Scoping review of propelling aids for manual wheelchairs

Effects of the SmartDrive on mobility, activity, and shoulder pain among manual wheelchair users with spinal cord injury - a prospective long-term cohort pilot study

PURPOSE

to investigate long-term effects of SmartDrive on mobility, everyday activity, and shoulder pain among spinal cord injured manual wheelchairs users.

MATERIAL AND METHODS

A prospective pilot intervention study was conducted at Spinalis/Aleris Rehab Station, Sweden. Participants were consecutively invited when evaluated for SmartDrive prescription. Assessments were done at baseline, intervention (use of SmartDrive), and after six months. A smartwatch registered wheelchair utilization including push intensity and pushes/day. Wheelchair Outcome Measure, pain rating instruments including Wheelchair User's Shoulder Pain Index, a wheelchair test, and semi-structured interviews were used. Descriptive statistics and content analysis approach were used.

RESULTS

Twenty-five persons were screened, six of 14 included completed the study. Drop-out reasons were not related to SmartDrive for five of the eight persons. After intervention, there was a tendency of decreased pain (median (IQR) 5/10 (2.6-6.6) vs 2.5 (2-3.2). All participants reported increased satisfaction of performance when "taking a walk", from median (IQR) 45/100 (27-70) at baseline to 95 (80-100) at 6 months. Two persons who could not ascend a slope at baseline could manage using the SmartDrive. Interviews revealed that the in general positive response persisted at six months. Also, with the SmartDrive the participants could go out despite pain, providing a sense of freedom and independence. Three incidents were reported.

CONCLUSION

This long-term pilot study indicates that a SmartDrive might be a valuable assistive device to promote mobility despite of shoulder pain. All participants considered it easy to use and experienced increased independence, however skills training and follow-ups are necessary. IMPLICATIONS FOR REHABILITATIONA Rear Drive Power Assist Device (RD-PAD) could increase satisfaction with self-selected activities.A RD-PAD could increase functional mobility by facilitating propelling longer distances and steeper slopes.A RD-PAD could improve perseverance of daily activities in spite of shoulder pain.A RD-PAD could be a valuable assistive aid for persons with paraplegia with different level of wheelchair skills but with good self-awareness regarding their abilities.Thorough assessment of initial wheelchair skills, training, and follow-up are important to enhance safety and maximize performance when using the RD-PAD.

Perception of autonomy among people who use wheeled mobility assistive devices: Dependence on the type of wheeled assistive technology

We evaluated perceived autonomy among users of different types of wheeled mobility assistive devices (WMADs) across five environments and identified the effect on user autonomy due to specific device characteristics. A study-specific questionnaire was used to assess satisfaction with autonomy of WMAD users in the Home, Buildings Outside of the Home, Outdoor Built, Outdoor Natural Environment, and Transportation. For each environment, 15 contextual factors were rated for their impact on participants' autonomy. Our results revealed that manual wheelchair with add-on (MWC+AO) users had higher overall satisfaction with their autonomy compared to other WMAD users. MWC+AO users reported higher satisfaction with autonomy due to their health conditions compared to other WMAD users across all environments. In Outdoor Natural Environments, MWC+AO users had the highest satisfaction with autonomy across all factors except for negotiating hills. When performing activities in Buildings, MWC users with and without add-ons reported higher satisfaction for all factors compared to power wheelchair users, except for maneuverability on different surfaces. Satisfaction with autonomy regarding contextual factors varied among WMAD users, however, MWC+AO(s) appeared to provide a more balanced sense of autonomy across most factors and environments. More in-depth investigations are required to evaluate impacts of add-on use on autonomy.

Comparison of Manual Wheelchair and Pushrim-Activated Power-Assisted Wheelchair Propulsion Characteristics during Common Over-Ground Maneuvers

Pushrim-activated power-assisted wheels (PAPAWs) are assistive technologies that use force sensor data to provide on-demand propulsion assistance to manual wheelchair users. However, available data about kinetic and kinematic of PAPAW use are mainly limited to experiments performed on a treadmill or using a dynamometer. In this work, we performed experiments to gather kinetics of wheelchair propulsion and kinematics of wheelchair motion for a variety of over-ground wheelchair maneuvers with a manual wheelchair with and without PAPAWs. Our findings revealed that using PAPAWs can significantly reduce the propulsion effort and push frequency. Both linear and angular velocities of the wheelchair were significantly increased when using PAPAWs. Less force and push frequency could potentially reduce risk of chronic upper limb injury. Higher linear velocity could be desirable for various daily life activities; however; the increase in the angular velocity could lead to unintended deviations from a desired path. Future research could investigate PAPAW controllers that amplify the desired intentions of users while mitigating any unwanted behaviours.

Perceptions of power-assist devices: interviews with manual wheelchair users

PURPOSE

The study had three main objectives. (1) To investigate the perceived impact of power-assist devices (PADs) on manual wheelchair (MWC) user mobility. (2) To compare perceptions about different types of PADs. (3) To identify preferred features and design characteristics of PADs.

METHODS

Semi-structured interviews were conducted with community-dwelling MWC users aged 31 years and older, with at least 2.5 years of experience using an MWC independently (n = 16). Data were thematically analysed using an inductive approach.

RESULTS

Two main themes related to participants' perceptions about the effects of PAD use were identified: (1) "Expanding my world", which illustrated the perceived benefits of using PADs (e.g., gaining a sense of autonomy and access to new environments, maintaining physical health) and (2) "Falling short", which described challenges with PADs (e.g., safety, reliability and portability issues). Participants also identified strengths and limitations of different types of PADs that were mainly related to specific user-device and device-environment interactions as well as various functional characteristics. Moreover, participants outlined their priorities for future PAD design, including improving controllability, customizability and affordability of these devices.

CONCLUSIONS

Participants' perceptions about PADs varied across different types of devices and in different contexts. However, PADs were generally perceived as enhancing the capabilities of MWCs. Our findings provide insight into the factors that can be considered when selecting a PAD and can inform the development of future PADs that are better equipped to overcome challenges that MWC users frequently encounter.Implications for RehabilitationPower-assist devices (PADs) for manual wheelchairs (MWCs) have the potential to improve the mobility, community participation and well-being of users.Some of the existing PADs have safety and reliability issues that affect their performance and limit their use by MWC users.The three types of PADs (front-mounted attachments, rear-mounted attachments, powered wheels) offer different types of assistance that can benefit users with various capabilities.

Effects of a trained mobility assistance dog on upper extremity muscular effort during wheelchair propulsion on tiled and carpeted floors in individuals with a spinal cord injury

BACKGROUND

Many manual wheelchair users with a spinal cord injury are at risk of developing secondary upper extremity musculoskeletal impairments. The use of a mobility assistance dog may represent a way to mitigate this risk. This study aims to compare upper extremity muscular effort in this population when propelling a manual wheelchair on tiled and carpeted surfaces with and without the assistance of a dog.

METHOD

Thirteen adults with a spinal cord injury propelled their manual wheelchairs at a self-selected natural speed over a 10-meter distance on tiled abrasive and carpeted floors with and without their mobility assistance dog. Surface electromyography of the pectoralis major, anterior deltoid, biceps, and triceps was recorded and normalized against its maximal value extracted from maximal voluntary contractions. Time needed to perform each task was also computed.

FINDINGS

The forward pull provided by the dog significantly and meaningfully reduced the muscular effort when propelling on the tiled floor and, even more so, on carpeted surfaces for the pectoralis major (-27.0% and -59.2%), the anterior deltoid (-54.8% and -92.4%), the biceps (-53.9% and -57.6%), and the triceps (-45.7% and -67.3%). The time needed to travel the 10-meter distance was also significantly and meaningfully reduced on the tiled and carpeted surfaces (-21.9% and -30.3%, respectively).

INTERPRETATION

The provision of a mobility assistance dog represents a viable rehabilitation alternative to minimizing upper extremity muscular effort while also optimizing speed during propulsion in manual wheelchair users with a spinal cord injury.