Validation of Using Smartphone Built-In Accelerometers to Estimate the Active Energy Expenditures of Full-Time Manual Wheelchair Users with Spinal Cord Injury

Community mobility and participation assessment of manual wheelchair users: a review of current techniques and challenges

According to the World Health Organization, hundreds of individuals commence wheelchair use daily, often due to an injury such as spinal cord injury or through a condition such as a stroke. However, manual wheelchair users typically experience reductions in individual community mobility and participation. In this review, articles from 2017 to 2023 were reviewed to identify means of measuring community mobility and participation of manual wheelchair users, factors that can impact these aspects, and current rehabilitation techniques for improving them. The selected articles document current best practices utilizing self-surveys, in-clinic assessments, and remote tracking through GPS and accelerometer data, which rehabilitation specialists can apply to track their patients' community mobility and participation accurately. Furthermore, rehabilitation methods such as wheelchair training programs, brain-computer interface triggered functional electric stimulation therapy, and community-based rehabilitation programs show potential to improve the community mobility and participation of manual wheelchair users. Recommendations were made to highlight potential avenues for future research.

Technologies measuring manual wheelchair propulsion metrics: a scoping review

The aim of this review is to investigate existing and developing technologies assessing metrics of manual wheelchair propulsion. A scoping review of scientific and gray literature was performed. Five databases were searched - Medline, Scopus, CINAHL, Institute of Electrical and Electronics Engineers (IEEE), and Embase. The 38 retained articles identified 27 devices categorized into accelerometers, wheelchair-mounted devices, instrumented wheels, and wearables. The devices included in this review can be used by manual wheelchair users to monitor propulsion effort and activity goals, by clinicians to assess rehabilitation programs, and to inform and guide future research. The findings support a need for further research into the development of custom algorithms for manual wheelchair user populations as well as further validation in broader free-living environments with equitable participant populations.

Encouraging People with Spinal Cord Injury to Take Part in Physical Activity in the COVID-19 Epidemic through the mHealth ParaSportAPP

Background: Although mHealth tools have great potential for health interventions, few experimental studies report on their use by people with spinal cord injuries in physical activity. Objective: The main objective of this study was to analyze the effect of the ParaSportAPP on different physical and psychological variables in people with paraplegia. Methods: Fourteen of these subjects made up the final sample. All the participants performed two pre-tests (control period) and a post-test with 8 months between the evaluations (COVID-19 broke out between pre-test 2 and the post-test). The ParaSportAPP was installed on their smartphones when they performed pre-test 2. The same tests were performed in the same order in all the evaluations: (i) the questionnaires PASIPD, HADS, RS-25; SCIM III and AQoL-8D, (ii) respiratory muscle strength, (iii) spirometry and (iv) cardiopulmonary exercise test. Results: The results showed no differences in any of the variables studied between the measurement times. Conclusions: Although none of the variables experienced improvements, the ParaSportAPP mobile application was able to lessen the impact of the pandemic on the variables studied.

The Symmetry of the Muscle Tension Signal in the Upper Limbs When Propelling a Wheelchair and Innovative Control Systems for Propulsion System Gear Ratio or Propulsion Torque: A Pilot Study

Innovative wheelchair designs require new means of controlling the drive units or the propulsion transmission systems. The article proposes a signal to control the gear ratio or the amount of additional propulsion torque coming from an electric motor. The innovative control signal in this application is the signal generated by the maximum voluntary contraction (MVC) of the muscles of the upper limbs, transformed by the central processing unit (CPU) into muscle activity (MA) when using a wheelchair. The paper includes research on eight muscles of the upper limbs that are active when propelling a wheelchair. Asymmetry in the value for MVC was found between the left and right limbs, while the belly of the long radial extensor muscle of the wrist was determined to be the muscle with the least asymmetry for the users under study. This pilot research demonstrates that the difference in mean MVCmax values between the left and the right limbs can range from 20% to 49%, depending on the muscle being tested. The finding that some muscle groups demonstrate less difference in MVC values suggests that it is possible to design systems for regulating the gear ratio or additional propelling force based on the MVC signal from the muscle of one limb, as described in the patent application from 2022, no. P.440187.

Measurement Performance of Activity Measurements with Newer Generation of Apple Watch in Wheelchair Users with Spinal Cord Injury

Background  The level of physical activity (PA) of people with spinal cord injury (SCI) has an impact on long-term complications. Currently, PA is mostly assessed by interviews. Wearable activity trackers are promising tools to objectively measure PA under everyday conditions. The only off-the-shelf, wearable activity tracker with specific measures for wheelchair users is the Apple Watch.

Objectives  This study analyzes the measurement performance of Apple Watch Series 4 for wheelchair users and compares it with an earlier generation of the device.

Methods  Fifteen participants with subacute SCI during their first in-patient phase followed a test course using their wheelchair. The number of wheelchair pushes was counted manually by visual inspection and with the Apple Watch. Difference between the Apple Watch and the rater was analyzed with mean absolute percent error (MAPE) and a Bland–Altman plot. To compare the measurement error of Series 4 and an older generation of the device a t -test was calculated using data for Series 1 from a former study.

Results  The average of differences was 12.33 pushes ( n  = 15), whereas participants pushed the wheelchair 138.4 times on average (range 86–271 pushes). The range of difference and the Bland–Altman plot indicate an overestimation by Apple Watch. MAPE is 9.20% and the t -test, testing for an effect of Series 4 on the percentage of error compared with Series 1, was significant with p  < 0.05.

Conclusion  Series 4 shows a significant improvement in measurement performance compared with Series 1. Series 4 can be considered as a promising data source to capture the number of wheelchair pushes on even grounds. Future research should analyze the long-term measurement performance during everyday conditions of Series 4.