Effect of a pushrim-activated power-assist wheelchair on the functional capabilities of persons with tetraplegia

OBJECTIVES: To test the differences between a pushrim-activated power-assisted wheelchair (PAPAW) and a traditional manual wheelchair while performing common driving activities and to assess their relative merits for people with tetraplegia. DESIGN: Repeated measures. SETTING: An activities of daily living (ADL) laboratory within a rehabilitation research center. PARTICIPANTS: Fifteen full-time manual wheelchair users with tetraplegia due to a spinal cord injury. INTERVENTIONS: Participants propelled both their own manual wheelchairs and a PAPAW 3 times over an ADL course. The order in which the 2 different wheelchairs were presented to the participants was randomized. MAIN OUTCOME MEASURES: Each participant's heart rate was monitored throughout testing by a digital, wireless heart-rate monitor. Time to complete the course was recorded, and participants were surveyed with a visual analog scale after the first, third, fourth, and sixth trials to determine the ease of completing each obstacle and their ergonomic preferences between the 2 wheelchairs. Participants also were observed throughout the trials to determine how much assistance they needed to complete each obstacle course. RESULTS: After using a Bonferroni adjustment, 4 obstacles (carpet, dimple strips, up a ramp, up a curb cut) were rated as being significantly easier ( P <.001) to complete when using the PAPAW. Participants also showed a significant decrease in mean heart rate throughout all 3 trials ( P =.015, P =.001, P =.003, respectively) when using a PAPAW. The amount of assistance needed by participants, the responses to ergonomic questions, and the overall time to complete the ADL course did not differ significantly between the 2 wheelchairs. CONCLUSIONS: For subjects with tetraplegia, PAPAWs have the potential to improve functional capabilities during certain ADLs, especially when propelling up ramps, over uneven surfaces, and over thick carpet.