Shoulder magnetic resonance imaging findings in manual wheelchair users with spinal cord injury

Objective: To investigate the prevalence of rotator cuff and long head of the biceps pathologies in manual wheelchair (MWC) users with spinal cord injury (SCI).Design: Cross-sectional study.Setting: Outpatient clinic at a tertiary medical center.Participants: Forty-four adult MWC users with SCI (36 men and 8 women) with an average age (SD) of 42 (13) years. SCI levels ranged from C6 to L1; complete and incomplete SCI.Outcome Measures: Participants’ demographic and anthropometric information, presence of shoulder pain, Wheelchair User’s Pain Index (WUSPI) scores, and magnetic resonance imaging findings of shoulder pathologies including tendinopathy, tendon tears, and muscle atrophy.Results: Fifty-nine percent of the participants reported some shoulder pain. The prevalence of any tendinopathy across the rotator cuff and the long head of biceps tendon was 98%. The prevalence of tendinopathy in the supraspinatus was 86%, infraspinatus was 91%, subscapularis was 75%, and biceps was 57%. The majority of tendinopathies had mild or moderate severity. The prevalence of any tears was 68%. The prevalence of tendon tears in the supraspinatus was 48%, infraspinatus was 36%, subscapularis was 43%, and biceps was 12%. The majority of the tears were partial-thickness tears. Participants without tendon tears were significantly younger (P < 0.001) and had been wheelchair user for a significantly shorter time (P = 0.005) than those with tendon tears.Conclusion: Mild and moderate shoulder tendinopathy and partial-thickness tendon tears were highly prevalent in MWC users with SCI. Additionally, the findings of this study suggest that strategies for monitoring shoulder pathologies in this population should not be overly reliant on patient-reported pain, but perhaps more concerned with years of wheelchair use and age.     

规范化轮椅技能训练对截瘫患者的康复疗效

目的：探讨规范化轮椅技能训练方案对截瘫患者的康复治疗效果.方法：将截瘫患者27例分为观察组20例和对照组7例,2组均接受常规康复训练,观察组在此基础上给予规范化轮椅技能训练.治疗前后采用改良Bathel指数（MBI）和轮椅技能测试（WST）进行评定.结果：治疗2个月后,2组MBI及WST评分均较治疗前显著提高（P＜0.01,0.05）,且观察组更高于对照组（P＜0.01）.结论：规范化轮椅技能训练可明显提高截瘫患者日常生活能力,增强康复治疗效果.     

Effects of hand cycle training on wheelchair capacity during clinical rehabilitation in persons with a spinal cord injury

Purpose.?To evaluate the effects of a structured hand cycle training programme on physical capacity in subjects with spinal cord injury (SCI) during clinical rehabilitation.

Method.?Twenty subjects with SCI who followed hand cycle training were compared with matched control subjects from a Dutch longitudinal cohort study, who received usual care.

Primary outcomes of physical capacity were peak power output (PO_peak), peak oxygen uptake (VO_2peak) and oxygen pulse during a hand rim wheelchair test. Secondary outcome measures were isometric peak muscle strength of the upper extremities and pulmonary function. Hand cycle capacity (PO_peak and VO_2peak) was evaluated in the training group only.

Results.?Strong tendencies for improvement were found in wheelchair capacity, reflected by PO_peak and oxygen pulse after additional hand cycle training. Significant effects on shoulder exo- and endo-rotation and unilateral elbow flexion strength were found but no improvements on pulmonary function.

Conclusions.?Additional hand cycle training during clinical rehabilitation seems to show similar or slightly favourable results on wheelchair capacity and muscle strength compared with regular care. The heterogeneous subject group and large variation in training period may explain the limited effects of additional hand cycle training on wheelchair capacity.     

The power of power wheelchairs: Mobility choices of community-dwelling,older adults

Background: Power wheelchairs are purported to have a positive effect on health, occupation, and quality of life. However, there is limited knowledge about what factors shape power wheelchair use decisions. Aims/objectives: A study was undertaken to understand the mobility choices of community-dwelling, power wheelchair users. Methods: A series of semi-structured qualitative interviews was conducted with 13 older adult power wheelchair users. Participants were interviewed at enrollment and four months later. Data analysis was informed by Bourdieu’s theoretical constructs of habitus, capital, and field. Results: Three main styles of power wheelchair use were identified: reluctant use, strategic use, and essential use, and each type is illustrated using an aggregate case study. Conclusion/significance: These findings highlight the need to alter the power relationship that exists between prescribers and device users and to effect policy changes that enable people with physical impairments to make as wide a range of mobility choices as possible.     

Consumer Participation in Identifying Research and Development Priorities for Power Wheelchair Input Devices and Controllers

A focus group comprised of persons who use power wheelchairs and professionals working in the field were asked to participate in a brainstorming session to determine priorities for the development and application of power mobility input devices and control concepts. The group consensus was that durability and reliability are the most important criteria. Essentially, the expectation is that a power wheelchair must work everyday in the way a person needs it and wants it. At the same time, there is a desire to enhance and advance the features of input devices and control systems. Many would say these changes constitute designing “smarter” power wheelchairs, such as systems that can independently detect obstacles and can provide users with more feedback. This paper presents the rationale behind forming this focus group and details of the results of a brainstorming session where ideas were generated and prioritized. The five most important issues as determined by the group are discussed in depth.     

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.

     

A description of manual wheelchair skills training curriculum in entry-to-practice occupational and physical therapy programs in Canada

Purpose: To describe the curriculum for manual wheelchair (MWC) skills training in entry-to-practice occupational (OT) and physical therapy (PT) programs in Canada. Methods: An online survey was sent to 28 directors of entry-to-practice OT and PT programs in Canadian universities. Responses were solicited from individuals who could report about wheelchair skills training. Fourteen survey questions asked about: (1) demographic information, (2) specific curriculum content for MWC skills training, (3) teaching methods used, (4) instructional methods and estimated time used to teach MWC skills and (5) whether validated wheelchair skills training programs were used in curriculum development. Results: Responses received from 21/28 programs, (OT-11/14; PT-10/14). About 16 of 21 programs included curriculum for MWC skills training. Informal hands-on instruction was the most common method used for teaching wheelchair skills (13/21), while multiple lectures were used the least (5/21). Only 8/21 used a validated wheelchair skills training program in curriculum development. Conclusion: Despite the public availability of a validated wheelchair skills program, there is little use of the program in entry-to-practice curriculum. Integrating online training programs into existing curricula or the development of post-professional training modules may help clinicians to better accommodate the mobility needs of the substantially increasing population with disabilities.

• Implications for Rehabilitation

• Current clinical curriculum includes basic wheelchair skills training, but not necessarily training in the advanced wheelchair skills that are needed for optimal wheelchair mobility.

• There is evidence for a standardized approach for providing wheelchair skills training, that may be administered through curriculum, online or through post-graduate training modules.

     

Power wheelchair driving challenges in the community: a users’ perspective

Purpose: There is limited information on the difficulties individuals experience in manoeuvring their power wheelchairs during daily activities. The aim of this study was to describe the nature and context of power wheelchair driving challenges from the perspective of the user. Methods: A qualitative design using semi-structured interviews with power wheelchair users. Qualitative content analysis was used to identify themes. Results: Twelve experienced power wheelchair users were interviewed. Findings revealed that power wheelchair driving difficulties were related to the accomplishment of activities of daily living, and the influence of environmental context. Four key themes emerged: (1) difficulties accessing and using public buildings-facilities, (2) outdoor mobility, (3) problems in performing specific wheelchair mobility tasks/manoeuvres and (4) barriers and circumstances that are temporary, unforeseen or specific to a particular context. Conclusion: This qualitative study furthers our understanding of the driving difficulties powered wheelchair (PW) users experience during daily activities. This knowledge will assist clinicians and researchers in two areas: in choosing assessment measures that are ecologically valid for power wheelchair users; and, in identifying and refining the content of training programs specific to the use of power wheelchairs.

• Implications for Rehabilitation

• A better understanding of the everyday challenges individuals experience in driving their power wheelchair will assist clinicians and researchers in:

• Choosing assessment measures and identifying training programs for this population.

• Refining the content of power wheelchair training programs.

     

Wheelchair backs that support the spinal curves: Assessing postural and functional changes

Objective: To compare outcomes using a wheelchair back designed to support the natural seated spinal curves versus an upholstered back that promotes posterior pelvic tilt and thoracolumbar kyphosis.Design: Cross-over intervention.Setting: Two free-standing spinal cord injury (SCI) model system hospitals.Participants: Fifty adults with motor complete SCI C6-T4, between the ages of 18–60 years who use a manual wheelchair for mobility were recruited from a convenience sample.Intervention: Each participant’s wheelchair back support was removed and replaced by an upholstered back and a solid back in randomized order. Postural and functional outcomes, pain, and satisfaction were evaluated using each back.Outcome measures: Seated postural measurements included pelvic angle, spinal angle of kyphosis and linear measurement of spine. Functional outcomes included vertical forward reach, one stroke push, timed forward wheeling, ramp ascent and descent. Numerical pain rating and a satisfaction survey provided input pertaining to both backs.Results: The solid back demonstrated significance in seated postural measurements. Participants using the solid back trended to higher scores in functional outcome measures including vertical forward reach, one stroke push and timed ramp ascent. Participants reported increased satisfaction with comfort and stability with the solid back.Conclusions: This pilot study demonstrated that a wheelchair back, which supports the seated spinal curves improves upright posture, functional reach, and wheelchair propulsion skills. Further research is necessary to demonstrate statistical findings as well as to assess back height and lateral support.