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Descriptive study about congruence in wheelchair prescription
Abstract and Figures
Wheelchair prescription is relevant in the prevention of muscular joint pathology, and to facilitate autonomy and the patient's social life. However, in order to reach this goal, respecting the standards with a client-centred approach is essential. Congruence between user ability and wheelchair characteristics by making wheelchairs more "user friendly" can improve patient independence, facilitate integration into society and improve the patient's quality of life. The purpose of this study was to analyse congruence of wheelchair use by our patients, through the consideration of specific recommendations related to each subject's individual clinical situation. The second aim of the paper was to improve wheelchair prescriptions, by identifying the most frequent mistakes in the prescription and construction of wheelchairs.
Observational study, outpatient.
One hundred-fifty wheelchair users (average age 46.7±17.3) were analysed and described at 16.2±8.5 years from the onset of their disability. The subjects were 80 males and 70 females.
Sixty-eight percent of the wheelchairs were not suitable for the patients, while 32% were suitable. We reported the incidence of non-congruence with respect to each wheelchair part.
After finding a correlation between the prescription sources and suitability, the authors suggested that wheelchair prescriptions should be carried out in specialized departments, or that physician competences, and collaboration between physicians and technicians must be improved. Our data indicates the necessity to pay more attention to wheelchair prescription while considering ergonomic fitting to the individual.
Identifying the most frequent mistakes in the prescription and construction of wheelchairs in this paper could help to make more appropriate prescriptions.
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... Yet, 55-68% of wheelchair users use inappropriate wheelchairs (e.g. inappropriate seat height, cushion and back height) due to factors such as users' obtaining wheelchairs without a prescription, wheelchairs were prescribed by non-specialized centres, errors in prescription and construction of wheelchairs, and challenges with insurances and refunding systems [48,49]. In order to reduce/prevent fall risk and fall-related injuries, improvements in accessibility of wheelchair prescription and appropriate follow-up are needed for wheelchair users living in the community [48,49]. ...
... inappropriate seat height, cushion and back height) due to factors such as users' obtaining wheelchairs without a prescription, wheelchairs were prescribed by non-specialized centres, errors in prescription and construction of wheelchairs, and challenges with insurances and refunding systems [48,49]. In order to reduce/prevent fall risk and fall-related injuries, improvements in accessibility of wheelchair prescription and appropriate follow-up are needed for wheelchair users living in the community [48,49]. ...
Introduction:
Wheelchair users with spinal cord injury are at a high risk of falls. However, the perspectives of wheelchair users with spinal cord injury on their fall circumstances and their preferences for fall prevention strategies/interventions remain understudied. Therefore, we aimed to: a) describe the circumstances of falls experienced by wheelchair users with spinal cord injury over a six-month period, b) explore their perspectives of why falls occurred in certain situations, and c) explore their perspectives on recommended content/structure of fall prevention strategies/interventions.
Methods:
This sequential explanatory mixed methods study had two phases. Phase I involved tracking of falls experienced by wheelchair users with spinal cord injury over six months, in which participants completed a survey after experiencing a fall to track the number/circumstance of each fall. Data from the surveys were descriptively reported. Phase II involved a photovoice focus group discussion of the survey findings and their preferences for fall prevention strategies/interventions. Data from the focus group discussion were analyzed using a thematic analysis.
Results:
Thirty-two participants completed phase I. More than half of the participants fell at least once in six months. Falls commonly occurred in the afternoon during a transfer, or when participants were wheeling over uneven ground. One-third of the falls caused an injury. Eleven participants that fell during phase I participated in the focus group. Two main themes were identified from the discussion: 1) "circumstances surrounding the falls" (e.g. when falls occurred, the home is a 'safe space') and 2) "suggestions and preferences for fall prevention strategies/interventions" (e.g. fall prevention involves all, fall prevention training available as needed).
Conclusion:
Fall prevention strategies/interventions should be an integral component of rehabilitation practices across the lifespan. Participants recommend customizing fall prevention strategies/interventions to their specific needs to guide the structure, content, and delivery of targeted fall prevention programs.
... Sabol et al. reported that an optimized seating system can improve quality of life, while the poorly designed system increases health risks, such as upper extremity pain and skin breakdown [34]. One study found that out of the participants, 68% of wheelchairs prescribed were not suitable for their users, and those non-suitable wheelchairs were often prescribed at nonspecialized facilities [35]. In order to improve the suitability of seating prescriptions, proper seating evaluations must be done that reduce pressure at the high risk regions, maintain a safe and effective posture for the user, and consider other factors of importance to the user's life. ...
Purpose:
To describe the current seating recommendations made by a seating clinic for wheelchair users who presented with a Pressure Injury (PrI) or history of PrI.
Methods:
Retrospective review of electronic medical records of 133 adults who used a wheelchair as their primary means of mobility who had a cushion evaluation during which interface pressure mapping data was documented.
Results:
Clinicians adjusted 71% of participants' wheelchair cushions, including 49% who received a new cushion, and 37% of participants' wheelchairs. The most common adjustments besides receiving a new cushion were: addition of an underlay, adjusting the inflation of a cushion, and adjustments to the foot or back support of the wheelchair. Forty-five participants only received adjustments (i.e. no new cushion), while 23 participants only received education and feedback rather than equipment modifications. Those 23 participants had significantly lower Peak Pressure Index (PPI) than those who received equipment modifications (mean [95% CI] 76.7 [59.1, 94.3] versus 111.6 [102.1, 121.2] respectively, p = 0.001). The PPI was reduced by an average of 22.5 mmHg from the initial to final seating system amongst those who received modifications ([13.9-31.0], p<.001).
Conclusions:
The seating clinicians considered interface pressure mapping in their decision-making and effectively reduced interface pressures with their interventions. Cushion replacement is important when someone presents with a PrI. However, adjusting an existing wheelchair cushion and/or seating system provides important additions and alternatives to consider for reducing interface pressure. There is also a role for education about proper use of equipment, weight shifts, and alternate seating surfaces.IMPLICATIONS FOR REHABILITATIONA cushion evaluation may involve evaluating more than one cushion configuration and using pressure mapping to compare the best options.To address perceived wheelchair cushion issues, posture and positioning should be evaluated and adjusted as necessary, in addition to evaluating the cushion itself.Common positioning modifications include: modifying/adding cushion underlays or inflation and foot and back supports in response to clients' changing postural needs and wheelchair components coming out of optimal position due to wear and tear.Adjustments to the wheelchair and cushion aim to distribute body weight over a larger surface area, reduce pressure at high-risk locations, improve posture, and increase function. These adjustments should consider individual's specific needs and goals, while also being mindful of funding barriers.
... Por tanto, los investigadores, fabricantes y médicos deben minimizar las cargas mecánicas durante la propulsión manual y optimizar la eficiencia del movimiento para mejorar la movilidad.En este contexto, la prescripción adecuada es importante para las necesidades y expectativas del usuario.(33) Se sabe que el 68 % de las sillas de ruedas no son apropiadas; esto puede interpretarse como resultado de errores de la indicación médica y favorece desenlaces negativos en el estado funcional y la condición musculoesquelética de los pacientes.(34) Características de la silla de ruedas para prevenir el STC y las lesiones en miembros superiores El ángulo y las dimensiones del asiento, la posición vertical y horizontal de las ruedas traseras, así como su tamaño e inclinación, afectan la eficiencia de la propulsión y la capacidad de conducción de la silla de ruedas. ...
Introducción: El síndrome de túnel de carpo es una neuropatía del nervio mediano muy frecuente en la población. Para los usuarios de sillas de ruedas hay mayor riesgo biomecánico por utilizar reiteradamente la muñeca en la propulsión de este vehículo.
Objetivo: Analizar los factores biomecánicos de la silla de ruedas que inciden en el desarrollo del síndrome de túnel del carpo.
Métodos: Se realizó una revisión sistemática con términos Mesh en bases de datos como Embase, Pubmed, Google Acedemics, Scielo desde 1988 hasta 2021. Se revisaron más de 200 artículos y por su impacto clínico, se seleccionaron 52 para la revisión.
Resultados: El 43 % de los usuarios de silla de ruedas presentan dolor en la muñeca y prevalece como diagnóstico el síndrome de túnel del carpo. La posición de la muñeca en la propulsión genera un aumento de presión en el túnel carpiano lo que condiciona la lesión del nervio mediano. Existen factores de riesgo como el género femenino, las pendientes, el terreno irregular, la vibración, la altura del asiento y el peso del paciente. Entender correctamente las fases de la autopropulsión con sus cuatro patrones, más una prescripción adecuada y los aditamentos necesarios para la silla de ruedas pueden disminuir el riesgo de padecer el síndrome de túnel del carpo.
Conclusión: Es importante involucrar de manera activa a los profesionales de la salud en la implementación de estrategias para el entrenamiento, prescripción y uso correcto de la silla de ruedas y con ello prevenir el padecimiento de el síndrome de túnel carpiano.
... It was possible because sport wheelchairs have undergone ergonomic modifications that improve the biomechanics of the user and adherence to physical activity programs [10]. The importance of wheelchair fit has long been described, and the need to ensure a proper match between the equipment and wheelchair user has been highlighted [37,38]. Although, there is little research to compare the obtained results, it seems that the greater progress was obtained by the study participants using the active wheelchairs. ...
(1) Background: Regular participation in physical activity (PA) prevents many medical complications and improves the physical fitness of people with spinal cord injury, and in turn improves the functional independence, psychosocial status and quality of life. The goal of Active Rehabilitation Camps (ARCs) is to use various forms of PA in order for the participants to obtain the greatest efficiency and independence in everyday life. (2) Purpose: To evaluate the improvement in physical performance of people with chronic spinal cord disabilities moving in wheelchairs taking part in the Active Rehabilitation Camp depending on (a) sex, (b) type of disability, (c) the level of injury and (d) the type of wheelchair. (3) Methods: The study included 42 wheelchair users: 28 men and 14 women aged 18–65 years (34.7 ± 14.9 years) taking part in the Active Rehabilitation Camp. Finally, the study involved 27 paraplegics, 9 tetraplegics and 6 individuals with myelomeningocele. The participants took part in four fitness tests: (1) sprint test (SP)—individual time to cover a distance of 15 m in the wheelchair; (2) slalom test (SL)—time to ride between four cones front and back; (3) basketball ball throw at a distance (BT), (4) zig-zag test (ZZ)—riding continuously for 6 min on the designated track. The tests were performed at the beginning and at the end of the ACR. Active wheelchairs were used by 32 participants, and 10 participants used the classic wheelchairs. (4) Results: Paraplegics achieved the best average results in all the tests and the best improvement in physical performance in comparison to individuals with myelomeningocele and tetraplegics. People in active wheelchairs achieved a statistically significant improvement in the results of SL and ZZ (p < 0.001). People with injury above Th-9 level of the spinal cord achieved a statistically significant improvement in the results of SP (p < 0.01), SL and ZZ (p < 0.01). People with injury below Th6 achieved a statistically significant improvement (p < 0.05) in SP, SL and ZZ. (5) Conclusions: Regular PA during the Active Rehabilitation Camp improves the physical performance of disabled people in wheelchairs, but the scale of improvement of physical performance fitness depends on the type of wheelchair used and the level and the type of injury.
... When prescribing and adapting wheelchair seating devices, physiotherapists and occupational therapists (OTs) use their professional skills and training to achieve the best possible position to improve the quality of life of their patients. 1 These tasks are complex, so they require the cooperation between multiple professionals and patients, 2 and the training and updating of the professionals involved. 3 In an ideal prescription situation, the professional would be consulted from the beginning, where he/she would have all the necessary resources to prescribe and adapt seating devices using the newest technologies and would accompany the entire process. ...
Introduction: A significant part of the professional activity of physiotherapists and occupational therapists who assist people with motor disabilities is the prescription and sometimes the construction of adapted seats for wheelchairs. This is a complex task that involves practice, continued education, and material and technical resources. These work together to provide the patient's access to the adapted product. Objective: To understand how the prescription and adaptation of wheelchair seats occur in practice in a public institution. Methods: This study had a qualitative approach, applied nature, and exploratory objective. We utilized the case study strategy, conducted through semi-structured interviews, with seven professionals from a public state institution. The data obtained and analyzed were professionals’ practical experiences on seat adaptation for their patients. Results: We found divergences between practice and theory in the institution. The context in which the professionals operate, issues related to the institution, the production capacity of the adaptations, financial and time limitations, custom, lack of protocols and training in the area, and social and patient pressure are some of the causes of these divergencies. Conclusion: On the basis, we drew an overview of the prescription and construction of adapted seats by the institution and described the main elements that influence this practice. We believe that the training and updating of professionals, providing more resources, and a better process planning can reduce the divergences between practice and theory.
Objective: To identify the health gains resulting from rehabilitation nursing care, at the self-care level, in patients undergoing upper abdominal surgery. Methodology: Systematic review of the literature with studies that included participants undergoing scheduled surgery of the abdominal and thoracic segments; with respiratory rehabilitation intervention in the pre and postoperative periods. Results: Studies with people with respiratory disease and aged 18 years or older, published from January 2017 to June 2022, in English, were included. PubMed was consulted, and after analysis of the references obtained, a final sample of five articles was obtained, which were integrated into this study. Conclusions: There is a direct improvement in respiratory functionality after a respiratory rehabilitation program. We highlight the importance of rehabilitation programmes focusing on patient empowerment in the preoperative period to prevent complications, particularly pulmonary complications, compared to a rehabilitation programme without preoperative follow-up. Gains resulting from nursing interventions were identified in terms of patient satisfaction, health promotion, prevention of complications, well-being and self-care, cost reduction and healthcare organization.KeywordsHealth gainsRehabilitation nursingAbdominal surgeryRespiratory rehabilitation
Objective: This study sought to understand which items are essential to the wheelchair from the perspective of a person with quadriplegic spinal cord injury (SCI). Method: The study was qualitative with semi-structured interviews and discourse analysis, as well as a checklist of the wheelchair being used and the wheelchair provided by the government’s Unified Health System (SUS). Results: The causes of SCI were motor vehicle accidents (60%), diving into shallow waters (30%) and being struck by a vehicle (10%), respectively and the injury time averaged 16.3 years (± 7.14). All of the subjects were in physiotherapy. The number of wheelchairs tested before finding the proper one were two to five and some participants practiced adapted sports with the wheelchair. The checklist showed that the government wheelchair had insufficient items and the discourse analysis resulted in four categories: Items, materials, and conditions; Learning functionality; Advantages and disadvantages of the wheelchair; and Feelings experienced. The wheelchair is essential to acquiring mobility for people with quadriplegia and trying out different models and getting orientation on the items are important for their acquisition. Suitable items facilitate acceptance, better adaptation, mobility and enable autonomy. Conclusion: The wheelchair from the government’s health system was insufficient, leading to its being abandoned, and wheelchairs acquired for their functionality, with essential items, responsive to the user’s individuality and taste proved to be useful and appropriate, despite their high cost.
The wheelchairs are the essential tool of mobility for most individuals with spinal cord injuries. One of the most important recommendations for people with spinal cord injuries is the type of wheelchair and the accessories needed to enable maximum functionality, including maximizing independent mobility, maximizing independent functioning, preventing and minimizing deformity or ensuring stable positioning, and projecting a healthy, vital, and attractive body image. When the capacity and fit of a wheelchair are matched to the needs and abilities of individuals with spinal cord injuries, health, function, community participation, and quality of life can be maximized. In principle, wheelchairs must meet certain criteria depending on the neurological level of injury, the remaining muscles and their strength, the patient’s height and weight, the patient’s functional level, the type of terrain, and the occupation and home adaptation of the patient. Improved wheelchairs have enabled people to play a more active role in sports, along with the disabled’s greater desire to be more active in all aspects of life.KeywordsWheelchairWheelchair prescriptionWheelchair mobility
Aims:
to evaluate how the act of holding a tennis racket influences the application of forces in the handrim during manual wheelchair propulsion at a self-selected comfortable speed and sprint.
Methods:
A case study was conducted with an experienced wheelchair tennis player who propelled the wheelchair in a straightforward trajectory at two different velocities (self-selected comfortable speed and sprint) in two different conditions (freehand and holding the racket). Kinetic and temporal data of the pushes were obtained with the SmartWheel system attached in substitution to the conventional rear wheel at the dominant side of the player.
Results:
holding the racket affects the propulsion pattern mainly when an accelerated movement is required (sprint). Compared to the propulsion at a self-selected speed, propelling the chair as fast as possible with the racket in hands resulted in lower total and tangential forces on the handrim, and decreased push time and increased push frequency.
Conclusion:
Such influence on both kinetic and temporal propulsion impact the mechanical efficiency of the manual wheelchair propulsion, which may, ultimately, affect the sport´s performance. Special attention should be directed to the propulsion training with the racket in maneuvers and motions that are characteristic of the wheelchair tennis match in an attempt to provide the athlete with proper technique for optimal propulsion efficiency and sports performance.
Este trabalho propõe um novo conceito de cadeira de rodas manual ergonômica com assistência motorizada servo controlada. A mobilidade em cadeira propulsionada manualmente é uma das formas mais utilizadas de locomoção entre pessoas com deficiências, porém expõe o usuário ao risco de lesão nos membros superiores e não propicia independência em todas as situações de locomoção diária. A primeira alternativa tecnológica aplicada pelo homem foi a motorização. No entanto, o uso desta não implica em melhora da mobilidade, pois leva o usuário ao sedentarismo. Neste sentido, fazendo a integração do histórico, ergonomia, biomecânica e engenharia mecatrônica, este projeto tem como objetivo o desenvolvimento do projeto conceitual ao protótipo - de uma cadeira de rodas manual com assistência motorizada complementar e proporcional à força propulsora aplicada pelo usuário. O delineamento do projeto envolveu o levantamento das evidências científicas relacionadas aos aspectos da configuração de cadeiras manuais determinantes para a melhoria do desempenho na mobilidade e conforto. A criação do conceito envolveu ainda a realização de estudos complementares dos aspectos mecânicos, ergonômicos e cinemáticos da locomoção em cadeiras manuais. O conceito do protótipo tem seus pilares na: propulsão, através de um servo-motor centralizado que atua nas duas rodas traseiras através de um diferencial mecânico, simplificando o controle da assistência motorizada; no projeto do aro propulsor ortogonal com acoplamento assimétrico com a roda em cambagem, proporcionando melhor acesso das mãos ao aro; projeto do aro propulsor, baseado em aspectos dactilo-anatômicos; projeto e configuração da cadeira, estruturada nas evoluções tecnológicas das cadeiras manuais e adaptada às características antropométricas da população brasileira; assistência motorizada controlada por um sistema de avaliação contínua da inclinação do terreno, forças aplicadas ao aro e o deslocamento angular das rodas medidos por acelerômetro, células de carga e encoder ótico, respectivamente. A efetivação do presente conceito favorece a mobilidade independente do cadeirante, podendo reduzir o custo referente ao uso prolongado de cadeiras manuais: lesão dos membros superiores e incapacidade funcional. Aprimorar a mobilidade de usuários de cadeira de rodas favorece sua independência e participação social, aspectos essenciais para a melhora da qualidade de vida.
Space requirements for accommodating wheeled mobility devices and their users in the built environment are key components of standards for accessible design. These requirements typically include dimensions for clear floor areas, maneuvering clearances, seat and knee clearance heights, as well as some reference dimensions on wheeled mobility device sizes. Recent research from four countries was reviewed and compared with their prevailing accessibility standards to identify needs for improving standards. Findings from ongoing anthropometry research on wheeled mobility in the U.S. were used for evaluating the adequacy of existing U.S. accessibility standards. Preliminary analysis suggests that the U.S. standards, which are based on research conducted in the 1970s, need to be updated to address advances in wheeled mobility technology and changes in user demographics. The analysis highlights the importance of integrating research with standards development, organizing international collaborations, and developing international standards.
The prevention or minimisation of the occurrence of pressure sores is an important consideration in the rehabilitation of physically disabled people, especially for the wheelchair user with a spinal cord injury.
Although there is little definitive information on the cause of pressure sores, several intrinsic and extrinsic factors have been highlighted. Probably the most significant causative factor is the application of force to the skin surface. The relationship between the magnitude of pressure and its duration; the temperature and humidity at the interface; and the physiological effects that this has on the microcirculation and lymphatic drainage are discussed in this article.
It is suggested that a rationale for the prevention of pressure sores includes the limitation of the duration of pressures applied to the skin surface and the reduction of the peak pressures particularly at vulnerable sites. In this context the design criteria for a clinical interface pressure measurement system, and the uses and limitations of the commercially available options, are considered. The development of a structured programme of wheelchair and support surface provision, assessment and follow-up is required.
Patients with spinal cord injury (SCI) may complain of upper extremity (UE) pain. The purpose of this study was to determine the frequency and severity of UE pain as well as its association with functional activities. Types of treatments that SCI patients received for UE pain and the benefits of these treatments were also identified.
A questionnaire of demographic variables and measures of UE pain intensity, location, treatment, and interference with functional activities was mailed to 170 persons with SCI. Data was analyzed by descriptive and comparative statistics.
Of the 130 persons who responded, 76 (58.5%) (38 paraplegic, 38 tetraplegic patients) reported UE pain: 71% had shoulder pain, 53% wrist pain, 43% hand pain, and 35% elbow pain. Pain interfered with transfers in 65% (36/55) of the patients who were doing them. Of ten functional activities, pain was more likely to be associated with pressure reliefs, transfers, and wheelchair mobility. Sixty-three per cent sought medical treatment for pain, and of those, 90% received either physical therapy, pharmacological treatment or massage. Although only 27% had wheelchair or home modification or joint protection education, these approaches were helpful for almost all and very helpful or extremely helpful in 26.6% and 63.6% of the patients, respectively.
UE pain is a common problem in individuals with SCI and has impact on daily activities. UE pain prevention and management programs are needed for SCI patients.
The aim of this study was to analyse the effects of wheelchair intervention from a client-centred perspective.
Results from 38 consecutive active wheelchair users visiting the wheelchair-seating department at the University Hospital in Linköping, Sweden, were analysed and described. All clients had defined problems related to wheelchair seating. Back pain was estimated before intervention and at follow-up, using a Visual Analogue Scale. The effect of intervention on different aspects of wheelchair functionality, seating and occupational performance was estimated by the clients at follow-up.
Two initial main problem areas were identified among the group; seating discomfort (87%) and back pain (63%). Back pain was significantly reduced at follow-up (p<0.001). Problems initially defined by the clients, e.g. seating discomfort, were affected positively, in 79% of all clients, as estimated by the clients at follow-up. No significant correlation was found between the initial cause of intervention or the highest ranked wheelchair functionality aspect and final acceptance of intervention.
The results from this study confirm the possibility of reducing, or even eliminating, common secondary problems such as back pain and discomfort, related to wheelchair seating by individually adjusted measures. Further research and development in this field is both necessary and cost-effective.
To determine the minimum space required for wheeled mobility device users to perform 4 maneuverability tasks and to investigate the impact of selected design attributes on space.
Case series.
University laboratory, Veterans Affairs research facility, vocational training center, and a national wheelchair sport event.
The sample of convenience included manual wheelchair (MWC; n=109), power wheelchair (PWC; n=100), and scooter users (n=14).
A mock environment was constructed to create passageways to form an L-turn, 360 degrees -turn in place, and a U-turn with and without a barrier. Passageway openings were increased in 5-cm increments until the user could successfully perform each task without hitting the walls. Structural dimensions of the device and user were collected using an electromechanical probe. Mobility devices were grouped into categories based on design features and compared using 1-way analysis of variance and post hoc pairwise Bonferroni-corrected tests.
Minimum passageway widths for the 4 maneuverability tasks.
Ultralight MWCs with rear axles posterior to the shoulder had the shortest lengths and required the least amount of space compared with all other types of MWCs (P<.05). Mid-wheel-drive PWCs required the least space for the 360 degrees -turn in place compared with front-wheel-drive and rear-wheel-drive PWCs (P<.01) but performed equally as well as front-wheel-drive models on all other turning tasks. PWCs with seat functions required more space to perform the tasks.
Between 10% and 100% of users would not be able to maneuver in spaces that meet current Accessibility Guidelines for Buildings and Facilities specifications. This study provides data that can be used to support wheelchair prescription and home modifications and to update standards to improve the accessibility of public areas.
A wheelchair seat and position help clients perform daily activities. The comfort of the wheelchair can encourage clients to participate in daily activities and can help prevent future complications.
This study evaluates how a shaped seat-cushion and two different back supports affect under-seat pressure, comfort, and pelvic rotation.
Thirty healthy subjects were tested using two differently equipped manual wheelchairs. One wheelchair had a Velcro adjustable back seat and a plane seat-cushion. The other wheelchair had a non-adjustable sling-back seat and a plane cushion. The second wheelchair was also equipped with a shaped cushion and/or a detachable lumbar support. Under-seat pressure, estimated comfort, and pelvic rotation were measured after 10 min in each wheelchair outfit.
Peak pressure increased with the shaped cushion compared to the plane cushion. No significant difference in estimated comfort was found. Pelvic posterior-rotation was reduced with the adjustable or detachable back-support irrespective of the shape of the seat cushion.
To support a neutral pelvic position and spinal curvature, a combination of a shaped cushion and a marked lumbar support is most effective.
The overall impact of a wheelchair on its user must be evaluated in light of both benefit and risk. Evaluation should include not only physical function, but also overall quality of life, integration into society, and cost effectiveness. The current study examined the impact of a donated, inexpensively made wheelchair on recipients in 2 different countries.
188 recipients of the Free Wheelchair Mission (FWM) wheelchair in India and Peru were surveyed in their local setting and language by social workers. Results were entered and transferred electronically for analysis.
At the time of the survey, the wheelchairs had been in use for an average of 18 months. 93.1% of recipients used their wheelchair more than 1 hour/day. Receipt and use of the FWM chair resulted in a significant shift toward independent function in 5 of 6 areas drawn from the International Classification of Functioning, Disability, and Health. The greatest maintenance problem was with the tires (19.7%), similar in frequency to reported U.S. users. There was an unexpected 11.7% decrease in the incidence of pressure ulcers with use of the wheelchair, most likely associated with increased mobility. Reported pain levels were not believed by participants to be related to use of the wheelchair. The impact on health and quality of life was generally viewed as positive. Monetary cost of the wheelchair is minimal.
In summary, recipient evaluation of the Free Wheelchair Mission wheelchair in 2 different countries has shown a positive, cost-effective benefit to both health and function without unusual risk.
Clearly, all considerations for wheelchair performance and their applicability to optimization of mobility are related to user position relative to the main wheel axis. It is also obvious that wheelchair performance is enhanced by a center of gravity position rearward of that which is characteristic of the generic wheelchair. The only obvious features of the generic wheelchair are excessive static stability and limitation of body motion. Perhaps at this stage the reader may be ready to accept some of the arguments presented above, but have reservations about prescribing a less stable wheelchair for the more severely disabled (e.g., quadraplegics). Consider that the reduction of rolling resistance, decrease in downhill turning tendancy, and required turning force would likely be even more important to the user with marginal physical capacity. This would appear as an attractive trade for reduction in static stability. The number of factors unfavorably affected by increased static stability would suggest the use of an anti-tipping device rather than designed static stability if this is thought to be an important consideration.
The purpose of this paper is to describe factors affecting wheelchair mobility in nonambulatory nursing home (NH) residents.
Prospective descriptive study of a convenience sample of nonambulatory NH residents.
Seven nursing homes.
Sixty-five nonambulatory residents.
One-minute, time-sampled observations of behavior for each resident were made every 15 minutes for 8 to 11 hours across 2 days, noting wheelchair propulsion activity for the dependent variable; independent variables included measures of wheelchair level of assistance, speed, endurance, handgrip strength, and balance.
A stepwise Multiple Regression analysis found wheelchair speed to be the single best predictor of the percentage of time residents were behaviorally observed wheelchair propelling (Multiple r = .45, P < .02). Handgrip strength and wheelchair endurance measures were highly intercorrelated with wheelchair speed. Wheelchairs that were either dysfunctional or inappropriately fitted to the residents' size were a major barrier to wheelchair use, affecting 46% of residents using wheelchairs.
Improving wheelchair skills with targeted intervention programs, along with making chairs more "user friendly" (e.g., grip extensions on brakes, foot pedals that one can move without bending over), could result in more wheelchair propulsion with resultant improvements in the NH resident's independence, freedom of movement, and quality of life.