Clinical Remote Monitoring of Individuals With Spinal Cord Injury at Risk for Pressure Injury Recurrence Using mHealth: Protocol for a Pilot, Pragmatic, Hybrid Implementation Trial

BACKGROUND

Pressure injuries are one of the most challenging secondary conditions for individuals with spinal cord injuries and related disorders (SCI/D) owing to inherent, lifelong risk factors that include a lack of sensory and motor function below the level of injury and reliance on a wheelchair for daily mobility, resulting in prolonged periods of sitting. Although many factors contribute to the development of pressure injuries, the pressure between the skin and a surface is always a factor and the development of injury is dependent on the magnitude and duration of the pressure. Clinically, broad recommendations for relieving pressure are used because we know very little about the unique day-to-day life patterns of the individual wheelchair user. Typically, it is after the occurrence of a pressure injury that the therapist will check equipment fit and the effectiveness of pressure offloading and ask about other surfaces they sit on in their home and community. This time-lapsed, largely self-reported data are fraught with recall bias and inaccuracies that the therapist incorporates into a plan of care.

OBJECTIVE

This study's objective is to pilot-test the implementation and clinical effectiveness of a telehealth model of care combined with our mobile health (mHealth) Assisted Weight-Shift device for remote monitoring of factors related to maintaining skin health and wheelchair setup. Our overall hypothesis is that this study will result in an effective implementation plan, and the enhanced connected model of care using remote monitoring of pressure management will result in pilot-level, improved clinical outcomes for adults with spinal cord injury at high risk for pressure injury recurrence.

METHODS

For all aims, we will use a mixed methods design using an exploratory, sequential approach to include the strengths of both qualitative and quantitative data. For aims 1 and 2, we will iteratively collect qualitative data from therapists, patients with SCI/D, and other stakeholders. For aim 3, we will perform a hybrid effectiveness-implementation randomized controlled trial to pilot-test the intervention. The projected results include an iteratively developed and tested implementation plan that meets moderate to high levels of acceptability, feasibility, and appropriateness. Additionally, the pilot trial results are expected to show positive trends in relevant clinical outcomes related to reduced pressure injury incidence, recurrence, and improved healing when compared with the standard of care.

RESULTS

Currently, 6 participants have been recruited for our aim-1 qualitative study.

CONCLUSIONS

This study will expand upon our previous study to move the Assisted Weight-Shift system into routine clinical care, which was a strong desire of adults with SCI/D for improved individualized care plans to prevent pressure injuries. The results of this study will guide the next steps in a full, hybrid effectiveness-implementation trial with the goal of improving care to prevent pressure injuries.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51849.

Lifestyle and health changes in wheelchair users with a chronic disability after 12 weeks of using the WHEELS mHealth application

PURPOSE

The aim of this study was to determine changes in physical activity, nutrition, sleep behaviour and body composition in wheelchair users with a chronic disability after 12 weeks of using the WHEELS mHealth application (app).

METHODS

A 12-week pre-post intervention study was performed, starting with a 1-week control period. Physical activity and sleep behaviour were continuously measured with a Fitbit charge 3. Self-reported nutritional intake, body mass and waist circumference were collected. Pre-post outcomes were compared with a paired-sample t-test or Wilcoxon signed-rank test. Fitbit data were analysed with a mixed model or a panel linear model. Effect sizes were determined and significance was accepted at p < .05.

RESULTS

Thirty participants completed the study. No significant changes in physical activity (+1.5 √steps) and sleep quality (-9.7 sleep minutes; -1.2% sleep efficiency) were found. Significant reduction in energy (-1022 kJ, d = 0.71), protein (-8.3 g, d = 0.61) and fat (-13.1 g, d = 0.87) intake, body mass (-2.2 kg, d = 0.61) and waist circumference (-3.3 cm, d = 0.80) were found.

CONCLUSION

Positive changes were found in nutritional behaviour and body composition, but not in physical activity and sleep quality. The WHEELS app seems to partly support healthy lifestyle behaviour.Implications for RehabilitationHealthy lifestyle promotion is crucial, especially for wheelchair users as they tend to show poorer lifestyle behaviour despite an increased risk of obesity and comorbidity.The WHEELS lifestyle app seems to be a valuable tool to support healthy nutrition choices and weight loss and to improve body satisfaction, mental health and vitality.

Usability of a navigation application for travel in Quebec City with wheeled mobility device and, further validation of the Evaluation of satisfaction with geospatial assistive technology

PURPOSE

Knowledge of route accessibility is indispensable for "wheeled mobility device" users to travel safely and efficiently; however, current navigation technologies hardly provide adapted information for this population. Aims of the study were to collect data on the usability of a navigation application and to propose a version 1.0 of the Evaluation of satisfaction with geospatial assistive technology (ESGAT), by addressing the criterion, construct and cross-cultural validities.

METHOD

A filmed field trial and a methodological study were conducted in parallel. Thirty wheeled mobility device users were filmed planning and making a 10-minute known journey using the HERE WeGo app. The ESGAT, ÉSTGA (French version) and the Computer System Usability Questionnaire were administered. A video observation grid addressed the effectiveness and efficiency during the journey. Descriptive, correlation and multiple match analyses were performed.

RESULTS

Fourteen men and 16 women averaging 45.9 years old tried out HERE WeGo; 14 were powered wheelchair users. Usability of the app was moderate (good effectiveness, moderate efficiency and quite satisfied). The criterion validity of the ÉSTGA was good (r = 0.598; p < 0.001). The construct validity was average considering the results for factor 1 (α = 0.789, acceptable), factor 2 (α = 0,586, low) and factor 3 (α = 0.409, unacceptable). The cross-cultural validity (French vs English) was moderate (r = 0.861; p < 0.001).

CONCLUSION

ESGAT and ÉSTGA 1.0 questionnaires are now available in English and French with a total mean score (11 items), an informatics subscore (mean of 5 items) and a geomatic subscore (mean of 6 items). Their validation should be pursued with new navigation applications. IMPLICATIONS FOR REHABILITATIONClinicians should ask their clients using a wheeled mobility device to test navigation applications to ensure their safety and complete the Evaluation of satisfaction with geospatial assistive technology (ESGAT 1.0), also available in French.Clinicians should inquire about satisfaction for items addressing informatics (Ease of access, Learnability, Hands-free function, Ease of use, Transportability and Appearance) and items addressing geomatic (Content, Geographic information, Effectiveness, Efficiency, Real-time navigation assistance, Aspect of security).Rehabilitation clinicians should inquire about the efficiency of the navigation app, considering avoiding or announcing potential obstacles such as: travelling on the street for a long portion of the trip and not on the sidewalk; verbal indication too soon or too late; incorrect indication; damaged, and congested sidewalk.

Accessible exercise for wheelchair users: comparing the usability of two adapted exercise machines

INTRODUCTION

Exercise is an important occupation for wheelchair users. Limited access to adapted aerobic exercise equipment in the community and lack of knowledge on how to exercise are barriers to exercise participation among wheelchair users. To address these barriers, the adapted rower (aROW) and adapted skier (aSKI) exercise machines and educational materials were created.

PURPOSE

1) To compare wheelchair users' perspectives of the effectiveness and usability of the aROW and aSKI. 2) To explore perceptions of educational materials to support use of the machines.

MATERIALS AND METHODS

A sequential, mixed-methods study design was used. Six wheelchair users trialled the machines, and completed an interview and two usability questionnaires. Qualitative data were analysed using thematic and conventional content analysis. Usability scores of both machines were compared using the Wilcoxon Signed Ranks Test.

RESULTS

Data show high usability of the aROW and aSKI. More set up challenges were reported for the aROW than the aSKI. Participants perceived both machines provided effective cardiovascular workouts, and each met their exercise goals differently. Participants preferred the instructional videos over instructional sheets and provided suggestions for improving both. The Wilcoxon Signed Ranks Test showed no statistically significant difference in usability between the aROW and aSKI.

CONCLUSION

Implementing the aROW and aSKI in the community may address some equity issues that wheelchair users face by providing more aerobic exercise options. Results will inform educational material revisions to support use of the machines.IMPLICATIONS FOR REHABILITATIONThe adapted rower (aROW) and adapted skier (aSKI) were perceived as highly usable, suggesting provision of more adapted aerobic exercise options, like the aROW and aSKI, may address some exercise-related equity issues wheelchair users experience.Wheelchair users may consider multiple factors when choosing adapted exercise equipment, highlighting the importance of providing multiple options for adapted aerobic exercise equipment to facilitate agency in choice of exercise.

Sensor Cell Network for Pressure, Temperature and Position Detection on Wheelchair Users

This work proposes an optical sensing network to monitor pressure and temperature in specific areas of a wheelchair to prevent pressure ulcers and to monitor the position of the wheelchair user by analyzing its pressure distribution. The sensing network is composed of six optical fiber Bragg grating (FBG)-based sensor cells. Each sensor cell is built from a polylactic acid (PLA) base and has two FBGs, one embedded in epoxy resin to monitor pressure variations (FBG_P) and another without resin to monitor temperature (FBG_T). Once produced, all sensor cells were experimentally characterized for pressure and temperature variations, resulting in an average pressure sensitivity of 81 ± 5 pm/kPa (FBG_P) and −5.0 ± 0.4 pm/kPa (FBG_T), and an average temperature sensitivity of 25 ± 1 pm/°C (FBG_P) and 47.7 ± 0.7 pm/°C (FBG_T). The sensor cells were then placed in six specific areas of a wheelchair (four in the seat area and two in the shoulder blade area) to carry out experimental tests, wherein the response of the sensors to a specific sequence of relief positions was tested. During the execution of the test, the optical signal of all sensors was monitored, in real time, with the pressure and temperature values detected in each zone of the wheelchair. In addition, random position changes were performed in order to evaluate the precision of the proposed sensing network in the identification of such positions.

A novel portable and cost-efficient wheelchair training roller for persons with disabilities in economically disadvantaged settings: the EasyRoller

PURPOSE

Stationary training rollers enable wheelchair users to maintain physical health and train as athletes, which serves to treat and prevent immobility-associated chronic disease and improve cardiorespiratory fitness required for sports performance. However, conventional exercise equipment is largely inaccessible for persons with disabilities in low-resource areas, primarily due to cost. The aim of this study was to prototype, develop, and test a portable, cost-efficient stationary training device for wheelchair users in low-resource settings - The EasyRoller.

MATERIALS AND METHODS

Stakeholder input from wheelchair athletes, trainers, and potential commercial manufacturers was solicited and utilized to conceptualize The EasyRoller design. The device was constructed from easily sourced, low cost components, following which it was user-tested with Para athletes. Feedback was analysed and incorporated into newer versions of the prototype.Results and conclusions: The EasyRoller creatively combines easily-sourced components to significantly cut down cost and ease both manufacture and repair for use in low-resource settings. The device is portable with a total weight of 34 pounds and total size of 42 linear inches while also affordable with a total cost of USD$199. Hereby, The EasyRoller has the potential to increase physical activity participation in populations with impairment who live in socioeconomically deprived world regions.Implications for rehabilitationExercise and physical activity are key aspects of health and quality of life for persons with disabilitiesStationary training rollers, devices that enable wheelchair users to train, are often bulky and expensive and therefore inaccessible for populations in socio-economically disadvantaged settingsThe EasyRoller is a portable and affordable training device that increases access to exercise and physical activity for these populations.

Evaluation of satisfaction with geospatial assistive technology (ESGAT): a methodological and usability study

Purpose: Manual wheelchair users are more vulnerable, in situations such as road crossings, hazardous sidewalks or curbs and crossing of buildings and facilities threshold. Geospatial assistive technology (GAT) can help with route planning. However, it is important to ensure the usability of such products, as well as the satisfaction of persons with reduced mobility. The study's aim was (1) to develop and validate a questionnaire on the satisfaction of GAT, in English and French, and to (2) assess satisfaction, efficacy and efficiency of a GAT with manual wheelchair users following a filmed trial in a dense urban area.Method: A methodological study was conducted (development of the questionnaire, assessment of its content validity, feasibility and practicability) followed by a trial and post-observations with the videos. Two questionnaires (English, French) were concurrently validated by two groups of experts (n = 8), and then field-tested by wheelchair users (n = 8), using Google Maps Pedestrian routeing tool.Results: The Evaluation of satisfaction with geospatial assistive technology (ESGAT) consists in a user profile and their experience with the technology, followed by 12 satisfaction criteria rated from 1-not satisfied to 5-very satisfied. Both questionnaires were rated as feasible and practicable to complete. The usability of Google Maps Pedestrian routeing tool was measured as "moderate" by manual wheelchairs since the total satisfaction score at the ESGAT was 3.9/5 (quite satisfied). The items with the lowest score were navigation assistance, hands-free function and security. The GAT was effective (87.5% have completed their destination) but not efficient (37.5% needed help).IMPLICATIONS FOR REHABILITATIONFor manual wheelchair users paired with geospatial assistive technology:• A 10 minutes questionnaire was developed and validated to assess their satisfaction after testing aid in an urban area.• Satisfaction criteria to address are ease of access (service), learnability, hands-free function, ease of use for planning as well for navigating, transportability/ appearance, content, geographic information, effectiveness, efficiency, navigation assistance and security• A field test is necessary to ensure the effectiveness of the technology in avoiding or announcing potential obstacles such as sidewalk crossing ramp, damaged and congested sidewalk; sidewalk tilt (side slopes); thresholds at destination; verbal indication too soon or too late; incorrect indication; the arrow does not indicate the right direction; readjustment of the route needed; a lack of indication; and human intervention needed.

Psychophysical Health Factors and Its Correlations in Elderly Wheelchair Users Who Live in Nursing Homes

Background: The aging is a multi-faceted process comprising both-the physical and mental alterations. Thus, the aim of the study was to evaluate the variables affecting the psychophysical state of the elderly people using wheelchairs and living in nursing homes (NH). Methods: 165 older wheelchair users were included in the study after meeting the inclusion criteria and expressing written consent. The assessment involved cognitive functioning, depression, body balance and flexibility, lung capacity and upper limbs dexterity, strenght and endurance. The results showed negative correlation between depression and balance, upper limb dexterity and endurance and shoulder flexion. A positive correlation between cognitive functioning and balance, upper limb dexterity, strenght and endurance, lung capacity and joint mobility was determined. Also, the study proved positive correlation between daily functioning and functional fitness, muscle strength and endurance, body flexibility, joint mobility. The regression analysis showed that better scores in balance test and joint mobility implied with higher scores in cognitive functioning. The most important determinants of functional fitness were balance, hand grip strenght and joint mobility. Conclusion: The future study should be focused on developing interventions aimed at senior wheelchair users living in NHs to prevent the deterioration of their mental and physical fitness.

Geospatial assistive technologies: potential usability criteria identified from manual wheelchair users

Purpose: To advance knowledge of specific usability criteria for Geospatial Assistive Technologies (GATs) and manual wheelchair users, and to develop a profile and expectations for potential future users.Method: A face-to-face cross-sectional study was conducted with 17 community-dwelling manual wheelchair users (aged 18-45 years) who use a mobile device. A semi-structured interview was conducted as follows: (1) four video clips presenting technologies related to GATs (applications on a smartphone or smart watch, augmented reality glasses, virtual reality helmet) were shown; (2) questions were asked about the perceived advantages and disadvantages of route planning prior to travel and navigation while receiving guidance in urban areas; and (3) an activity to rank fifteen defined usability criteria by importance was conducted. Two questionnaires were also self-administered: the Temple University Community Participation Measure and the Wheelchair Use Confidence Scale for Manual Wheelchair Users (WheelCon).Results: This study defines a comprehensive sample profile of manual wheelchair users with GAT and 19 distinctive usability criteria for GATs specifically suited to manual wheelchair users. Fifteen criteria were identified as the most important (actual use, appearance, Bluetooth, comfort, dimensions, ease of use, efficiency, familiarity, features, hands-free operation, information content, quality of information and transportability). Information content and transportability demand higher expectations while the emerging Bluetooth and free-hands criteria are associated with transportability.Conclusion: The results obtained using a user-centric approach yielded useful data to improve GATs and broaden the concept of compatibility among users and specific-use situations to ensure usability.Implications for rehabilitation For manual wheelchair users paired with a geospatial assistance technology:• The smart phone is preferred (compared to the smart watch, augmented reality glasses or virtual reality helmet) for both plan and navigation tasks. Actual use, comfort, ease of use, familiarity, features and informative content are important criteria and the smart phone as mobile device for GATs is perceived favourably to meet the requirements coming up with these criteria.• Especially suitable for guidance and manual wheelchair navigation (double-task), two emergent criteria emerge regarding the usability of GATs: hands-free and Bluetooth. Hands-free is associated with potential usability issues regarding smart phone transportability and to the relevance of augmented reality glasses or smart watches as mobile device for GATs. The Bluetooth connexion appears as being part of the solution for increasing the transportability of any of these mobile devices.• Appearance and dimension of GATs, their efficiency for planning and navigating, and the quality of the delivered information are other important usability criteria.• Since information content and transportability are targeted as the two most important criteria, we should pay special attention in the future to the availability of information about accessibility of destinations and also, to appropriate fixation and Bluetooth systems ensuring, partially or completely, hands-free operation in order to meet user needs.

Geospatial assistive technologies for wheelchair users: a scoping review of usability measures and criteria for mobile user interfaces and their potential applicability

Background: Wheelchair users are increasingly using route planners and navigation systems to help them get around the city. The absence of a list of usability criteria for wheelchair user-centred design and recommending geospatial assistive technologies creates uncertainty about the choices to be made by rehabilitation clinicians and geographic information systems specialists. The aim of this study was to compile such a list by identifying usability criteria from standardized questionnaires linked to user interfaces and geospatial assistive technologies (GATs).Material and methods: We conducted a scoping review in ACM Digital Library, Inspec/Compendex and PsycINFO for the period 2005-2016 using keyword strategies. From 84 articles identified, after screening and exclusion procedures, 15 articles were selected. Data were extracted from them and reported in table 1 (relevant questionnaires listed in alphabetical order, type of user interface, population studied, psychometric properties, type of measurement scale and information about the construct, number of subscales and items) and in table 2 (usability criteria up to 20 items for the questionnaires, scales or constructs, pointing criteria as gold standard in physical rehabilitation and as in geographic information).Results: We identified 87 usability criteria in 12 standardized questionnaires in 15 articles (with at least two types of psychometric properties). There are 54 usability criteria that could be used in clinical situations concerning their potential applicability to GATs for wheelchair users: 20 are familiar to rehabilitation clinicians who recommend assistive technologies, 21 are generic to GATs while 13 are specific to mobile applications or voice recognition systems. It remains 34 criteria that are not actually familiar to clinicians: actual use, content (including content-clarity, content-color, content-consistency, content-credibility, content-legibility, content-relevance, content-trustworthy, and content-understandable), control-obviousness, customer service behavior, delivery format, design-application, ease of navigation, entry-point type, everyday words, fingertip-size controls, font, functions-expected, functions-integration, gestalt, graphics, habit, hierarchy, input, network externality, speech characteristics, structure, subtle animation, time spent waiting, transition, user goal orientation and verbosity.Conclusions: More research is needed to develop a questionnaire specific to geospatial assistive technologies for wheelchair users linked with mobile applications and information content.Implications for rehabilitationFor manual wheelchair users paired with geospatial assistance technology, "effectiveness, efficiency, learnability and satisfaction" are essential criteria for route planning and navigation task.Clinicians can optimize the selection of a geospatial assistance technology considering 16 criteria: appearance, assistance-human support, comfort, ease of holding, ease of use, emotional aspect, endurance, facilitating conditions, intention to use, minimal memory load, physical effort, price value, simplicity, social influence, training and usefulness.Clinicians should have in mind that WC users want to plan a route with as few obstacles as possible. Information on the screen should be accessible to WC users (text, contrast, symbols, graphics, photos, voice, vibration, route views). Hands are occupied with the hand rims, WC users would prefer "listen to verbal" instructions to continue their route instead of looking on their electronic device. 34 criteria are specific for route planning and navigation task.

Applicability of an elastic band exercise program to wheelchair-bound older adults with and without dementia: A self-rating survey

AIM

To investigate the perceptions of wheelchair-bound older adults with and without dementia toward the Wheelchair-bound Senior Elastic Band exercise program, and to compare the differences of their perceptions to the program.

METHODS

A descriptive and comparative design was applied. Data were derived from the experimental groups of two cluster-randomized controlled trials. A total of 133 participants from eight long-term care facilities were recruited: dementia trial (four facilities, n = 73) and non-dementia trial (four facilities, n = 60). All participants received the Wheelchair-bound Senior Elastic Band exercises, which included three phases of warm-up, aerobic motion and harmonic stretching, three times per week, 40 min per session for 6 months. The self-rating survey using the criteria of simplicity, safety, appropriateness and helpfulness was applied to rate the program through face-to-face individual interviews at the end of the study.

RESULTS

Wheelchair-bound older adults with or without dementia have positive perceptions of the Wheelchair-bound Senior Elastic Band exercise program with regard to its simplicity, safety, appropriateness and helpfulness after 6 months of practice (mean scores ranged 8.75-9.59). No significant differences were found between groups on self-rating of the program in most of the criteria.

CONCLUSIONS

Older adults with dementia might be able to express their perceptions toward the exercise program through the self-rating survey, as did the participants without dementia. The participants' perceptions provide direct feedback for modifying, improving and sustaining the long-term implementation of the program. Geriatr Gerontol Int 2019; 19: 103-107.

Perspectives and experiences of Thai adults using wheelchairs regarding barriers of access to dental services: a mixed methods study

PURPOSE

To explore the perspectives and experiences of Thai wheelchair users regarding barriers of access to dental services and report potential solutions in terms of customer satisfaction.

PARTICIPANTS AND METHODS

We conducted a 2-phase cross-sectional study with quantitative and qualitative components at a community club for individuals with disabilities in Pathum Thani province, Thailand, in February 2018. In quantitative phase, participants were interviewed using a structured questionnaire that consisted of 1) questions on demographic characteristics and 2) adapted questions that were based on the modified Penchansky and Thomas dimensions of access. Enter method of binary logistic regression analysis was used. Regarding qualitative phase, focus group discussions were conducted using the themes of a semi-structured discussion guide. Thematic analysis was used.

RESULTS

A total of 156 wheelchair users participated in the quantitative phase. Most study participants had not attended dental care services in the previous year (78.2%). Multivariate analysis found a statistically significant association that indicated that participants who had education level ≤primary education were 3.5 times more likely to had not attended a dental appointment in the previous year (P=0.003). In the qualitative phase, 33 participants were included in 3 focus groups (each comprising 11 participants), they were wheelchair users with education >primary, who did not go to see a dentist in the previous 12 months. Findings of the 3 focus groups suggest generally negative views about Thai dental services for all dimensions of access.

CONCLUSION

This study reflects the unheard voices of wheelchair users and provides rigorous evidence in Thai context that difficulties of access to dental services persist. Policy makers and oral health professionals in oral health system should be alerted to the explicit barriers reported, such that equitable and equal dental services for disabled individuals can be developed.

Dynamic Three-Dimensional Ultrasound to Evaluate Scapular Movement Among Manual Wheelchair Users and Healthy Controls

BACKGROUND

A large percentage of individuals with spinal cord injury (SCI) report shoulder pain that can limit independence and quality of life. The pain is likely related to the demands placed on the shoulder by transfers and propulsion. Shoulder pathology has been linked to altered scapular mechanics; however, current methods to evaluate scapular movement are invasive, require ionizing radiation, are subject to skin-based motion artifacts, or require static postures.

OBJECTIVE

To investigate the feasibility of applying 3-dimensional ultrasound methods, previously used to look at scapular position in static postures, to evaluate dynamic scapular movement.

METHODS

This study evaluated the feasibility of the novel application of a method combining 2-dimensional ultrasound and a motion capture system to determine 3-dimensional scapular position during dynamic arm elevation in the scapular plane with and without loading.

RESULTS

Incremental increases in scapular rotations were noted for extracted angles of 30°, 45°, 60°, and 75° of humeral elevation. Group differences were evaluated between a group of 16 manual wheelchair users (MWUs) and a group of age- and gender-matched able-bodied controls. MWUs had greater scapular external rotation and baseline pathology on clinical exam. MWUs also had greater anterior tilting, with this difference further accentuated during loading. The relationship between demographics and scapular positioning was also investigated, revealing that increased age, pathology on clinical exam, years since injury, and body mass index were correlated with scapular rotations associated with impingement (internal rotation, downward rotation, and anterior tilting).

CONCLUSIONS

Individuals with SCI, as well as other populations who are susceptible to shoulder pathology, may benefit from the application of this imaging modality to quantitatively evaluate scapular positioning and effectively target therapeutic interventions.

Effects of Krankcycle Training on Performance and Body Composition in Wheelchair Users

Innovation in training equipment is important for increasing training effectiveness, performance and changes in body composition, especially in wheelchair users with paraplegia. The main objective of a workout session is to induce an adaptation stimulus, which requires overload of involved muscles by voluntary effort, yet this overload may be highly influenced by the size of the spinal cord lesion. Krancykl construction is designed to allow exercise on any wheelchair and with adjustable height or width of crank handles, where even the grip handle may be altered. The aim of this study was to determine the differences in body composition, performance and the rate of perceived exertion (RPE) in paraplegics with a different level of paralyses after a 12 week training programme of a unilateral regime on Krankcycle equipment (a crank machine). The study sample included four men and one women at a different spine lesion level. The 12 weeks programme was successfully completed by four participants, while one subject got injured during the intervention process. Three participants were paraplegics and one was quadriplegic with innervation of the biceps humeri, triceps humeri and deltoideus. The Krankcycle 30 min programme was followed by four other exercises, which were performed after themselves rather than in a circuit training manner as the latter would result in much longer rest periods between exercises, because paraplegics have to be fixed by straps during exercise on hydraulic machines. The RPE after the workout decreased following the twelve week adaptation period.

Universal design and the challenge of diversity: reflections on the principles of UD, based on empirical research of people's mobility

PURPOSE

The author analyses some theoretical presuppositions of the Universal Design approach. She shows that it is based on two paradoxes: (1) it reduces diversity to the "universal", (2) it depends on an asymmetrical view of abilities and disabilities. The author suggests a way of changing this concept in order to take into account uniqueness and diversity, in order to allow the shaping of abilities.

METHODS

The data are taken from an ethnographical survey carried out between 2007 and 2009 made up of in-depth interviews with wheelchair users and their families. The interviews were analysed inductively using the Nvivo© programme.

RESULTS

The mobility of people in wheelchairs, and their capacity to act, are linked to their particular experience and are the result of a process of adjustment and arrangement. This process involves specific and varied resources and leads to changes in the individuals, in their dis/abilites, but also in their perceptions.

CONCLUSIONS

This analysis leads to a change in the question of policy. This question is no longer "how to include diversity using the definition of 'universal'", but "how to bring out and articulate this diversity, so as to vary the qualities of persons and the world in which they live". Implications for Rehabilitation "Inaccessibility" is analysed in terms of a discrepancy between the user and her/his environment and in terms of experience. Accessibility is analysed as a process of adjustment and practical arrangements between the person and her/his environment. The universalism of Universal Design is criticized in the way it tries to force the variety of users into the uniqueness of one materiality. Emphasis is put on diversity and the necessity of articulating this diversity in a plural world offering various resources that individuals can call upon to act, depending on what they are and on what they want to become.

Prevalence of carpal tunnel syndrome and wrist osteoarthritis in long-term paraplegic patients compared with controls

We compared functional and structural changes in the hands, in particular the prevalence of carpal tunnel syndrome, in 56 paraplegic patients who had been wheelchair dependent for over 25 years with a group of able-bodied volunteers (with matching criteria for gender and age). The hands were assessed by clinical examination, electrophysiology, disabilities of the arm shoulder and hand score and magnetic resonance imaging. Hand function was worse and wrist pain was experienced more often in the paraplegic patients, and they also had a significantly higher prevalence of carpal tunnel syndrome both clinically and electrophysiologically. The prevalence of wrist and trapeziometacarpal osteoarthritis was significantly higher in the right hand.