Stroke pattern classification during manual wheelchair propulsion in the elderly using fuzzy clustering

Effects of Motor Skill-Based Training on Wheelchair Propulsion Biomechanics in Older Adults: A Randomized Controlled Trial

OBJECTIVE

To identify whether motor skill-based training improves wheeling biomechanics in older adults and whether transfer or retention occurs.

DESIGN

Randomized controlled trial.

SETTING

Human mobility laboratory.

PARTICIPANTS

Able-bodied older adults 50 years and older deemed ready to participate in physical activity (N=34).

INTERVENTION

Participants were randomized to 1 of 3 groups: experimental group with 6 motor skill-based training sessions, active control group with dose-matched uninstructed practice, and the inactive control group (no training or practice). The experimental group's training sessions consisted of two 5-minute blocks of wheelchair propulsion training, separated by a 5-minute break, for a total of 60 minutes of wheeling. Breaks included education and discussion related to wheelchair propulsion. Training focused on increasing push angle, decreasing push frequency, decreasing negative braking forces, and using a circular wheeling pattern with smooth pushes.

MAIN OUTCOME MEASURES

Temporal spatial and kinetic variables (ie, push angle, push frequency, total and tangential forces, negative force) were evaluated during steady-state wheeling and biomechanical variables were assessed with the SmartWheel Clinical Protocol to identify transfer.

RESULTS

The training group significantly increased push angle and decreased push frequency compared with the practice (P<.05) and control groups (P<.05), which were retained over time and transferred to overground wheeling on tile (P≤.05). The dose-matched practice group did not differ from the inactive control group for any variables (P>.05).

CONCLUSIONS

Older adults improve select biomechanical variables following motor skill-based training, which are retained over time and transfer to overground wheeling. Participants in the active control group did not improve with uninstructed practice compared with the inactive control group.

The influence of speed and grade on wheelchair propulsion hand pattern

BACKGROUND

The hand pattern used during manual wheelchair propulsion (i.e., full-cycle hand path) can provide insight into an individual's propulsion technique. However, previous analyses of hand patterns have been limited by their focus on a single propulsion condition and reliance on subjective qualitative characterization methods. The purpose of this study was to develop a set of objective quantitative parameters to characterize hand patterns and determine the influence of propulsion speed and grade of incline on the patterns preferred by manual wheelchair users.

METHODS

Kinematic and kinetic data were collected from 170 experienced manual wheelchair users on an ergometer during three conditions: level propulsion at their self-selected speed, level propulsion at their fastest comfortable speed and graded propulsion (8%) at their level self-selected speed. Hand patterns were quantified using a set of objective parameters, and differences across conditions were identified.

FINDINGS

Increased propulsion speed resulted in a shift away from under-rim hand patterns. Increased grade of incline resulted in the hand remaining near the handrim throughout the cycle.

INTERPRETATION

Manual wheelchair users change their hand pattern based on task-specific constraints and goals. Further work is needed to investigate how differences between hand patterns influence upper extremity demand and potentially lead to the development of overuse injuries and pain.

Comparison of overground and treadmill propulsion patterns of manual wheelchair users with tetraplegia

PURPOSE

The purpose of this investigation was to compare overground and treadmill propulsion patterns in persons with tetraplegia.

METHODS

In this case series study, we recruited eight adult subjects with tetraplegia (5 men and 3 women, aged 32.5 ± 9.5). All subjects used manual wheelchairs. We used a video motion capture system to record movements as the subject manually wheeled overground and on a treadmill. We classified propulsion patterns into one of four patterns and measured five different geometric variables of each pattern. We compared them statistically using ANOVA.

RESULTS

There were significant differences in max height/max length x 100 (H/L%) between propulsion over ground (mean 20% ± 15.3/Lhand, mean 21.3% ± 16.5/Rhand) versus propulsion on treadmill surfaces (roller: mean 30.9% ± 11.2/Lhand, mean 33.5% ± 12.8/Rhand; belted: mean 27.7% ± 8.7/Lhand, mean 34.9% ± 14.2/Rhand) and between the left and right hand.

CONCLUSION

Results indicated area and H/L% were different among the three surface types and between right and left sides. Caution must be used in extrapolating treadmill results to propulsion over ground or in assuming bilateral symmetry.

Fuzzy logic: A "simple" solution for complexities in neurosciences?

Background:

Fuzzy logic is a multi-valued logic which is similar to human thinking and interpretation. It has the potential of combining human heuristics into computer-assisted decision making, which is applicable to individual patients as it takes into account all the factors and complexities of individuals. Fuzzy logic has been applied in all disciplines of medicine in some form and recently its applicability in neurosciences has also gained momentum.

Methods:

This review focuses on the use of this concept in various branches of neurosciences including basic neuroscience, neurology, neurosurgery, psychiatry and psychology.

Results:

The applicability of fuzzy logic is not limited to research related to neuroanatomy, imaging nerve fibers and understanding neurophysiology, but it is also a sensitive and specific tool for interpretation of EEGs, EMGs and MRIs and an effective controller device in intensive care units. It has been used for risk stratification of stroke, diagnosis of different psychiatric illnesses and even planning neurosurgical procedures.

Conclusions:

In the future, fuzzy logic has the potential of becoming the basis of all clinical decision making and our understanding of neurosciences.