Tissue Shape and Deformation Versus Pressure as a Characterization of the Seating Interface

A review of pressure measurements as a characterization of the seating interface is presented along with a discussion of their limitations in evaluating potentially adverse conditions that may lead to pressure sore formation. A theoretical rationale is then developed for using tissue shape and deformation, in contrast to pressure, as a conceptualization of the seating interface. Previous studies that have investigated shape and deformation as a characterization of the seating interface, as well as those that have utilized shape measurement for cushion fabrication, are reviewed in light of the theoretical rationale presented. It is concluded that although the efficacy of tissue shape and deformation as a characterization of the seating interface has not been clinically proven, they provide a more direct measure of the net effect of external load, mechanical tissue properties, and boundary conditions (cushion effects) as compared to pressure measurements.     

Transportation Safety Standards for Wheelchair Users: A Review of Voluntary Standards for Improved Safety,Usability, and Independence of Wheelchair-Seated Travelers

Safe transportation for wheelchair users who do not transfer to the vehicle seat when traveling in motor vehicles requires after-market wheelchair tiedown and occupant restraint systems (WTORS) to secure the wheelchair and provide crashworthy restraint for the wheelchair-seated occupant. In the absence of adequate government safety standards, voluntary standards for the design and performance of WTORS, and for wheelchairs used as seats in motor vehicles, have been developed. The initial versions of these standards qualify equipment for use in all types and sizes of motor vehicles using a 30-mph (48-kph), 20-g frontal sled-impact test. The wheelchair standard requires four accessible, crash-tested securement points on wheelchairs so they can be more easily and effectively secured using a four-point strap-type tie-down system. Future voluntary standards are aimed at reducing injury risk for wheelchair-seated occupants in rear impacts and at providing a method for evaluating the crashworthiness of wheelchair seating systems independent of wheelchair base-frames. They also address improved usability and independence for wheelchair-seated travelers using public transportation by specifying universal docking interface geometry for wheelchairs and design and performance requirements for rear-facing wheelchair passenger stations for use in the very low-g environments of large fixed-route transit buses.     

Riding a Bus While Seated in a Wheelchair: A Pilot Study of Attitudes and Behavior Regarding Safety Practices

A total of 283 wheelchair-seated bus riders responded to a 35-item Web-based survey investigating their experiences on public, fixed-route buses. The survey addressed the use of wheelchair tiedowns and occupant restraint systems (WTORS), the attitudes and behaviors of wheelchair users toward the use of this equipment, and the transit experience. Results indicate that consistent use of four-point tiedown and occupant restraint systems is fairly low. Only 33.2% of the participants reported always securing their wheelchair, and 62.2% reported using occupant restraints consistently. A preference for fixed-route over paratransit was related to larger city size. Implementation of transit agency policy regarding WTORS was found to be inconsistent. Easier-to-use WTORS and improved operator training in larger transit agencies would likely increase the correct use of safety equipment and improve wheelchair users' bus-riding experiences.     

Responsiveness of the Seated Postural Control Measure and the Level of Sitting Scale in children with neuromotor disorders

Purpose.?Responsiveness of the Seated Postural Control Measure (SPCM) and the Level of Sitting Scale (LSS) was explored for children with neuromotor disorders. Total change scores for alignment (SPCM-A), function (SPCM-F) and sitting ability (LSS) were compared with a criterion change measure, the Global Change Scale (GCS). The a priori hypotheses predicted moderate correlations (r?>?0.40).

Method.?Both SPCM and LSS were administered twice, 6 months apart. Parents and two therapists rated changes in alignment and function, and indicated importance of those changes on the GCS. Participants (n?=?114) were divided into two groups: those whose posture was expected to change, (with a range of diagnoses) and those who were expected to remain stable (with a diagnosis of cerebral palsy). Ages ranged from 1 to18 years.

Results.?Fair-to-moderate significant correlations (p?≤?0.01) were found between SPCM-F and LSS change scores and parents' and therapists' rating of change and importance of change on the GCS. Correlations for SPCM-A change scores were insignificant. The standardised response mean values for SPCM-F and LSS confirmed a minimal clinically important difference.

Conclusions.?SPCM-F shows promise as a responsive outcome measure, however; SPCM-A requires further work. LSS may be useful for evaluative purposes, in addition to its role as a classification index.     

北京市发育障碍儿童康复及其影响因素调查

目的了解发育障碍儿童接受康复的情况及其影响因素。方法采用问卷调查法调查北京市残疾儿童调查中确定的三类发育障碍儿童269人,其中智力组237人、肢体组57人、精神组26人。结果智力组从未接受过康复训练/医疗的比例为71.31%;肢体组为33.93%;精神组为42.31%;康复服务主要集中在功能训练和医学治疗方面,心理咨询等服务极少;发育障碍儿童是否采取康复的影响因素包括独生子女与否(P<0.01)、母亲年龄(P<0.001)、母亲文化程度(P<0.05)、父母是否知道发育迟缓儿童需早期干预(P<0.001)、合并残疾种类数(P<0.001)等。结论影响残疾儿童康复的影响因素很多,应该对贫困家庭采取康复救助政策,当务之急是加强康复服务方面的健康教育,对残疾人及其家属开展康复知识普及服务。     

社区康复在残疾人康复体系中的意义及发展现状

社区康复作为社区发展计划的一项康复策略,具有覆盖面广、方便、经济、有效的特点,可有效提高社区残疾人的生存质量,在我国得到发展推广。目前在残疾人中开展社区康复也面临诸多问题,已不能满足社区残疾人多样化的康复需求,所以宣传社区康复理念、建立康复队伍、加强多部门合作,重视农村社区康复发展成为必然趋势。     

Comparison of seating,powered characteristics and functions and costs of electrically powered wheelchairs in a general population of users

Purpose: To profile and compare the seating and powered characteristics and functions of electrically powered wheelchairs (EPWs) in a general user population including equipment costs.

Method: Case notes of adult EPW users of a regional NHS service were reviewed retrospectively. Seating equipment complexity and type were categorized using the Edinburgh classification. Powered characteristics and functions, including control device type, were recorded.

Results: 482 cases were included; 53.9% female; mean duration EPW use 8.1 years (SD 7.4); rear wheel drive 88.0%; hand joystick 94.8%. Seating complexity: low 73.2%, medium 18.0%, high 8.7%. Most prevalent diagnoses: multiple sclerosis (MS) 25.3%, cerebral palsy (CP) 18.7%, muscular dystrophy (8.5%). Compared to CP users, MS users were significantly older at first use, less experienced, more likely to have mid-wheel drive and less complex seating. Additional costs for muscular dystrophy and spinal cord injury users were 3–4 times stroke users.

Conclusions: This is the first large study of a general EPW user population using a seating classification. Significant differences were found between diagnostic groups; nevertheless, there was also high diversity within each group. The differences in provision and the equipment costs across diagnostic groups can be used to improve service planning.

• Implications for Rehabilitation

• At a service planning level, knowledge of a population’s diagnostic group and age distribution can be used to inform decisions about the number of required EPWs and equipment costs.

• At a user level, purchasing decisions about powered characteristics and functions of EPWs and specialised seating equipment need to be taken on a case by case basis because of the diversity of users’ needs within diagnostic groups.

• The additional equipment costs for SCI and MD users are several times those of stroke users and add between 60 and 70% of the cost of basic provision.

     

两省一市残联及卫生系统康复治疗师现状调查

目的 了解山东、河南及北京残联及卫生系统康复治疗师现状.方法采用问卷调查法对两省一市残联及卫生系统收集数据进行统计分析.结果残联系统康复治疗师学历以本科以下为主,河南最高为85.8％,北京最低为52.6％;无医学背景者河南、山东均占50.0％以上,北京仅为2.5％;无资格证书现象均在20.0％以上,河南高达83.0％,差异均有统计学意义(P＜0.001).卫生系统康复治疗师学历以本科以下为主,山东最高为98.6％,河南、北京为50.0％以下;职称以初中级为主;无资格证书以河南最高67.7％,山东、北京接近50.0％,差异均有统计学意义(P＜0.05).结论两省一市康复从业人员数量不足、康复专业人员整体水平偏低的现状亟待改善.     

Are Seating Systems With a Medial Knee Support Really Helpful for Hip Displacement in Children With Spastic Cerebral Palsy GMFCS IV and V?

Objective

To evaluate whether medial knee support (MKS) in seating systems aggravates hip displacement in children with cerebral palsy (CP).

Wheelchair service provision education and training in low and lower middle income countries: a scoping review

Purpose: Improving access to education and training for those providing wheelchair and seating assistive technology to meet personal posture and mobility requirements, as a basic human right, is a priority. This review considers education and training available to personnel within low and lower middle income countries (LLMIC), to ascertain where gaps in knowledge exist and identify human resource education priorities.

Method: A scoping review, mapping out existing scientific and grey literature within the field between 1993 and 2017 was conducted. The search strategy included use of online databases, manual analogue searches and key stakeholder informant advice. A content analysis process was applied to organize the literature retrieved and extract key themes.

Results: Education and training in LLMIC appears ad hoc and limited, however, there is growing recognition as to its importance, notably by the World Health Organization and nongovernmental organizations, delivering education initiatives to a number of countries, along with the development of a credentialing test. Inconsistency exists regarding personnel responsible for wheelchair provision, with no specific professional clearly recognized to oversee the system within many LLMIC.

Conclusions: Education and training is required for all stakeholders involved in wheelchair provision. Advocating for programme development to enhance personnel skills, build capacity and ensure best practice is a priority. Pilot sites, delivering and credentialing appropriate wheelchair provision education and training within context should be considered. Measuring outcomes and transferable skills should be part of education programme delivery structures. Considering a new discipline responsible for oversight of wheelchair provision should be investigated.

• Implications for rehabilitation

• Education and training is an essential step in the wheelchair provision process in the bid to obtain an appropriate wheelchair via appropriate provision services. However, it is more than education and training; its a human rights issue.

• Mandatory education and training needs to be a requirement for all stakeholders involved in wheelchair provision.

• Key wheelchair personnel need to establish their central role in this arena.

• The study raises awareness as to the importance of working with governments to commit to building sustainable wheelchair provision infrastructures.

     

Cross-Validation of a Screening Tool to Distinguish Between Fallers and Nonfallers in Community-Dwelling Older Adults With Knee Osteoarthritis

ObjectivesThis study aimed to cross-validate a previously developed knee osteoarthritis falls (KOAF) screening tool to distinguish between fallers and nonfallers among community-dwelling older adults with knee osteoarthritis (OA).DesignCross-sectional survey study.SettingThree independent orthopedic clinics.ParticipantsOlder outpatients with knee OA (N=86; 71 women, 15 men; mean age, 75.2±6.2y).InterventionsNot applicable.Main Outcome MeasuresThe primary outcome was to identify fallers and nonfallers among outpatients with OA based on their history of falls within the past year. We investigated factors including sex, age, body mass index, Kellgren-Lawrence grade, affected side (bilateral or unilateral knee OA), number of comorbidities, pharmacotherapy, physical therapy, pain, and activity as individual predictors of falls. Participants performed the one-leg standing test and the 5 times sit-to-stand test to determine motor function. Sensitivity, specificity, likelihood ratio, and post-test probability of the KOAF screening tool were calculated using receiver operating characteristic (ROC) curve analysis.ResultsThe results of the one-leg standing test and 5 times sit-to-stand test differed significantly between the 2 groups (P<.05). ROC curve analysis showed that the area under the curve was 0.88 (95% confidence interval, 0.80-0.96; P<.001). The post-test probability of falls was 83.3% (positive likelihood ratio, 11.54) when the total score of KOAF screening tool was 2 points and 2.6% (negative likelihood ratio, 0.06) when the total score of KOAF screening tool was less than 1 point.ConclusionsCross-validation results for the KOAF screening tool were better, confirming that the screening tool could distinguish between fallers and nonfallers with high accuracy. Our findings suggest that this simple screening tool could be readily used in clinical practice and could aid in clinical decision-making through providing choices for physical therapy evaluation and recommendations for physical therapy programs.