Experienced sitting-related problems and association with personal, lesion and wheelchair characteristics in persons with long-standing paraplegia and tetraplegia

The use of standing powered wheelchairs from the perspective of individuals with spinal cord injury

PURPOSE

The aim of this study was to investigate the experiences of standing powered wheelchair (SPWC) users with spinal cord injury (SCI).

MATERIALS AND METHODS

This cross-sectional study included 20 participants with SCI. SPWC daily usage time (total, in sitting position and standing position) and the frequency of using the SPWC's standing feature were recorded. Participants' level of satisfaction and comfort associated with the SPWC were assessed on a five-point Likert scale. If there was a dissatisfaction reason with the SPWC, the issues related to it were recorded. Participants were asked about their positive and adverse experiences with the use of SPWC.

RESULTS

Mean age of the participants was 41.65 (± 9.35) years. Eighty percent were tetraplegic. Ninety percent of the participants stood for at least 30 minutes at least one day a week, and 55% stood for at least 30 minutes at least four days a week. The most commonly reported perceived benefits were improvement in activities of daily living, bowel movements, and blood pressure regulation, better perception of body image, and feeling better. The most frequently identified reasons for dissatisfaction with the SPWC were its big dimensions, heavy weight, and difficulty of use in indoor environment and on uneven surfaces.

CONCLUSIONS

The findings show positive perceived experiences for SPWC users with SCI in terms of physical, social, and psychological aspects. Prospective controlled studies are needed to explore the benefits of SPWC use regarding secondary complications of SCI.

Handbike configurations and the prevalence of experienced sitting and riding-related problems in recreational handcyclists training for the HandbikeBattle

Implications for rehabilitationA large variety in handbike configurations is seen in recreationally-active handcyclists.Although the majority of the recreationally-active handcyclists seemed to be satisfied with their handbike configurations, 31-50% of them thought that their handbike configuration could be improved.Evidence-based guidelines for handbike fitting should be developed in the future.

"It's been a double-edged sword": An online qualitative exploration of the impact of COVID-19 on individuals with spinal cord injury in the US with comparisons to previous UK findings

OBJECTIVE

The impact of COVID-19 lockdowns and social distancing for persons with spinal cord injury (SCI) are poorly understood. This exploratory online qualitative study collected self-reported COVID-19 experiences from persons with SCI in the United States (US). To enrich understanding, these data were compared to similar previously-published data from a sample of SCI participants from the United Kingdom (UK).

DESIGN

Explorative, online qualitative study. Participants completed an online survey of open-ended qualitative questions pertaining to their experiences during the pandemic. Thematic analysis was utilized to generate themes from the US data. These themes were compared to our previously-published thematic analysis of data from the UK.

SETTING

Community-based sample of persons with SCI in the US.

PARTICIPANTS

Participants were recruited via SCI-focused research registries and social media outlets serving the SCI community, using convenience sampling (n = 36). Key themes identified in the US data were compared to themes identified in a similar sample from the UK (n = 42) collected at the same time and published previously.

RESULTS

Analysis resulted in three themes from the US data, each containing positive and negative qualitative reflections. Themes included (1) health and access to care, (2) making sense of the pandemic, and (3) daily life during the pandemic. Each theme captured common facets of life during the pandemic, often shared by those without physical disabilities, but included accounts particularly relevant to persons with disabilities. Comparisons to thematic findings from the UK study revealed similarities (e.g. healthcare access challenges, isolation) and differences (e.g. importance of previous SCI experiences).

CONCLUSION

We detailed common experiences of COVID-19 pandemic lockdowns and their impact on people with SCI, while contrasting these with sense-making positive reflections and social benefits that appeared to be helpful in managing distress and coping with the pandemic.

Identification of wheelchair seating criteria in adults with neuromuscular diseases: A Delphi study

BACKGROUND

Adults with neuromuscular diseases like spinal muscular atrophy or Duchenne muscular dystrophy require full-time use of a wheelchair (WC) and perform all activities of daily living in a sitting position. Optimal configuration of the WC and seating system is essential to maintain the health and quality of life of users. However, few recommendations for configuration exist. The aim of this study was to identify and select 10 WC seating criteria that ensure an optimal sitting posture for health and quality of life.

METHODS

A four round Delphi method was used to collect the opinions of WC users and health professionals (HP), separately. First, the HP were asked if they believed that different criteria would apply to each disease. Then the HP and SMA II and DMD WC user experts responded to electronic surveys in 4 rounds.

RESULTS

Overall, 74 experts took part: 31 HP, 21 WC users with SMA II and 22 WC users with DMD. In total, 52% of HP believed that different criteria would apply to each disease. Ten criteria were identified by the HP for SMA II and 10 for DMD. Of the 40 criteria selected, 30 (75%) were common to each panel. Six topics were similar across panels: comfort, access to the joystick, prevention of pain, stability, pressure management and power seat functions. However, power seat functions did not reach consensus between HP and WC users (30-33% of agreement for HP and 93-100% for the WC user panels, p < 0.001).

CONCLUSION

Adults with SMA II and DMD had similar WC seating needs. Therefore, the same recommendations can be applied to these groups. Further research is necessary to understand the impact of cost on the prescription of power seat functions by health professionals.

Should Non-Pharmacological and Non-Surgical Interventions be Used to Manage Neuropathic Pain in Adults With Spinal Cord Injury? - A Systematic Review

Spinal Cord Injury (SCI) results in a permanent or temporary alteration of the motor, sensory and/or autonomic functions, frequently leading to neuropathic pain. To deal with this comorbidity, several non-pharmacological and non-surgical (NP-NS) interventions have been developed. However, their efficacy is still uncertain. The aim of this study was to systematically synthetize the available evidence assessing the efficacy of NP-NS interventions for treating neuropathic pain in people with SCI. Thus, an electronic search was conducted in five databases (Pubmed, Scopus, Cochrane Central, Web of Science and EBSCO) and trials registry databases, in addition to a manual search strategy to retrieve additional records. The review included randomized controlled trials with adults with SCI, in any stage of the condition. Data on the efficacy of the interventions was narratively synthetized. Once the research was completed, of 4853 identified references, 24 were included with a total of 653 participants with SCI and neuropathic pain, mostly male and with paraplegia. These studies investigated the effect of 13 types of NP-NS interventions with different protocols and methodological limitations. Seven different assessment scales were analyzed, with neuropathic pain being the primary outcome in 21 studies. Such high heterogeneity impaired the conduction of meta-analysis for any of the interventions. Although promising results were found regarding analgesic effect of NP-NS on neuropathic pain in people with SCI, it is not yet possible to safely state that these interventions are in fact effective. Further studies with homogeneous protocols and methodological quality are still needed. PERSPECTIVE: This article presents a review of existing studies on the effectiveness of NP-NS interventions in neuropathic pain in SCI. This synthesis could potentially alert and motivate clinicians to develop studies on this topic, so that interventions can be objectively evaluated and recommendations for an evidence-based practice be created.