill and one-third of users can perform it. Older people are less likely to report being able to complete the skill. These findings have implications for wheelchair skills training during the wheelchair-provision process.

• Implications for Rehabilitation

• Only just over half of manual wheelchair users are aware of the tilt-rest skill and only about one-third of users can perform it.

• Older people are less likely to report being able to complete the skill.

• These findings have clinical implications for wheelchair skills training during the, specifically that clinicians responsible for manual wheelchair-provision process should ensure that appropriate wheelchair users have the opportunity to learn this skill.

     

Learning to use a rear-mounted power assist for manual wheelchairs

Abstract

Objectives: 1) To investigate how much training manual wheelchair users perceive is required to learn to use a rear-mounted power assist safely and confidently. 2) To evaluate how the power assist affected wheelchair users’ ability to negotiate a standardized obstacle course, wheelchair skills capacity and wheelchair mobility confidence.

Method: This study used a pre- versus post-test intervention design. Outcome measures included a standardized obstacle course, and modified versions of the Wheelchair Skills Test 4.2 (WST) and the Wheelchair Confidence Measure.

Results: The 11 participants felt safe and confident using the power assist within one to two training sessions. However, some potential safety concerns were noted. Participants performed two obstacle course tasks significantly more quickly with the power assist.

Conclusions: Participants felt safe using the device with limited training and the device facilitated some mobility task performance. Further research is needed to understand the outcomes of long-term, community use.

• Implications for Rehabilitation

• Most experienced wheelchair users wanted only one or two training sessions with a new rear mounted power assist device; however, some safety concerns were noted.

• The device did not appear to affect user’s confidence.

• The device enabled users to perform some mobility tasks more quickly and allowed some users to perform some mobility tasks they were unable to perform in their regular MWC.

     

Wheeled mobility skills of wheelchair basketball players: a randomized controlled study

Purpose: The aim of this study was to assess the influence of wheelchair basketball sport on the functional abilities of wheelchair users.

Method: This is a randomized controlled study. Wheelchair basketball players (n?=?111) and non-player (n?=?85) were included in this study. We administered the questionnaire version of the wheelchair skills test questionnaire (WST_Q), recording the participants’ capacity and performance scores on each of 32 skills.

Results: Player group have the baseline values of WST_Q higher than control group. The mean total percentage score of player group was significantly greater than control group (p?<?0.05). The get over 15?cm level (respectively, rations of capacity and performance of groups: player/control: 50.5–20% and 54.1–24.7%) and the ascends 10° incline (player/control 96.4–48.2% and 98.2–54.1%).

Conclusions: Participation in regular wheelchair basketball sport may preserve and augment functional abilities in with wheelchair user

• Implications for rehabilitation

• The skills-sports relationship is reciprocal. With increased wheelchair skills, people may be more inclined to engage in sports; subsequently, with greater sports, wheelchair skills could improve.

• Wheelchair mobility skills during clinical rehabilitation should reflect the daily activities and needs of each wheelchair user. WST-Q provides advantages in terms of requiring less time and material in using of clinical.

     

Psychosocial factors associated with physical activity in ambulatory and manual wheelchair users with spinal cord injury: a mixed-methods study

Purpose: To identify psychosocial factors which explain lower levels of leisure time physical activity (LTPA) in persons with spinal cord injury (SCI) who are ambulatory relative to those who use manual wheelchairs. Method: For the quantitative study component, 347 adults with SCI (78% male; M age?=?47.7) completed baseline measures of LTPA attitudes, subjective norms, perceived behavioural control and intentions. Six months later, LTPA was assessed. The qualitative component involved semi-structured interviews with six ambulant adults with SCI (five male, M age?=?52.8) addressing LTPA experiences with an emphasis on barriers and facilitators. Results: Ambulatory individuals had poorer attitudes towards LTPA than chair users (p?=?0.004). Their attitudes had significant indirect effects on LTPA, through intentions. Perceived behavioural control was a significant negative predictor of LTPA. Qualitative analysis revealed three themes: an underestimated disability, low wheelchair skill self-efficacy and experiencing chronic pain. Conclusions: Poorer attitudes towards LTPA may partially explain why ambulatory individuals are less active. The qualitative and quantitative data suggest ambulators are an often-overlooked subgroup in need of targeted resources to enhance their attitudes, wheelchair skill self-efficacy and awareness of LTPA opportunities.

• Implications for Rehabilitation

• Rehabilitation practitioners must be sensitive to the unique needs of spinal cord injured individuals who are ambulatory, and tailor physical activity promotional strategies to suit the needs of this distinct group.

• Lack of wheelchair skills is a participation barrier for ambulators; ambulators should be introduced to activities that do not require wheelchair use, such as swimming, hand-cycling and adapted forms of circuit training.

• Strategies that encourage wheelchair skill development in non-wheelchair using ambulators, may increase physical activity opportunities for this segment of the spinal injured population.

     

Goal satisfaction improves with individualized powered wheelchair skills training

Purpose: To determine improvements in goal satisfaction following individualized mobility-related powered wheelchair skills training and whether changes in satisfaction are maintained 3 months post-training.

Materials and methods: Seventeen powered wheelchair users, from two centres, who were randomized to the training intervention from a larger multicentre study, were included in this secondary analysis. The intervention consisted of five 30-min individualized Wheelchair Skills Training Program sessions. Participants rated their current satisfaction with each of their goals from 0 to 10 (10 being the highest) prior to training, immediately after the intervention, and approximately 3 months following the intervention. Themes relating to the participants’ goals were also explored.

Results: Goal satisfaction scores improved statistically (p?r?=?0.387, n?=?17, p?=?.125). The majority of goals set fell into the broader “manoeuvring” category.

Conclusion: Goal satisfaction following the Wheelchair Skills Training Program improved years after initially learning how to operate a powered wheelchair. The five training sessions were effective in improving goal satisfaction. The quantification of goal satisfaction appears to be a sensitive outcome for powered wheelchair users undergoing mobility-related training.

• Implications for rehabilitation

• Goal satisfaction improved following the Wheelchair Skills Training Program.

• Even with years of powered wheelchair experience, the majority of goals set fell into the broader “manoeuvring” category.

• An individual’s goal satisfaction may not correlate with whether they have attained their goal as determined by a trainer.

     

Important wheelchair skills for new manual wheelchair users: health care professional and wheelchair user perspectives

Purpose: The purpose of this project was to identify wheelchair skills currently being taught to new manual wheelchair users, identify areas of importance for manual wheelchair skills' training during initial rehabilitation, identify similarities and differences between the perspectives of health care professionals and manual wheelchair users and use the ICF to organize themes related to rehabilitation and learning how to use a manual wheelchair. Method: Focus groups were conducted with health care professionals and experienced manual wheelchair users. ICF codes were used to identify focus group themes. Results: The Activities and Participation codes were more frequently used than Structure, Function and Environment codes. Wheelchair skills identified as important for new manual wheelchair users included propulsion techniques, transfers in an out of the wheelchair, providing maintenance to the wheelchair and navigating barriers such as curbs, ramps and rough terrain. Health care professionals and manual wheelchair users identified the need to incorporate the environment (home and community) into the wheelchair training program. Conclusions: Identifying essential components for training the proper propulsion mechanics and wheelchair skills in new manual wheelchair users is an important step in preventing future health and participation restrictions.

• Implications for Rehabilitation

• Wheelchair skills are being addressed frequently during rehabilitation at the activity-dependent level.

• Propulsion techniques, transfers in an out of the wheelchair, providing maintenance to the wheelchair and navigating barriers such as curbs, ramps and rough terrain are important skills to address during wheelchair training.

• Environment factors (in the home and community) are important to incorporate into wheelchair training to maximize safe and multiple-environmental-setting uses of manual wheelchairs.

• The ICF has application to understanding manual wheelchair rehabilitation for wheelchair users and therapists for improving the understanding of manual wheelchair use.

     

Everyday life for users of electric wheelchairs – a qualitative interview study

Purpose: The aim of this paper is to explore how users of electric wheelchairs experience their everyday life and how their electric wheelchairs influence their daily occupation. Occupation is defined as a personalized dynamic interaction between person, task and environment, and implies the value and meaning attached. Method: Nine semi-structured interviews were conducted with experienced electric wheelchair users. ValMo was used as the theoretical framework for both interviewing and the analysis. The transcribed interviews were analysed using thematic analysis. Results: Findings revealed key elements in electric wheelchair users’ experience of how the use of a wheelchair influences everyday life and occupation. Four central themes emerged from the participants’ experiences 1) The functionality of the wheelchair, 2) The wheelchair as an extension of the body, 3) The wheelchair and social life, and 4) The wheelchair and identity issues. The themes were interrelated and show how all levels of occupation were influenced both in a positive and negative way, and how it affected identity. Conclusions: It is essential that professionals working with electric wheelchair users are aware of how all levels of occupation and identity are influenced by using a wheelchair. This will assist professionals in supporting the users living an autonomous and meaningful life.

Implications for Rehabilitation

• All levels of occupation and identity are influenced by using a wheelchair.

• It is important that the electric wheelchair functions as an extension of the user’s body and that surroundings are made as accessible as possible.

• When choosing an electric wheelchair it is important that professionals make assessments that embrace all levels of the user’s occupation.

     

A systematic review: the influence of real time feedback on wheelchair propulsion biomechanics

Background: Clinical guidelines recommend that, in order to minimize upper limb injury risk, wheelchair users adopt a semi-circular pattern with a slow cadence and a large push arc.

Objectives: To examine whether real time feedback can be used to influence manual wheelchair propulsion biomechanics.

Review methods: Clinical trials and case series comparing the use of real time feedback against no feedback were included. A general review was performed and methodological quality assessed by two independent practitioners using the Downs and Black checklist. The review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines.

Results: Six papers met the inclusion criteria. Selected studies involved 123 participants and analysed the effect of visual and, in one case, haptic feedback. Across the studies it was shown that participants were able to achieve significant changes in propulsion biomechanics, when provided with real time feedback. However, the effect of targeting a single propulsion variable might lead to unwanted alterations in other parameters. Methodological assessment identified weaknesses in external validity.

Conclusions: Visual feedback could be used to consistently increase push arc and decrease push rate, and may be the best focus for feedback training. Further investigation is required to assess such intervention during outdoor propulsion.

• Implications for Rehabilitation

• Upper limb pain and injuries are common secondary disorders that negatively affect wheelchair users’ physical activity and quality of life.

• Clinical guidelines suggest that manual wheelchair users should aim to propel with a semi-circular pattern with low a push rate and large push arc in the range in order to minimise upper limbs’ loading.

• Real time visual and haptic feedback are effective tools for improving propulsion biomechanics in both complete novices and experienced manual wheelchair users.