Wheelchair repairs, breakdown, and adverse consequences for people with traumatic spinal cord injury

The impact of a low cost wheelchair on the quality of life of the disabled in the developing world

Background

People with disabilities in the developing world do not have equal and adequate access to education, employment, or medical care. Their physical or mental condition, compounded by a lack of financial and technological resources, imposes a burden on both the family and the State. A wheelchair is a form of assistive technology which eases that burden for many. This study examines the impact of a simple, donated chair on the health, quality of life, and function of a subject population.

Material/Methods

Surveys were administered to 519 disabled recipients of a semi-rigid depot style wheelchair in 3 different countries at the time they received their chair and again after 12 months of use. Surveys evaluated physical and emotional health, functional independence, and lifestyle.

Results

On initial reports, 46.6% of subjects said they never left home, 52.3% were hospitalized one or more days/month, 70.3% reported daily pain, and 48.7% reported a negative mood state. Following 12 months of using the wheelchair, both the reported overall health rating and mood state increased by 20%; pain was significantly diminished. Although some areas in the ICF function measure improved more than others, the overall reported level of independence rose by 11%.

Conclusions

A representative sample of the disabled in 3 countries of the world is socially isolated, in poor health, and with limited function. Receipt of a simple, depot style wheelchair significantly improved their quality of life, health indicators, and the ICF function measure following 12 months of use.

An impact assessment and critical appraisal of the ISO standard for wheelchair vocabulary

Wheelchairs are, for users, a primary means of mobility and an important means of performing activities of daily living. A common, accepted vocabulary is required to support and foster evidence-based practice and communication amongst professionals and with users. The international standard for wheelchair vocabulary, ISO 7176-26:2007, specifies terms and definitions with the purpose of eliminating confusion from the duplication or inappropriate use of terms. The aim of this study was to assess its impact and, based on that assessment, critically appraise the standard. Two databases were searched returning 189 and 283 unique articles with wheelchair in the title published between 2004-2006 and 2009-2011 respectively. Compliance, based on title and abstract usage, was poor, ranging from 0 to 50% correct usage, with no significant difference between pre- and post-publication. A review of prescription forms found only 9% correct usage. A survey of NHS wheelchair managers found that only 30% were positive that they had a copy despite 67% agreeing that the standard is important. The ISO wheelchair vocabulary standard was found not to be achieving its stated purpose. It is recommended that it be revised taking into account the findings of this study including the need for targeted dissemination and increased awareness.

Efficacy and retention of the French-Canadian version of the wheelchair skills training program for manual wheelchair users: a randomized controlled trial

OBJECTIVES

To test the hypotheses that, in comparison with a control group that received standard care, users of manual wheelchairs who also received the French-Canadian version of the Wheelchair Skills Training Program (WSTP) would significantly improve their wheelchair-skills capacity and that these improvements would be retained at 3 months.

DESIGN

Multicenter, single-blind, randomized controlled trial.

SETTING

Three rehabilitation centers in Montréal, Quebec, Canada.

PARTICIPANTS

Manual wheelchair users (N=39), a sample of convenience.

INTERVENTION

Participants were randomly allocated to the WSTP or control groups. Participants in both groups received standard care. Participants in the WSTP group also received a mean of 5.9 training sessions (a mean total duration of 5h and 36min).

MAIN OUTCOME MEASURES

The French-Canadian version of the Wheelchair Skills Test (WST) (Version 3.2) was administered at evaluation at first time period (baseline) (t1), evaluation at second time period (posttraining) (t2) (a mean of 47d after t1), and at evaluation at third time period (follow-up) (t3) (a mean of 101d after t2).

RESULTS

At t2, the mean ± SD total percentage WST capacity scores were 77.4%±13.8% for the WSTP group and 69.8%±18.4% for the control group (P=.030). Most of this difference was due to the community-level skills (P=.002). The total and subtotal Wheelchair Skills Test scores at t3 decreased by ≤0.5% from the t2 values, but differences between groups at t3, adjusting for t1, did not reach statistical significance (P≥.017 at a Bonferroni-adjusted α level of .005).

CONCLUSION

WSTP training improves wheelchair skills immediately after training, particularly at the community-skills level, but this study did not show statistically significant differences between the groups at 3 months.

Increases in wheelchair breakdowns, repairs, and adverse consequences for people with traumatic spinal cord injury

OBJECTIVE

The aims of this study were to report the current incidence of wheelchair breakdowns, repairs, and consequences and to compare current data with historical data.

DESIGN

A convenience sample survey of 723 participants with spinal cord injury who use a wheelchair for more than 40 hrs/wk treated at a Spinal Cord Injury Model Systems center was conducted.

RESULTS

Significant increases were found in the number of participants reporting repairs (7.8%) and adverse consequences (23.5%) in a 6-mo period (2006-2011) compared with historical data (2004-2006) (P < 0.001). When examining current data, minorities experienced a greater frequency and higher number of reported consequences (P = 0.03). Power wheelchair users reported a higher number of repairs and consequences than did manual wheelchair users (P < 0.001). Wheelchairs equipped with seat functions were associated with a greater frequency of adverse consequences (P = 0.01). Repairs did not vary across funding source, but individuals with wheelchairs provided by Medicare and Medicaid reported a higher frequency of consequences than did the combined group of the Department of Vocational Rehabilitation, Worker's Compensation, and the Veterans Administration (P = 0.034 and P = 0.013, respectively).

CONCLUSIONS

The incidence and consequences of repairs are increasing from what was already a very high statistic in this United States population. Further investigation into causality is required, and intervention is needed to reverse this potential trend.

Mobility profile and wheelchair driving skills of powered wheelchair users: sensor-based event recognition using a support vector machine classifier

This paper presents a method to automatically recognize events and driving activities during the use of a powered wheelchair (PW). The method uses a support vector machine classifier, trained from sensor-based data from a datalogging platform installed on the PW. Data from a 3D accelerometer positioned on the back of the PW were collected in a laboratory space during PW driving tasks. 16-segmented events and driving activities (i.e. impacts from different side on different objects, rolling down or up on incline surface, going across threshold of different height) were performed repeatedly (n=25 trials) by one operator at three different speeds (slow, normal, high). We present results from an experiment aiming to classify five different events and driving activities from the sensor data acquired using the datalogging platform. Classification results show the ability of the proposed method to reliably segment 100% of events, and to identify the correct event type in 80% of events.

Comparison of prosthetic feet prescribed to active individuals using ISO standards

BACKGROUND

Little research has been done on the robustness of prosthetic feet prescribed to military personnel, and manufacturers are not required to test their products prior to sale. This is problematic because the prosthetic feet used by active individuals are subjected to loading conditions not seen in normal gait.

OBJECTIVES

To evaluate whether commercially available heavy-duty prosthetic feet intended for use by military personnel meet ISO 10328 standards.

STUDY DESIGN

Bench testing of heavy-duty prosthetic feet using ISO 10328 standards.

METHODS

Prosthetic feet from three different manufacturers were tested according to ISO 10328 standards, using a testing frame fitted with axial load and displacement transducers. Pass/fail information was recorded as well as the stiffness and creep of each foot before and after cyclic testing.

RESULTS

All feet passed the ISO 10328 standards at the highest loading level, and some significant differences were found within a given model of prosthesis when comparing stiffness and creep before and after cyclic testing.

CONCLUSIONS

This study demonstrated that manufacturers of heavy-duty prosthetic feet adhere to the voluntary ISO 10328 standards. However, these standards may be insufficient because the tests simulate only idealized gait. Further development of the standards may be necessary to reproduce the circumstances that occur during extreme usage to ensure that prosthetic feet do not fail.

Wheelchair-related accidents: relationship with wheelchair-using behavior in active community wheelchair users

OBJECTIVE

To report the prevalence, mechanisms, self-perceived causes, consequences, and wheelchair-using behaviors associated with wheelchair-related accidents.

DESIGN

A case-control study.

SETTING

Community.

PARTICIPANTS

A sample of experienced, community-dwelling, active manual and powered wheelchair users (N=95) recruited from a hospital assistive technology service center.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Wheelchair-using behaviors, wheelchair-related accidents over a 3-year period, and the mechanisms and consequences of the accidents.

RESULTS

Among the 95 participants, 52 (54.7%) reported at least 1 accident and 16 (16.8%) reported 2 or more accidents during the 3 years prior to the interview. A total of 74 accidents, were categorized into tips and falls (87.8%), accidental contact (6.8%), and dangerous operations (5.4%). A logistic regression found individuals who failed to maintain their wheelchairs regularly (odds ratio [OR]=11.28; 95% confidence interval [CI], 2.62-48.61) and used a wheelchair not prescribed by professionals (OR=4.31; 95% CI, 1.10-16.82) had significantly greater risks of accidents. In addition to the risk factor, lack of regular wheelchair maintenance, the Poisson regression corroborated the other risk factor, seat belts not used (incident rate ratio=2.14; 95% CI, 1.08-4.14), for wheelchair-related accidents.

CONCLUSIONS

Wheelchair-related accidents are closely related to their wheelchair-using behaviors. Services including professional evaluation, repair, maintenance, and an educational program on proper wheelchair use may decrease the risks of wheelchair accidents.