Turning in Circles: Understanding Manual Wheelchair Use Towards Developing User-Friendly Steering Systems

Pilot Study of a Peer-Led Wheelchair Training Program to Improve Self-Efficacy Using a Manual Wheelchair: A Randomized Controlled Trial

Shoulder pain in wheelchair users with tetraplegia and paraplegia

Although an essential component of best practice, wheelchair skills training is often inadequate; occupational therapy practitioners' professional preparation is a contributing factor. To assess the effectiveness of a boot camp on capacity and self-efficacy in wheelchair skills and self-efficacy in clinical practice, retention of improvements, and effective boot-camp attributes. Concurrent, embedded, mixed-methods cohort design that used blinded, repeated-measures quantitative evaluation with 4-mo follow-up and directed content analysis of a qualitative questionnaire. University entry-to-practice program. Convenience sample (N = 42) of final-year students. A 4-hr boot camp with demonstration and supervised practice. Content incorporated skill performance, training and motor-learning strategies, and safe supervision. Skill performance capacity (Wheelchair Skills Test-Questionnaire), self-efficacy with manual wheelchair use (Wheelchair Use Confidence Scale), confidence in provision of manual wheelchair training services (Self-Efficacy in Assessing, Training, and Spotting test), and a boot-camp experience questionnaire. Within-subjects analysis of variance revealed significant improvements on all measures (p < .001) with large effect sizes (ηp² = .68-.88). All measures except skill capacity demonstrated retention; skill capacity decreased 5.3% (95% confidence interval [2.0, 8.5]) but was significantly higher than baseline. Three themes influenced practice confidence: knowledge acquisition, experiential learning, and client empathy. Results confirm improved wheelchair self-efficacy, capacity, and self-efficacy with clinical intervention skills. Retention of outcomes suggests the potential impact on future practice. Experiential learning supports performance component acquisition and imparts empathy of client experience, which may improve occupational therapy practitioners' perceptions of client potential. A 4-hr experiential boot camp can increase students' capacity and confidence to deliver wheelchair skills training to future clients. Experiential learning increased students' appreciation for clients' experience and expectation of client potential.

Système d’aide au choix et aux réglages du fauteuil roulant manuel

For persons with disabilities, access to transportation is necessary for integration into society. The Americans with Disabilities Act (ADA) has been instrumental in assuring transportation access to individuals with disabilities for purposes of employment, education, and recreation. A substantial number of wheelchair users may not be able to transfer from their wheelchair to a motor vehicle seat during transportation. It is necessary to afford these wheelchair users the same level of safety as occupants seated in motor vehicle seats. The purpose of this study was to investigate the response of a manual wheelchair used as a motor vehicle seat, while the motor vehicle is subjected to rear impact. The specific aims of the study were to (1) identify the most common wheelchair failure mechanisms in a forward facing manual wheelchair subjected to rear impact, (2) develop and validate a computer simulation model of a wheelchair and seated occupant in rear impact, (3) develop wheelchair manufacturer transportation safety design guidelines under rear impact conditions for adult manual wheelchairs, by defining critical loads, wheelchair response, and common failure mechanisms, and (4) develop Wheelchair Tiedown and Occupant Restraint System (WTORS) manufacturer safety design guidelines under rear impact conditions for securing adult manual wheelchairs, by defining critical loads. In the first part of the study, several rear impact sled tests were performed with a commercial, WC19, manual wheelchair in its original configuration. The wheelchair occupant was represented by a midsized male anthropomorphic test device (ATD) and the sled tests were carried out according to the proposed ISO rear impact standard. The first set of sled tests were used to identify common wheelchair failure mechanisms under rear impact conditions: front securement point hardware failure, seatback failure, and failure of the wheelchair frame. A second set of sled tests were conducted with three reinforced, manual, WC19 wheelchairs which did not exhibit failures. Test results from the reinforced wheelchairs were used in the development and validation of a MADYMOTM computer simulation model of the rear impact scenario. During the validation process, key outcome measures from the sled tests were compared to those in the model. Statistical analysis was performed to quantify how well the model outcome measures matched those obtained from sled tests. The model was ultimately deemed validated and used to conduct the parametric sensitivity analysis. In the parametric sensitivity analysis key model parameters were varied, while outcome measures associated with wheelchair component and WTORS loading

Objective: To systematically identify factors associated with participation in social and community activities for adult wheelchair users (WCUs). Data sources: PubMed/MEDLINE, CINAHL, PsycINFO and EMBASE. Study selection: Quantitative and qualitative peer-reviewed publications were included, which were written in English, reported original research and investigated factors associated with social and community participation in adult WCUs. Data extraction: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. Factors were organized using the International Classification of Functioning, Disability and Health (ICF). Data synthesis: Thirty-five studies were selected: two of power WCUs, 10 of manual WCUs and 23 of both. Six qualitative studies, ranging in quality from 8/10 to 9/10 and 29 quantitative studies were included, ranging in quality from 4/15 to 11/15. Fifteen body function, 4 activity, 5 participation, 15 environmental and 14 personal factors were found to be associated with social and community participation. Conclusions: Social and community participation of WCUs is associated with factors from all ICF domains. Wheelchair factors, accessibility, skills with wheelchair use, pain, finances and education are modifiable factors frequently reported to be associated with participation. Experimental research focusing on modifiable factors is needed to further our understanding of factors influencing participation among WCUs.Implications for RehabilitationWheelchair factors, including comfort and durability, are associated with participation and may be targeted in clinical intervention.Wheelchair skills are clinically modifiable and have been shown to improve participation in manual wheelchair users.Body functions (e.g. confidence, depression and fatigue) and personal factors (e.g. finances and level of education) may be considered for clinical intervention.

Rates and Predictors of Manual and Powered Wheelchair Use for Persons With Stroke: A Retrospective Study in a Canadian Rehabilitation Center

ObjectiveSteering-by-leaning is a promising innovation for manual wheelchairs. It may enable improved energy efficiency, one-handed manoeuvrability, and increased trunk activity during wheelchair use in daily life. To explore the feasibility of this concept, the lateral trunk function of active wheelchair users was assessed before comparing 3 preliminary dynamic backrest designs in a virtual steering exercise.DesignRepeated measures, cross-over study.SubjectsA convenience sample of 15 individuals who had been full-time users of manual wheelchair for at least 1 year.MethodsActive core strength and lateral leaning range of motion were captured while sitting freely. Participants subsequently tested 3 dynamic wheelchair backrest designs on an individually adjusted laboratory wheelchair prototype by performing a virtual steering exercise. Deviations from a target movement path were analysed using repeated measures analysis of variance and Pearson correlation coefficients.ResultsFunctional leaning range of motion ranged from below 10° to almost 70°, but increased significantly with use of the simplest backrest design based on a 2-dimensional hinge joint. No correlation was found between functional levels and performance parameters in the virtual steering exercise.ConclusionUsing an individually fitted and calibrated design, upper body-actuated wheelchair steering using a laterally tilting backrest is accessible to wheelchair users across a wide spectrum of physical abilities.LAY ABSTRACTManual wheelchairs not only enable mobility, but also provide postural support to users through passive seating elements. The consequences of static sitting, however, include pain, deformities, and pressure injuries. The concept of backrest steering in manual wheelchairs may improve overall energy efficiency while promoting active trunk movement, but its applicability is questionable given the varying levels of trunk control among users. In this study, active trunk function of 15 full-time users of manual wheelchairs was measured prior to testing 3 prototype dynamic backrest designs in a virtual steering exercise. The results highlight the broad spectrum of abilities in this population, but suggest that active movement can be supported by simple mechanisms. No meaningful relationship was found between trunk abilities and performance in the virtual steering exercise, indicating that upper body-actuated steering of manual wheelchairs is accessible to users across a wide spectrum of physical abilities.

Wheelchair propulsion interventions typically teach manual wheelchair users to perform wheelchair propulsion biomechanics as recommended by the Clinical Practice Guidelines (CPG). Outcome measures for these interventions are primarily laboratory based. Discrepancies remain between manual wheelchair propulsion (MWP) in laboratory-based examinations and propulsion in the real-world. Current developments in machine learning (ML) allow for monitoring of MWP in the real world. In this study, we collected data from participants enrolled in two wheelchair propulsion interventions, then built an ML algorithm to distinguish CPG recommended MWP patterns from non-CPG-recommended patterns. Eight primary manual wheelchair users did not initially follow CPG recommendations but learned and performed CPG propulsion after the interventions. Participants each wore two inertial measurement units as they propelled their wheelchairs on a roller system, indoors overground, and outdoors. ML models were trained to classify propulsion patterns as following the CPG or not following the CPG. Video recordings were used for reference. For indoor detection, we found that a subject-independent model was able to achieve 85% accuracy. For outdoor detection, we found that the subject-independent model achieved 75.4% accuracy. These results provide further evidence that CPG and non-CPG-recommended MWP patterns can be predicted with wearable sensors using an ML algorithm.

Background: The aim was to explore independent wheeled mobility in children with CP, and identify predictors of early independent wheeled mobility and changes over time across birth cohorts. Methods: We included data from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP) comprising 11,565 assessments of 1780 children born in 2002–2019. Variables included demographic data, Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels, wheelchair use, and independent wheeled mobility. Cox proportional hazard regression was used to identify predictors for early independent wheeled mobility. Kaplan–Meier survival curves were used to compare birth cohorts. Results: Of 769 (43%) children who used a wheelchair, 511 (67%) had independent wheeled mobility. Two thirds of the children (n = 337) achieved independent wheeled mobility before age 7. Most children with independent wheeled mobility used powered wheelchairs. Children at GMFCS levels III and IV were more likely to reach independent wheeled mobility at an early age. Children at MACS levels III–V had a lower probability of early independent wheeled mobility. The average age of achieving independent mobility decreased from 9.5 to 4.0 years between birth years 2002 and 2019. Conclusions: Two in three children were independent wheelchair users before 7 years of age, and the age of obtaining independent wheeled mobility has decreased over the last 20 years. Children with better hand function were more likely to obtain early independent wheeled mobility. Early intervention programs to promote mobility, development and participation should include powered mobility, adapted steering options, and interventions for hand function.

Wheelchair Skills Training to Improve Confidence With Using a Manual Wheelchair Among Older Adults: A Pilot Study

Manual wheelchairs: research and innovation in sports and daily life

Manual wheelchairs (MWC) users have limited mobility during winter months as they encounter many environmental barriers that restrict their community participation. This paper outlines the creation and standardization of an outdoor environment designed to simulate the real-life conditions and obstacles experienced by MWC users in winter. This study consisted of four phases. In Phase 1, researchers used a qualitative ethnographic approach to document the specific challenges and adaptive strategies used by MWC users in winter conditions. In Phase 2, key informants with expertise in MWC winter mobility were invited to co-design the Standardized Navigation Of Winter Mobility & Accessibility Network (SNOWMAN) course. Participants reviewed draft design solutions and offered their input and suggestions to expand upon the initial design. A second co-design workshop included additional key informants, including service providers, policymakers, and professionals with expertise in landscape architecture and engineering, to validate the design solution. The workshops resulted in a detailed illustration of the SNOWMAN course, including five sections: platforms with side slopes, a miniature ice rink, curbs and curb cuts, a path with uneven winter surfaces, and modular ramps at various slopes. Phases 3 and 4 marked the conclusion of the study and involved fabrication of the SNOWMAN course and establishment of a standardized protocol for course setup and maintenance. The project aimed to offer several additional potential benefits, supported by the various stakeholders across the study phases, that extend beyond creation of a controlled and safe environment for wheelchair users to develop their winter mobility skills. Practicing wheelchair skills in this area may assist wheelchair users in gaining confidence which may ultimately translate to increased participation in the community.

This study aimed to review the application of commercial smartwatches as a tool for monitoring health and exercise variables and the accuracy of their measurements, with users being people with physical disabilities who use manual wheelchairs. The searches were conducted in PubMed, Scopus, Web of Science, and IEEEXplore. Studies were included regardless of experimental design as long as they involved people with physical disability or without any physical disabilities who used manual wheelchairs in evaluations with commercial smartwatches. Thirteen studies were included in the review. Overall, there was no consensus on the accuracy of wheelchair-related measurements, such as physical tests and daily activities, with only the Apple Watch® Series 1 and 4 and the Fitbit Charge 2® providing acceptable information. Regarding the physiological measurements offered by smartwatches during physical evaluations, only the Xiaomi Mi Band 5® provided reliable heart rate readings. Additionally, the Apple Watch® Series 5 did not demonstrate sufficient sensitivity to detect falls from the wheelchair. Finally, despite these limitations, commercial smartwatches are seen as a promising tool for self-care and increased autonomy. However, restrictions must be considered, especially in contexts where movements are subtle or gradual, and they should not be used for clinical purposes or disease diagnosis.

Effect of a pushrim-activated power-assist wheelchair on the functional capabilities of persons with tetraplegia