Effects of Seated Postural Stability and Trunk and Upper Extremity Strength on Performance during Manual Wheelchair Propulsion Tests in Individuals with Spinal Cord Injury: An Exploratory Study

Performance, asymmetry and biomechanical parameters in wheelchair rugby players

The practice of the wheelchair rugby is becoming more and more worldwide. However, few biomechanical studies have focused on this sport. The aim of this study was to compare kinematic parameters of wheelchair rugby players, classified as defensive players (LP-D) versus offensive players (HP-O). Twenty-nine wheelchair rugby players (17 LP-D and 12 HP-O) performed a 20-m sprint test. The peak velocities, temporal parameters (propulsion phase time, deceleration phase time, cycle time and cycle frequencies) and asymmetries (the difference in peak velocities between the right and the left wheels) were measured at the acceleration and constant peak velocity phases of the sprint by an inertial measurement unit which was placed on each rear wheel. At the acceleration and constant peak velocity phases, peak velocities and cycle frequencies were higher in HP-O players than LP-D players. The deceleration phase times and the cycle times were higher in LP-D players than HP-O players. However, no significant difference in asymmetry was found between LP-D players and HP-O players. The HP-O players showed superior performance than the LP-D players, but they could be more exposed at risk of injury at their upper limbs than LP-D players.

Steering-by-leaning facilitates intuitive movement control and improved efficiency in manual wheelchairs

BACKGROUND

Manual wheelchair propulsion is widely accepted to be biomechanically inefficient, with a high prevalence of shoulder pain and injuries among users. Directional control during wheelchair movement is a major, yet largely overlooked source of energy loss: changing direction or maintaining straightforward motion on tilted surfaces requires unilateral braking. This study evaluates the efficiency of a novel steering-by-leaning mechanism that guides wheelchair turning through upper body leaning.

METHODS

16 full-time wheelchair users and 15 able-bodied novices each completed 12 circuits of an adapted Illinois Agility Test-course that included tilted, straight, slalom, and 180° turning sections in a prototype wheelchair at a self-selected functional speed. Trials were alternated between conventional and steering-by-leaning modes while propulsion forces were recorded via instrumented wheelchair wheels. Time to completion, travelled distance, positive/negative power, and work done, were all calculated to allow comparison of the control modes using repeated measures analysis of variance.

RESULTS

Substantial average energy reductions of 51% (able-bodied group) and 35% (wheelchair user group) to complete the task were observed when using the steering-by-leaning system. Simultaneously, able-bodied subjects were approximately 23% faster whereby completion times did not differ for wheelchair users. Participants in both groups wheeled some 10% further with the novel system. Differences were most pronounced during turning and on tilted surfaces where the steering-by-leaning system removed the need for braking for directional control.

CONCLUSIONS

Backrest-actuated steering systems on manual wheelchairs can make a meaningful contribution towards reducing shoulder usage while contributing to independent living. Optimisation of propulsion techniques could further improve functional outcomes.

Influence of wheelchair type on Wheelchair Propulsion Test performance in community-dwelling, adult wheelchair users1

BACKGROUND: The clinimetric properties of the Wheelchair Propulsion Test (WPT) have not been developed thoroughly. OBJECTIVE: To determine inter-rater reliability and reference values for the Wheelchair Propulsion Test (WPT) for active wheelchair users and to compare WPT performance between various types of manual wheelchairs at different paces. METHODS: This was a cross-sectional, descriptive study. Participants propelled a manual wheelchair 10 m while time and the number of pushes were recorded. Trials were performed in three different manual wheelchairs (a lightweight wheelchair (LW), an ultralightweight wheelchair (ULW), and the participant’s personal, customized wheelchair) at a comfortable pace and a fast pace. RESULTS: The ICC values ranged from 0.861 to 0.999 for both speed and number of pushes. Comfortable wheelchair propulsion speed ranged from 1.51 (0.31) m/s to 1.65 (0.33) m/s depending on the wheelchair utilized. Across both pace conditions, participants were significantly faster when using their personal wheelchair compared to the ULW (P < 0.001) and LW (P < 0.001). Push frequency was significantly greater during the fast pace condition compared to the comfortable pace condition (P < 0.001). CONCLUSIONS: Reference values for the WPT in active wheelchair users have been identified. Participants who utilize their personal wheelchair demonstrate faster wheelchair propulsion speeds complemented by greater push frequencies.

Influence of Wheelchair Type on Kinematic Parameters in Wheelchair Rugby

Introduction

In wheelchair rugby, players use either an offensive or defensive wheelchair depending on their field position and level of impairment. Performance of wheelchair rugby players is related to several parameters, however it is currently unclear if differences in performance are related to wheelchair type or no: the effect of wheelchair type on performance variables has not been evaluated. The aim of this study was to compare offensive and defensive wheelchairs on performance variables during a straight-line sprint.

Methods

Thirteen able-bodied people performed two 20 m sprint trials: one with an offensive and one with a defensive wheelchair. Data were collected using inertial measurement units fixed on the wheelchair. Peak wheelchair velocities and left-right asymmetries in peak wheel velocities were measured during the acceleration and constant peak velocity phases. Sprint time, cycle frequency, and mean and maximum velocity were calculated over the entire sprint.

Results

The peak velocities of the first 2 pushes (acceleration phase) were significantly higher with the defensive than the offensive wheelchair (p &lt; 0.04 and p &lt; 0.02). Mean and maximum sprint velocity were significantly higher (p &lt; 0.03 and p &lt; 0.04, respectively) with the defensive wheelchair. Cycle frequency and asymmetry did not differ between wheelchairs.

Conclusion

Performance was higher with the defensive than the offensive wheelchair, suggesting that the frequent finding that the higher performance of offensive as compared to defensive players is not related to the use of an offensive wheelchair.

Design of an Automated Multiposition Dynamic Wheelchair

This work presents a design for an automatized multiposition dynamic wheelchair used to transport quadriplegic patients by reconfiguring a manual wheelchair structure. An electric actuator is attached to a four-bar mechanism fixed to each side of a wheelchair’s backrest to reach multiposition. The entire device is actuated through a PID controller. An experimental test is carried out in a simplified wheelchair structure. Finally, the structure of the wheelchair is evaluated through the Dynamic analysis and Finite Element Method under the payload computed with the most critical position reached by the mechanism.

Community exercise for individuals with spinal cord injury with inspiratory muscle training: A pilot study

Context/Objective: Respiratory disorders are a common cause of rehospitalization, and premature death in individuals with spinal cord injuries (SCI). Respiratory training combined with community exercise programs may be a method to reduce secondary complications in this population.Objective: The present study explores the inclusion of inspiratory muscle training (IMT) in an existing community exercise program.Design: Case series.Setting: Community.Participants: Participants (N = 6) completed the exercise program. Five were male and one was female; four reported incomplete injuries, and two reported complete injuries; four had cervical injuries, and two had thoracic injuries. The average age was 33 years (SD = 18.6) and time since injury was 7 years (SD = 4.0).Interventions: Participants completed an 8-week program, once-per-week for 4 h that included a circuit of resistance training, aerobic exercise, trunk stability, and education. IMT was completed as a home exercise program.Outcome Measures: Transfer test, T-shirt test, four-directional reach, four-directional trunk strength, weekly training diaries, and a subjective interview.Results: Twenty-eight training logs were collected. All measures improved: transfer test (mean = -14.62, SD = 7.00 s), T-shirt test (mean = -7.83, SD = 13.88 s), four-directional reach (mean = 3.75, SD = 8.06 in) and hand-held dynamometer (mean = 6.73, SD = 8.02 kg). Individuals reported a positive impact of the program.Conclusions: This pilot study demonstrated community exercise with IMT use may have positive impact on functional measures for people with SCI who are vulnerable to respiratory compromise. Continued education may increase successful health outcomes.Trial Registration: NCT03743077.

Reliability and validity of the function in sitting test among non-ambulatory individuals with spinal cord injury

Context: Trunk impairment among non-ambulatory individuals with spinal cord injury (SCI) reduces the ability to maintain a functional sitting position and perform activities of daily living. Measuring functional sitting balance is complex and difficult in a clinical setting. The function in sitting test (FIST) is a clinical measure that includes the assessment of all the components of sitting balance. The purpose of this study is to assess the reliability and validity of the 14-item FIST among non-ambulatory individuals with SCI. Participants: Twenty-six individuals with chronic SCI. Outcome measures: Participants were evaluated with the FIST, the modified Functional Reach Test (lateral and forward mFRT) and a posturography assessment (virtual time to contact - VTC). The FIST was re-assessed during a second study visit 12 weeks later. Test-retest reliability was evaluated using intraclass coefficient correlation (ICC), the minimal detectable change (MDC) was calculated and the internal consistency reliability was assessed using Cronbach's coefficient-α. Concurrent validity of the FIST was also tested with the mFRT and the VTC. Results: Test-retest reliability was found to be excellent (ICC = 0.95) with a MDC of 4. The internal consistency was satisfactory (0.81). Moreover, the FIST correlates with the lateral mFRT (r = 0.64, P = 0.001) but not with the forward mFRT and the VTC. Conclusion: These observations provide evidence that the FIST is a reliable clinical measure with partially established validity for non-ambulatory individuals with SCI. Further studies are needed to strengthen the validity of the FIST and explore this measure in a larger sample.

Effects of an Overground Walking Program With a Robotic Exoskeleton on Long-Term Manual Wheelchair Users With a Chronic Spinal Cord Injury: Protocol for a Self-Controlled Interventional Study

BACKGROUND

In wheelchair users with a chronic spinal cord injury (WUSCI), prolonged nonactive sitting time and reduced physical activity-typically linked to this mode of mobility-contribute to the development or exacerbation of cardiorespiratory, musculoskeletal, and endocrine-metabolic health complications that are often linked to increased risks of chronic pain or psychological morbidity. Limited evidence suggests that engaging in a walking program with a wearable robotic exoskeleton may be a promising physical activity intervention to counter these detrimental health effects.

OBJECTIVE

This study's overall goals are as follows: (1) to determine the effects of a 16-week wearable robotic exoskeleton-assisted walking program on organic systems, functional capacities, and multifaceted psychosocial factors and (2) to determine self-reported satisfaction and perspectives with regard to the intervention and the device.

METHODS

A total of 20 WUSCI, who have had their injuries for more than 18 months, will complete an overground wearable robotic exoskeleton-assisted walking program (34 sessions; 60 min/session) supervised by a physiotherapist over a 16-week period (one to three sessions/week). Data will be collected 1 month prior to the program, at the beginning, and at the end as well as 2 months after completing the program. Assessments will characterize sociodemographic characteristics; anthropometric parameters; sensorimotor impairments; pain; lower extremity range of motion and spasticity; wheelchair abilities; cardiorespiratory fitness; upper extremity strength; bone architecture and mineral density at the femur, tibia, and radius; total and regional body composition; health-related quality of life; and psychological health. Interviews and an online questionnaire will be conducted to measure users' satisfaction levels and perspectives at the end of the program. Differences across measurement times will be verified using appropriate parametric or nonparametric analyses of variance for repeated measures.

RESULTS

This study is currently underway with active recruitment in Montréal, Québec, Canada. Results are expected in the spring of 2021.

CONCLUSIONS

The results from this study will be essential to guide the development, implementation, and evaluation of future evidence-based wearable robotic exoskeleton-assisted walking programs offered in the community, and to initiate a reflection regarding the use of wearable robotic exoskeletons during initial rehabilitation following a spinal cord injury.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03989752; https://clinicaltrials.gov/ct2/show/NCT03989752.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/19251.

Reliability of measurement of active trunk movement in wheelchair basketball players

The study aim was to assess the reliability to active trunk movements measurement in four sitting positions in wheelchair basketball players and to check their trunk movements in these positions. Eighteen volunteer wheelchair basketball athletes, with a minimum of five years’ training experience, were asked to perform the maximum range of active trunk movement in three planes in four sitting positions (in a sports wheelchair with straps, without straps, on a table with feet on the floor, on a table without foot support). The range of movement was measured by the Kinect for Windows V2 sensor twice (with one-week interval). To assess the reliability, different statistical methods were used for each movement: significance of differences between the results (p-value), interclass correlation coefficient (ICC) and minimal detectable change (MDC). The limits of agreement analysis (LOA) were calculated. Differences between trunk movements in four positions were checked by the MANOVA (Wilk’s Lambda and ETA² were calculated if data were normally distributed). The significance level was set at α < .05. Friedman ANOVA and non-parametric Wilcoxon test with the Bonferroni correction were applied when data were not normally distributed. The significance level after Bonferroni correction was set at α < .013 (α = p/k, where p = .05, k–number of positions = 4). The measurement of active trunk movement in each plane was reliable (p > .05, no differences between the results, “very good”ICC, between .96-.99). In the position with straps, the trunk movement was significantly bigger than in other positions (p < .05), except for the position without straps (p > .05). The Kinect for Windows V2 sensor measured active trunk movement in a reliable manner and it can be recommended as a reliable tool for measuring trunk function. Utilizing straps by wheelchair basketball players increases their trunk movement.

Advanced weight-bearing mat exercises combined with functional electrical stimulation to improve the ability of wheelchair-dependent people with spinal cord injury to transfer and attain independence in activities of daily living: a randomized controlled trial

STUDY DESIGN

Randomized controlled trial.

OBJECTIVE

To determine the effects of advanced weight-bearing mat exercises (AWMEs) with/without functional electrical stimulation (FES) of the quadriceps and gastrocnemius muscles on the ability of wheelchair-dependent people with spinal cord injury (SCI) to transfer and attain independence in activities of daily living (ADLs).

SETTING

An outpatient clinic, Iran.

METHODS

People with traumatic chronic paraplegia (N = 16) were randomly allocated to three groups. The exercise group (EX; N = 5) performed AWMEs of quadruped unilateral reaching and tall-kneeling for 24 weeks (3 days/week). Sessions were increased from 10 min to 54 min over the 24-week period. The exercise-FES group (EX + FES; N = 5) performed AWMEs simultaneously with FES of the quadriceps and gastrocnemius muscles. The control group performed no exercise and no FES (N = 6). The primary outcomes were the total Spinal Cord Independence Measure-III (SCIM-III) to reflect independence with ADL, and the sum of the four SCIM-III transfer items to reflect ability to transfer. There were six other outcomes.

RESULTS

The mean (95% CI) between-group differences of the four transfer items of the SCIM-III for the EX vs. control group was 1.8 points (0.2-3.4), and for the EX + FES vs. control group was 2 points (0.4-3.6). The equivalent differences for the total SCIM-III scores were 2.7 points (-0.6-6.0) and 4.1 points (0.8-7.4), respectively. There were no significant between-group differences for any other outcomes.

CONCLUSIONS

Advanced weight-bearing mat exercises improve the ability of wheelchair-dependent people with SCI to transfer and attain independence in ADL.

Predictors of shoulder pain in manual wheelchair users

BACKGROUND

Manual wheelchair users rely on their upper limbs to provide independent mobility, which leads to high muscular demand on their upper extremities and often results in shoulder pain and injury. However, the specific causes of shoulder pain are unknown. Previous work has shown that decreased shoulder muscle strength is predictive of shoulder pain onset, and others have analyzed joint kinematics and kinetics, propulsion technique and intra-individual variability for their relation to shoulder pathology. The purpose of this study was to determine in a longitudinal setting whether there are specific biomechanical measures that predict shoulder pain development in manual wheelchair users.

METHODS

All participants were asymptomatic for shoulder pain and categorized into pain and no pain groups based on assessments at 18 and 36 months later. Shoulder strength, handrim and joint kinetics, kinematics, spatiotemporal measures, intra-individual standard deviations and coefficients of variation were evaluated as predictors of shoulder pain.

FINDINGS

Individuals who developed shoulder pain had weaker shoulder adductor muscles, higher positive shoulder joint work during recovery, and less trunk flexion than those who did not develop pain. In addition, relative intra-individual variability was a better predictor of shoulder pain than absolute variability, however future work is needed to determine when increased versus decreased variability is more favorable for preventing shoulder pain.

INTERPRETATION

These predictors may provide insight into how to improve rehabilitation training and outcomes for manual wheelchair users and ultimately decrease their likelihood of developing shoulder pain and injuries.

Pain, fatigue, function and participation among long-term manual wheelchair users partnered with a mobility service dog

PURPOSE

To assess the effects of a mobility service dog (MSD) on pain, fatigue, wheelchair-related functional tasks, participation and satisfaction among manual wheelchair users over a nine-month period.

METHOD

A longitudinal study with repeated assessment times before and three, six and nine months after intervention was achieved. Intervention consisted in partnering each participant with a MSD. The setting is a well-established provincial service dog training school and participants homes. A convenience sample of 24 long-term manual wheelchair users with a spinal cord injury was involved. Outcome measures were: Wheelchair User's Shoulder Pain Index (WUSPI), Rate of Perceived Exertion (RPE), vitality scale from the SF-36, grip strength, Wheelchair Skills Test (WST), Canadian Occupational Performance Measure (COPM), Reintegration to Normal Living Index (RNLI), Life Space Assessment, Psychosocial Impact of Assistive Devices Scale (PIADS) and Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0).

RESULTS

Shoulder and wrist pain as well as fatigue decreased significantly over time with the use of a MSD as evidenced by scores from WUSPI, RPE and SF-36 (feeling less worn out). Manual wheelchair propulsion skills (steep slopes, soft surfaces and thresholds) improved significantly over time as confirmed by the WST. Participation increased significantly over time as revealed by the COPM (for five occupations) and the RNLI (for five items). Satisfaction with the MSD was high over time (QUEST: nine items) and with a high positive psychosocial impact (PIADS: 10 items).

CONCLUSION

MSD represents a valuable mobility assistive technology option for manual wheelchair users. IMPLICATIONS FOR REHABILITATION   For manual wheelchair users partenered with mobility service dog  • Shoulder pain and fatigue significantly decreased and continued to decrease between the third and sixth month and the ninth month.   • Performance with propelling the wheelchair up steep slopes increased from 41 to 88% and on soft surfaces increased from 53 to 100% after 3 months, respectively.   • Occupational performance satisfaction was significantly increased for mobility in relation with the transfers, navigating in a natural environment and picking up objects.   • High satisfaction towards psychosocial competency, psychosocial adequacy and self-esteem were reported at months three, six and nine.