Manual Wheelchair Skills Capacity Predicts Quality of Life and Community Integration in Persons With Spinal Cord Injury

Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA.
Archives of physical medicine and rehabilitation (Impact Factor: 2.57). 06/2012; 93(12). DOI: 10.1016/j.apmr.2012.05.021
Source: PubMed


To determine wheelchair (WC) skills success rates for manual WC users with spinal cord injury (SCI), to determine subject characteristics associated with the lowest success rates of WC skills, and to characterize the relationship between WC skills and measures of community integration and quality of life (QOL).

Cross-sectional multisite study.

Six Spinal Cord Injury Model Systems (SCIMS) centers.

Individuals with SCI (N=214) who were at least 11 months postinjury, treated at an SCIMS center, and who used a manual WC as their primary means of mobility.

Not applicable.

Main outcome measures:
Wheelchair Skills Test (WST) and questionnaires of demographics and characteristics, QOL, and community participation.

Of the 31 skills in the WST assessed, success rates ranged from 19.6% to 100%. Eight skills had success rates of ≤75%: folding/unfolding the WC (71.5%), ascending (19.6%) and descending (47.2%) a 15-cm curb, ascending (23.2%) and descending (26.5%) stairs, transferring from ground to WC (40.6%), turning 180° in wheelie position (55.2%), and holding a 30-second stationary wheelie (59.9%). Male sex, paraplegia, employed status, lower education, younger age at injury, and white race were among the participant characteristics bivariately associated with higher success rates of several WC skills. After controlling for covariates, higher success rates of several WC skills and a higher total WST score predicted better self-perceived health, higher life satisfaction, and more community participation.

For people with SCI who use a manual WC as their primary means of mobility, their ability to perform manual WC skills is associated with higher community participation and life satisfaction. Factors contributing to low success rates need to be investigated, and interventions to improve these rates are needed.

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    • "Approximately 2 million Americans use a manual wheelchair for mobility (LaPlante and Kaye, 2010). Although the use of a manual wheelchair provides numerous benefits (Hosseini et al., 2012), the repetitive strain encountered by the upper limb during propulsion places significant demand on the tissues (Nichols et al., 1979; Gellman et al., 1988; Curtis et al., 1999; Finley et al., 2004) and has been implicated in upper limb injury (Cooper et al., 1998). "
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    ABSTRACT: Findings: (1) Individuals using a semi-circular pattern experienced lower jerk at their arm joints than those using a double loop pattern (P<0.05, η(2)=0.32)wrist;(P=0.05, η(2)=0.19)elbow;(P<0.05, η(2)=0.34)shoulder and (2) individuals with shoulder pain had lower peak jerk magnitude during the recovery phase (P≤0.05, η(2)=0.36)wrist;(P≤0.05, η(2)=0.30)elbow;(P≤0.05, η(2)=0.31)shoulder. Conclusions: Jerk during wheelchair propulsion was able to distinguish between pattern types (semi-circular and double loop) and the presence of shoulder pain. Jerk provides novel insights into wheelchair propulsion kinematics and in the future it may be beneficial to incorporate jerk based metric into rehabilitation practice.
    Full-text · Article · Oct 2015 · Journal of Biomechanics
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    • "Contextual factors may also be personal, such as age and confidence (self-efficacy) with wheelchair use. At the activity level, wheelchair mobility skill and proficiency have also been identified as significant contributors to participation [9] [10] [11] [12]. Wheelchair skills have been amenable to improvement through training, particularly when delivered in a structured format. "
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    ABSTRACT: Restricted mobility is the most common impairment among older adults and a manual wheelchair is often prescribed to address these limitations. However, limited access to rehabilitation services results in older adults typically receiving little or no mobility training when they receive a wheelchair. As an alternative and novel approach, we developed a therapist-monitored wheelchair skills home training program delivered via a computer tablet. To optimize efficacy and adherence, principles of self-efficacy and adult learning theory were foundational in the program design. A participatory action design approach was used to engage older adult wheelchair users, care providers, and prescribing clinicians in an iterative design and development process. A series of prototypes were fabricated and revised, based on feedback from eight stakeholder focus groups, until a final version was ready for evaluation in a clinical trial. Stakeholder contributions affirmed and enhanced the foundational theoretical principles and provided validation of the final product for the target population.
    Full-text · Article · Sep 2014 · BioMed Research International
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