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Dany H Gagnon - One of the best experts on this subject based on the ideXlab platform.
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changes to biceps and supraspinatus tendons in response to a progressive maximal treadmill based propulsion aerobic fitness test in Manual Wheelchair users a quantitative musculoskeletal ultrasound study
Rehabilitation Research and Practice, 2021Co-Authors: Mylene Leclerc, Cindy Gauthier, Rachel Brosseau, Francois Desmeules, Dany H GagnonAbstract:Objective To investigate if the completion of a recently developed treadmill-based Wheelchair propulsion maximal progressive workload incremental test alters the integrity of the long head of the biceps and supraspinatus tendons using musculoskeletal ultrasound imaging biomarkers. Method Fifteen Manual Wheelchair users completed the incremental test. Ultrasound images of the long head of the biceps and supraspinatus tendons were recorded before, immediately after, and 48 hours after the completion of the test using a standardized protocol. Geometric, composition, and texture-related ultrasound biomarkers characterized tendon integrity. Results Participants propelled during 10.2 ± 2.9 minutes with the majority (N = 13/15) having reached at least the eighth stage of the test (speed = 0.8 m/s; slope = 3.6°). All ultrasound biomarkers characterizing tendon integrity, measured in the longitudinal and transversal planes for both tendons, were similar (p = 0.063 to 1.000) across measurement times. Conclusion The performance of the motorized treadmill Wheelchair propulsion test to assess aerobic fitness produced no changes to ultrasound biomarkers of the biceps or supraspinatus tendons. Hence, there was no ultrasound imaging evidence of a maladaptive response due to overstimulation in these tendons immediately after and 48 hours after the performance of the test.
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comparison of the 6 min propulsion and arm crank ergometer tests to assess aerobic fitness in Manual Wheelchair users with a spinal cord injury
American Journal of Physical Medicine & Rehabilitation, 2020Co-Authors: Alec Bass, Cindy Gauthier, Rachel Brosseau, Simon Decary, Dany H GagnonAbstract:OBJECTIVE The 6-Min Manual Wheelchair Propulsion Test is proposed to easily and rapidly assess aerobic fitness among long-term (≥3 mos) Manual Wheelchair users with spinal cord injury. However, aerobic responses to this test have not been established. This study aimed (1) to characterize aerobic responses during the 6-Min Manual Wheelchair Propulsion Test, (2) to establish parallel reliability between the 6-Min Manual Wheelchair Propulsion Test and the Maximal Arm Crank Ergometer Test, and (3) to quantify the strength of association between the total distance traveled during the 6-Min Manual Wheelchair Propulsion Test and peak oxygen consumption. DESIGN Twenty Manual Wheelchair users with a spinal cord injury completed both tests. Aerobic parameters were measured before, during, and after the tests. Main outcome measures were peak oxygen consumption and total distance traveled. RESULTS Progressive cardiorespiratory responses, consistent with guidelines for exercise testing, were observed during both tests. Similar peak oxygen consumption values were obtained during both tests (6-Min Manual Wheelchair Propulsion Test: 20.2 ± 4.9 ml/kg·min; Maximal Arm Crank Ergometer Test: 20.4 ± 5.0 ml/kg·min), were highly correlated (r = 0.92, P < 0.001), and had a good agreement (mean absolute difference = 0.21, 95% confidence interval = -0.70 to 1.11, P = 0.639). The peak oxygen consumption and total distance traveled (mean = 636.6 ± 56.9 m) during the 6-Min Manual Wheelchair Propulsion Test were highly correlated (r = 0.74, P < 0.001). CONCLUSIONS The 6-Min Manual Wheelchair Propulsion Test induces progressive aerobic responses consistent with guidelines for exercise testing and can be used to efficiently estimate aerobic fitness in Manual Wheelchair users with a spinal cord injury. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Explain how to administer the Six-Minute Manual Wheelchair Propulsion Test in long-term Manual Wheelchair users with a spinal cord injury; (2) Contrast how the workload is developed between the Six-Minute Manual Wheelchair Propulsion Test and the Maximal Arm Crank Ergometry Test and recognize how these differences may affect physiological responses; and (3) Explain why caution is advised regarding the use of the Six-Minute Manual Wheelchair Propulsion Test if aiming to estimate aerobic fitness. LEVEL Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Manual Wheelchair users gradually face fewer postural stability and control challenges with increasing rolling resistance while maintaining a rear wheel wheelie
Human Movement Science, 2018Co-Authors: Mathieu Lalumiere, Guillaume Desroches, Francois Routhier, Philippe Gourdou, Laurent J Bouyer, Dany H GagnonAbstract:Abstract Teaching Manual Wheelchair users to perform wheelies using various rolling resistances is expected to facilitate learning of this advanced Wheelchair skill. However, limited scientific evidence is available to support this approach. This study aimed to measure and compare postural stability and control requirements when maintaining a stationary wheelie on different rolling resistances. Eighteen Manual Wheelchair users with a spinal cord injury performed in a random order and maintained four 30-second wheelies on four rolling resistances: natural hard floor (NAT), 5-cm thick soft foam (LOW), 5-cm thick memory foam (MOD), and rear wheels blocked by wooden blocks (HIGH). All wheelies were performed over a large instrumented force plate to continuously record the center of pressure (CoP). To quantify postural stability, resultant and directional time- and frequency-domain CoP measures were computed and compared across all four rolling resistances. All resultant time-domain measures confirmed increased postural stability from NAT to LOW and from MOD to HIGH rolling resistances. Most time-domain measures confirmed a shift in postural control from an anticipatory to a predominantly compensatory strategy, accompanied by increased reliance on proprioceptive feedback, especially from NAT to LOW and from MOD to HIGH rolling resistances. Postural stability gradually increased with various rolling resistances while maintaining a stationary wheelie, whereas the postural control strategy shifted from an anticipatory to a reactive strategy. Blocking the rear wheels is recommended when first teaching this advanced Wheelchair skill. Rapid progression on foam and natural surfaces is advocated to refine learning and enhance proper postural control strategies.
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reliability and minimal detectable change of a new treadmill based progressive workload incremental test to measure cardiorespiratory fitness in Manual Wheelchair users
Journal of Spinal Cord Medicine, 2017Co-Authors: Cindy Gauthier, Jasmine Arel, Rachel Brosseau, Audrey L Hicks, Dany H GagnonAbstract:Background: Cardiorespiratory fitness training is commonly provided to Manual Wheelchair users (MWUs) in rehabilitation and physical activity programs, emphasizing the need for a reliable task-specific incremental Wheelchair propulsion test.Objective: Quantifying test-retest reliability and minimal detectable change (MDC) of key cardiorespiratory fitness measures following performance of a newly developed continuous treadmill-based Wheelchair propulsion test (WPTTreadmill).Methods: Twenty-five MWUs completed the WPTTreadmill on two separate occasions within one week. During these tests, participants continuously propelled their Wheelchair on a motorized treadmill while the exercise intensity was gradually increased every minute until exhaustion by changing the slope and/or speed according to a standardized protocol. Peak oxygen consumption (VO2peak), carbon dioxide production (VCO2peak), respiratory exchange ratio (RERpeak), minute ventilation (VEpeak) and heart rate (HRpeak) were computed. Time to exhaus...
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reliability and minimal detectable change of a new treadmill based progressive workload incremental test to measure cardiorespiratory fitness in Manual Wheelchair users
Journal of Spinal Cord Medicine, 2017Co-Authors: Cindy Gauthier, Jasmine Arel, Rachel Brosseau, Audrey L Hicks, Dany H GagnonAbstract:Background: Cardiorespiratory fitness training is commonly provided to Manual Wheelchair users (MWUs) in rehabilitation and physical activity programs, emphasizing the need for a reliable task-spec...
Michael L Boninger - One of the best experts on this subject based on the ideXlab platform.
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Manual Wheelchair skills capacity predicts quality of life and community integration in persons with spinal cord injury
Archives of Physical Medicine and Rehabilitation, 2012Co-Authors: Shahla M Hosseini, Michael L Boninger, Lee R Kirby, Michelle L Oyster, Amanda L HarringtonAbstract:Abstract Hosseini SM, Oyster ML, Kirby RL, Harrington AL, Boninger ML. Manual Wheelchair skills capacity predicts quality of life and community integration in persons with spinal cord injury. Objectives To determine Wheelchair (WC) skills success rates for Manual WC users with spinal cord injury (SCI), to determine subject characteristics associated with the lowest success rates of WC skills, and to characterize the relationship between WC skills and measures of community integration and quality of life (QOL). Design Cross-sectional multisite study. Setting Six Spinal Cord Injury Model Systems (SCIMS) centers. Participants Individuals with SCI (N=214) who were at least 11 months postinjury, treated at an SCIMS center, and who used a Manual WC as their primary means of mobility. Intervention Not applicable. Main Outcome Measures Wheelchair Skills Test (WST) and questionnaires of demographics and characteristics, QOL, and community participation. Results Of the 31 skills in the WST assessed, success rates ranged from 19.6% to 100%. Eight skills had success rates of ≤75%: folding/unfolding the WC (71.5%), ascending (19.6%) and descending (47.2%) a 15-cm curb, ascending (23.2%) and descending (26.5%) stairs, transferring from ground to WC (40.6%), turning 180° in wheelie position (55.2%), and holding a 30-second stationary wheelie (59.9%). Male sex, paraplegia, employed status, lower education, younger age at injury, and white race were among the participant characteristics bivariately associated with higher success rates of several WC skills. After controlling for covariates, higher success rates of several WC skills and a higher total WST score predicted better self-perceived health, higher life satisfaction, and more community participation. Conclusions For people with SCI who use a Manual WC as their primary means of mobility, their ability to perform Manual WC skills is associated with higher community participation and life satisfaction. Factors contributing to low success rates need to be investigated, and interventions to improve these rates are needed.
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Manual Wheelchair skills capacity predicts quality of life and community integration in persons with spinal cord injury
Archives of Physical Medicine and Rehabilitation, 2012Co-Authors: Shahla M Hosseini, Lee R Kirby, Michelle L Oyster, Amanda Harrington, Michael L BoningerAbstract:Abstract Hosseini SM, Oyster ML, Kirby RL, Harrington AL, Boninger ML. Manual Wheelchair skills capacity predicts quality of life and community integration in persons with spinal cord injury. Objectives To determine Wheelchair (WC) skills success rates for Manual WC users with spinal cord injury (SCI), to determine subject characteristics associated with the lowest success rates of WC skills, and to characterize the relationship between WC skills and measures of community integration and quality of life (QOL). Design Cross-sectional multisite study. Setting Six Spinal Cord Injury Model Systems (SCIMS) centers. Participants Individuals with SCI (N=214) who were at least 11 months postinjury, treated at an SCIMS center, and who used a Manual WC as their primary means of mobility. Intervention Not applicable. Main Outcome Measures Wheelchair Skills Test (WST) and questionnaires of demographics and characteristics, QOL, and community participation. Results Of the 31 skills in the WST assessed, success rates ranged from 19.6% to 100%. Eight skills had success rates of ≤75%: folding/unfolding the WC (71.5%), ascending (19.6%) and descending (47.2%) a 15-cm curb, ascending (23.2%) and descending (26.5%) stairs, transferring from ground to WC (40.6%), turning 180° in wheelie position (55.2%), and holding a 30-second stationary wheelie (59.9%). Male sex, paraplegia, employed status, lower education, younger age at injury, and white race were among the participant characteristics bivariately associated with higher success rates of several WC skills. After controlling for covariates, higher success rates of several WC skills and a higher total WST score predicted better self-perceived health, higher life satisfaction, and more community participation. Conclusions For people with SCI who use a Manual WC as their primary means of mobility, their ability to perform Manual WC skills is associated with higher community participation and life satisfaction. Factors contributing to low success rates need to be investigated, and interventions to improve these rates are needed.
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shoulder ultrasound abnormalities physical examination findings and pain in Manual Wheelchair users with spinal cord injury
Archives of Physical Medicine and Rehabilitation, 2008Co-Authors: Steven W Brose, Michael L Boninger, Bradley Fullerton, Thane Mccann, Jennifer L Collinger, Bradley G Impink, Trevor A DysonhudsonAbstract:Abstract Brose SW, Boninger ML, Fullerton B, McCann T, Collinger JL, Impink BG, Dyson-Hudson TA. Shoulder ultrasound abnormalities, physical examination findings, and pain in Manual Wheelchair users with spinal cord injury. Objectives To investigate the presence of ultrasound (US) abnormalities in Manual Wheelchair users with spinal cord injury (SCI) using a quantitative Ultrasound Shoulder Pathology Rating Scale (USPRS). To investigate physical examination (PE) findings using a quantitative Physical Examination of the Shoulder Scale (PESS), and to obtain data about pain and other subject characteristics such as age, years with SCI, and weight. Design Case series. Setting National Veterans' Wheelchair Games 2005 and 2006. Participants Volunteer sample of Manual Wheelchair users with SCI participating in the National Veterans' Wheelchair Games. Interventions Not applicable. Main Outcome Measures Presence of relationships between US findings, PE findings, pain, and subject characteristics. Results The USPRS correlated with age, duration of SCI, and weight (all P r =.258, P =.073). Several US findings related to presence of PE findings for specific structures. The PESS score correlated with the WUSPI ( r =.679, P P P =.002). Conclusions PE and US abnormalities are common in Manual Wheelchair users with SCI. The USPRS and PESS demonstrated evidence for external validity and hold promise as research tools. Untreated shoulder pain is common in Manual Wheelchair users with SCI, and further investigation of this pain is indicated.
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shoulder biomechanics during the push phase of Wheelchair propulsion a multisite study of persons with paraplegia
Archives of Physical Medicine and Rehabilitation, 2008Co-Authors: Jennifer L Collinger, Robert Price, Michael L Boninger, Alicia M Koontz, Sue Ann Sisto, Michelle Tolerico, Rory A CooperAbstract:Abstract Collinger JL, Boninger ML, Koontz AM, Price R, Sisto SA, Tolerico ML, Cooper RA. Shoulder biomechanics during the push phase of Wheelchair propulsion: a multisite study of persons with paraplegia. Objectives To present a descriptive analysis and comparison of shoulder kinetics and kinematics during Wheelchair propulsion at multiple speeds (self-selected and steady-state target speeds) for a large group of Manual Wheelchair users with paraplegia while also investigating the effect of pain and subject demographics on propulsion. Design Case series. Setting Three biomechanics laboratories at research institutions. Participants Volunteer sample of 61 persons with paraplegia who use a Manual Wheelchair for mobility. Intervention Subjects propelled their own Wheelchairs on a dynamometer at 3 speeds (self-selected, 0.9m/s, 1.8m/s) while kinetic and kinematic data were recorded. Main Outcome Measures Differences in demographics between sites, correlations between subject characteristics, comparison of demographics and biomechanics between persons with and without pain, linear regression using subject characteristics to predict shoulder biomechanics, comparison of biomechanics between speed conditions. Results Significant increases in shoulder joint loading with increased propulsion velocity were observed. Resultant force increased from 54.4±13.5N during the 0.9m/s trial to 75.7±20.7N at 1.8m/s ( P Conclusions Body-weight maintenance, as well as other interventions designed to reduce the force required to propel a Wheelchair, should be implemented to reduce the prevalence of shoulder pain and injury among Manual Wheelchair users.
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assessing mobility characteristics and activity levels of Manual Wheelchair users
Journal of Rehabilitation Research and Development, 2007Co-Authors: Michelle Tolerico, Dan Ding, Rory A Cooper, Rosemarie Cooper, Shirley G. Fitzgerald, Donald M Spaeth, Annmarie Kelleher, Michael L BoningerAbstract:Although engaging in an active lifestyle is beneficial for maintaining quality of life, a majority of Wheelchair users are inactive. This study investigated the mobility characteristics and activity levels of Manual Wheelchair users in the residential setting and at the National Veterans Wheelchair Games (NVWG). Demographic factors that may have influenced activity in the home environment were also identified. Fifty-two Manual Wheelchair users completed a brief survey, and their activity was monitored with a custom data logger over a period of 13 or 20 days. We found that they traveled a mean +/- standard deviation of 2,457.0 +/- 1,195.7 m/d at a speed of 0.79 +/- 0.19 m/s for 8.3 +/- 3.3 h/d while using their primary Wheelchair in the home environment. No significant differences in mobility characteristics or activity levels were found for level of spinal cord injury or disability. We also found that subjects traveled significantly farther and faster and were active for more hours during an average day at the NVWG than in the home environment (p < 0.001). We found that Manual Wheelchair users who were employed covered more distance, accumulated more minutes, and traveled a greater average maximum distance between consecutive stops than those who were unemployed. Results from this study provide a better understanding of the activity levels achieved by Manual Wheelchair users and insight into factors that may influence this activity.
Patrick Dehail - One of the best experts on this subject based on the ideXlab platform.
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comparison of peak shoulder and elbow mechanical loads during weight relief lifts and sitting pivot transfers among Manual Wheelchair users with spinal cord injury
Journal of Rehabilitation Research and Development, 2008Co-Authors: Dany H Gagnon, Sylvie Nadeau, Luc Noreau, Patrick DehailAbstract:INTRODUCTION Individuals who sustain a complete spinal cord injury (SCI) rely on their upper limbs (ULs) for Manual Wheelchair propulsion and many other Wheelchair-related functional activities, such as weight-relief lifts (WRLs) and transfer tasks [1-2]. Over time, such an increased use of their ULs may augment the risk of experiencing secondary impairments affecting the integrity of the skeletal, muscular, neurological, or vascular structures of the shoulder, elbow, or wrist joints [1-2]. These impairments may, in turn, deleteriously affect ability to perform functional activities and may restrict social participation among individuals with SCI [3-4]. To prevent the development and perpetuation of this potentially damaging cycle, researchers have studied Manual Wheelchair propulsion extensively and developed precise clinical practice guidelines to protect UL joint integrity among individuals with SCI [1]. Somewhat surprisingly, still a paucity of biomechanical studies focus on WRLs and transfer tasks, although these activities most likely rank among the most demanding Wheelchair-related activities for the ULs [1,5-7], and no study has compared these two tasks. When performing WRLs in a seated position, individuals with SCI generally place both hands on the armrests or on the top part of the tires/hand rims of the Wheelchair, slightly in front of the hip joints in a symmetrical position. Thereafter, most individuals slightly bend their head and trunk forward, while flexing and adducting their shoulders and extending their elbows at the same time, to lift their body weight off the seat. WRLs are routinely performed by individuals with SCI in daily life for various reasons. For example, clinical practice guidelines recommend performing WRL every 15 to 30 minutes of sitting and supporting body weight off the seat for at least 30 seconds, ideally for a period of about 2 minutes to bring the tissue oxygen level back to an unloaded level [8]. When individuals with paraplegia performed WRLs, high (>50% [EMG.sub.max]) to moderate (25%-50% [EMG.sub.max]) muscular demands of the latissimus dorsi, sternal pectoralis major, and long head of the triceps have been documented, especially during the lift phase. For those with tetraplegia (SCI at cervical [C]-level C5 to C7) having the capacity to perform WRLs, an increased level of activation is required at the anterior deltoid to produce elbow extension and compensate for the complete paralysis of the triceps brachii [9-11]. Consequently, individuals with tetraplegia (SCI at C5 to C7) have been found to predominantly rely on their shoulder muscles (flexor and adductor) as well as their elbow flexors and wrist flexors when performing WRLs [12]. When these individuals lifted 90 percent of their body weight, the mean peak shoulder and elbow flexor moments were 0.65 and 0.41 Nxm/kg, respectively [12]. The corresponding value for the shoulder adduction moment was about 0.55 Nxm/kg [12]. When individuals with paraplegia performed WRLs in a Wheelchair [5], mean peak shoulder and elbow flexor moments of 0.6 and 0.5 Nxm/kg, respectively, were reported. Of greater importance, shoulder and elbow peak absolute resultant moments were found to be more than five and nine times greater, respectively, when WRLs were performed, compared with level Manual Wheelchair propulsion [5]. When performing sitting pivot transfers (SPTs), individuals with SCI generally place one hand beside the proximal half of the thigh slightly in front of the hip joint (trailing hand) on the initial surface, with the other hand positioned on the target surface (leading hand), far enough away to leave adequate space for the buttocks to land at the end of the transfer [13]. From this position, they habitually flex and rotate the trunk and head forward and sideways while lifting the body off the initial surface and pivoting the buttocks in one motion to the target surface. …
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comparison of peak shoulder and elbow mechanical loads during weight relief lifts and sitting pivot transfers among Manual Wheelchair users with spinal cord injury
Journal of Rehabilitation Research and Development, 2008Co-Authors: Dany H Gagnon, Sylvie Nadeau, Luc Noreau, Patrick DehailAbstract:This study compared shoulder and elbow joint forces and moments between weight-relief lifts (WRLs) and sitting pivot transfers (SPTs) among Manual Wheelchair users with spinal cord injury (SCI) (N = 13) during biomechanical laboratory assessment. Minimum and maximum values were reported for each triaxial component of the joint force at the dominant shoulder and elbow during SPTs (leading and trailing roles) and WRLs. Peak shoulder flexor and adductor moments, along with elbow flexor and extensor moments, observed during the same period were also analyzed. The SPTs predominantly exposed (p < 0.001) the shoulder joints to substantial posteriorly directed forces (leading = -2.6 N/kg; trailing = -3.1 N/kg) compared with WRLs (-2.2 N/kg), whereas superiorly directed forces (2.9 N/kg) were principally sustained ( p < 0.001) during WRLs compared with SPTs (leading = 1.5 N/kg; trailing = 1.5 N/kg). High superiorly directed forces (3.6 to 3.9 N/kg) were observed at the elbow, which were comparable (p = 0.33) between the two tasks. The peak shoulder flexor (leading = 1.36 N m/kg; trailing = 1.45 N m/kg) and adductor moments (leading only = -0.46 N m/kg), along with the peak elbow flexor moments (leading = 0.24 N m/kg; trailing = 0.15 N m/kg), were significantly more elevated (p < 0.021) during SPTs than during WRLs. Peak shoulder adductor (-0.46 vs -0.24 N m/kg) and elbow flexor moments were also more elevated ( p = 0.03) at the leading upper limb compared with the trailing one. The peak elbow extensor moments did not differ ( p = 0.167) between the two tasks (-0.17 to -0.25 N m/kg). SPTs exposed the shoulder and elbow joints to greater mechanical loads than WRLs among individuals with SCI.
Rory A Cooper - One of the best experts on this subject based on the ideXlab platform.
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physical activity classification utilizing sensewear activity monitor in Manual Wheelchair users with spinal cord injury
Spinal Cord, 2013Co-Authors: Shivayogi V Hiremath, Dan Ding, Jonathan Farringdon, Nisarg Vyas, Rory A CooperAbstract:Physical activity classification utilizing SenseWear activity monitor in Manual Wheelchair users with spinal cord injury
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shoulder biomechanics during the push phase of Wheelchair propulsion a multisite study of persons with paraplegia
Archives of Physical Medicine and Rehabilitation, 2008Co-Authors: Jennifer L Collinger, Robert Price, Michael L Boninger, Alicia M Koontz, Sue Ann Sisto, Michelle Tolerico, Rory A CooperAbstract:Abstract Collinger JL, Boninger ML, Koontz AM, Price R, Sisto SA, Tolerico ML, Cooper RA. Shoulder biomechanics during the push phase of Wheelchair propulsion: a multisite study of persons with paraplegia. Objectives To present a descriptive analysis and comparison of shoulder kinetics and kinematics during Wheelchair propulsion at multiple speeds (self-selected and steady-state target speeds) for a large group of Manual Wheelchair users with paraplegia while also investigating the effect of pain and subject demographics on propulsion. Design Case series. Setting Three biomechanics laboratories at research institutions. Participants Volunteer sample of 61 persons with paraplegia who use a Manual Wheelchair for mobility. Intervention Subjects propelled their own Wheelchairs on a dynamometer at 3 speeds (self-selected, 0.9m/s, 1.8m/s) while kinetic and kinematic data were recorded. Main Outcome Measures Differences in demographics between sites, correlations between subject characteristics, comparison of demographics and biomechanics between persons with and without pain, linear regression using subject characteristics to predict shoulder biomechanics, comparison of biomechanics between speed conditions. Results Significant increases in shoulder joint loading with increased propulsion velocity were observed. Resultant force increased from 54.4±13.5N during the 0.9m/s trial to 75.7±20.7N at 1.8m/s ( P Conclusions Body-weight maintenance, as well as other interventions designed to reduce the force required to propel a Wheelchair, should be implemented to reduce the prevalence of shoulder pain and injury among Manual Wheelchair users.
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assessing mobility characteristics and activity levels of Manual Wheelchair users
Journal of Rehabilitation Research and Development, 2007Co-Authors: Michelle Tolerico, Dan Ding, Rory A Cooper, Rosemarie Cooper, Shirley G. Fitzgerald, Donald M Spaeth, Annmarie Kelleher, Michael L BoningerAbstract:Although engaging in an active lifestyle is beneficial for maintaining quality of life, a majority of Wheelchair users are inactive. This study investigated the mobility characteristics and activity levels of Manual Wheelchair users in the residential setting and at the National Veterans Wheelchair Games (NVWG). Demographic factors that may have influenced activity in the home environment were also identified. Fifty-two Manual Wheelchair users completed a brief survey, and their activity was monitored with a custom data logger over a period of 13 or 20 days. We found that they traveled a mean +/- standard deviation of 2,457.0 +/- 1,195.7 m/d at a speed of 0.79 +/- 0.19 m/s for 8.3 +/- 3.3 h/d while using their primary Wheelchair in the home environment. No significant differences in mobility characteristics or activity levels were found for level of spinal cord injury or disability. We also found that subjects traveled significantly farther and faster and were active for more hours during an average day at the NVWG than in the home environment (p < 0.001). We found that Manual Wheelchair users who were employed covered more distance, accumulated more minutes, and traveled a greater average maximum distance between consecutive stops than those who were unemployed. Results from this study provide a better understanding of the activity levels achieved by Manual Wheelchair users and insight into factors that may influence this activity.
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shoulder joint kinetics and pathology in Manual Wheelchair users
Clinical Biomechanics, 2006Co-Authors: Jennifer L Mercer, Michael L Boninger, Alicia M Koontz, Trevor A Dysonhudson, Dianxu Ren, Rory A CooperAbstract:Background. Manual Wheelchair users rely heavily on their upper limbs for independent mobility which likely leads to a high prevalence of shoulder pain and injury. The goal of this study was to examine the relationship between shoulder forces and moments experienced during Wheelchair propulsion and shoulder pathology. Methods. Kinetic and kinematic data was recorded from 33 subjects with paraplegia as they propelled their Wheelchairs at two speeds (0.9 and 1.8 m/s). Shoulder joint forces and moments were calculated using inverse dynamic methods and shoulder pathology was evaluated using a physical exam and magnetic resonance imaging scan. Findings. Subjects who experienced higher posterior force (Odds Ratio (OR) = 1.29, P = 0.03), lateral force (OR = 1.35, P = 0.047), or extension moment (OR = 1.35, P = 0.09) during propulsion were more likely to exhibit coracoacromial ligament edema. Individuals who displayed larger lateral forces (OR = 4.35, P = 0.045) or abduction moments (OR = 1.58, P = 0.06) were more likely to have coracoacromial ligament thickening. Higher superior forces (OR = 1.05, P = 0.09) and internal rotation moments (OR = 1.61 P = 0.02) at the shoulder were associated with increased signs of shoulder pathology during the physical exam. Interpretation. Specific joint forces and moments were related to measures of shoulder pathology. This may indicate a need to reduce the overall force required to propel a Wheelchair in order to preserve upper limb integrity. Potential interventions include changes to Wheelchair setup, propulsion training, or alternative means of mobility. � 2006 Elsevier Ltd. All rights reserved.
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impact of a pushrim activated power assisted Wheelchair on the metabolic demands stroke frequency and range of motion among subjects with tetraplegia
Archives of Physical Medicine and Rehabilitation, 2004Co-Authors: David S Algood, Rory A Cooper, Rosemarie Cooper, Shirley G. Fitzgerald, Michael L BoningerAbstract:Abstract Algood SD, Cooper RA, Fitzgerald SG, Cooper R, Boninger ML. Impact of a pushrim-activated power-assisted Wheelchair on the metabolic demands, stroke frequency, and range of motion among subjects with tetraplegia. Arch Phys Med Rehabil 2004;85:1865–71. Objectives To determine differences in metabolic demands, stroke frequency, and upper-extremity joint range of motion (ROM) during pushrim-activated power-assisted Wheelchair (PAPAW) propulsion and traditional Manual Wheelchair propulsion among subjects with tetraplegia. Design Repeated measures. Setting A biomechanics laboratory within a Veterans Affairs medical center. Participants Fifteen full-time Manual Wheelchair users who had sustained cervical-level spinal cord injuries. Interventions Participants propelled both their own Manual Wheelchairs and a PAPAW through 3 different resistances (slight, 10W; moderate, 12W; high, 14W) on a Wheelchair dynamometer. Each propulsion trial was 3 minutes long. Main outcome measures Primary variables that were compared between the 2 Wheelchairs were participants' mean steady-state oxygen consumption, ventilation, heart rate, mean stroke frequency, and maximum upper-extremity joint ROM. Results When using the PAPAW, participants showed a significant ( P Conclusions For subjects with tetraplegia, PAPAWs reduce the energy demands, stroke frequency, and overall joint ROM when compared with traditional Manual Wheelchair propulsion.
Lee R Kirby - One of the best experts on this subject based on the ideXlab platform.
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Manual Wheelchair skills training for community dwelling veterans with spinal cord injury a randomized controlled trial
PLOS ONE, 2016Co-Authors: Lee R Kirby, Doug Mitchell, Sunil Sabharwal, Mark Mccranie, Audrey NelsonAbstract:Objectives To test the hypotheses that community-dwelling veterans with spinal cord injury (SCI) who receive the Wheelchair Skills Training Program (WSTP) in their own environments significantly improve their Manual Wheelchair-skills capacity, retain those improvements at one year and improve participation in comparison with an Educational Control (EC) group. Methods We carried out a randomized controlled trial, studying 106 veterans with SCI from three Veterans Affairs rehabilitation centers. Each participant received either five one-on-one WSTP or EC sessions 30–45 minutes in duration. The main outcome measures were the total and subtotal percentage capacity scores from the Wheelchair Skills Test 4.1 (WST) and Craig Handicap Assessment and Reporting Technique (CHART) scores. Results Participants in the WSTP group improved their total and Advanced-level WST scores by 7.1% and 30.1% relative to baseline (p < 0.001) and retained their scores at one year follow-up. The success rates for individual skills were consistent with the total and subtotal WST scores. The CHART Mobility sub-score improved by 3.2% over baseline (p = 0.021). Conclusions Individualized Wheelchair skills training in the home environment substantially improves the advanced and total Wheelchair skills capacity of experienced community-dwelling veterans with SCI but has only a small impact on participation.
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Wheelchair propulsion test development and measurement properties of a new test for Manual Wheelchair users
Archives of Physical Medicine and Rehabilitation, 2013Co-Authors: Sussan Askari, Lee R Kirby, Kim Parker, Kara Thompson, Jonathan OneillAbstract:Abstract Objective To develop and assess some of the measurement properties of a simple and inexpensive test that can be used to evaluate the Wheelchair mobility of Manual Wheelchair users. Design The initial phase of the study was developmental and descriptive. For the assessment of reliability and validity, correlations and comparisons were carried out using within-participant and subgroup comparisons. Setting Rehabilitation center. Participants Manual Wheelchair users (N=58), a sample of convenience. Intervention The Wheelchair Propulsion Test (WPT) consists of wheeling 10m while time is recorded with a stopwatch, and the number of cycles and propulsion methods are recorded by observation. The WPT was administered once to each participant. Participants in subgroups involved in the assessment of reliability, construct, and concurrent validity had an additional WPT on the same occasion. Main Outcome Measures Derived measures—speed (m/s), push frequency (cycles per second) and effectiveness (meters per cycle)—from the WPT and, for concurrent validity, an instrumented rear wheel. Results Regarding intra- and interrater reliability, intraclass correlation coefficients ranged from .72 to .96. Content validity was qualitatively good. For construct validity, on univariate or multivariate analyses, we found statistically significant relations between WPT measures and age, sex, duration of Wheelchair use, type of Wheelchair frame, and rolling surface. For concurrent validity, the WPT and instrumented wheel variables were highly correlated ( r range, .92–.99), and there were no clinically significant differences between them. Conclusions The WPT appears to be a simple and inexpensive test with good measurement properties that can be used for people who use hand and/or foot propulsion. However, further study is needed before widespread implementation can be recommended.
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Manual Wheelchair skills objective testing versus subjective questionnaire
Archives of Physical Medicine and Rehabilitation, 2012Co-Authors: Paula W Rushton, Lee R Kirby, William C MillerAbstract:Abstract Rushton PW, Kirby RL, Miller WC. Manual Wheelchair skills: objective testing versus subjective questionnaire. Objectives To test the hypothesis that the total scores of the Wheelchair Skills Test (WST) version 4.1, an observer-rated scale of Wheelchair performance, and the Wheelchair Skills Test Questionnaire (WST-Q) version 4.1, a self-report of Wheelchair skills, are highly correlated. We also anticipate that the WST-Q scores will be slightly higher, indicating an overestimation of capacity to perform Wheelchair skills as compared with actual capacity. Design A cross-sectional, within-subjects comparison design. Setting Three Canadian cities. Participants Convenience sample of community-dwelling, experienced Manual Wheelchair users (N=89) ranging in age from 21 to 94 years. Intervention Not applicable. Main Outcome Measures Participants completed the subjective WST-Q version 4.1 followed by the objective WST version 4.1 in 1 testing session. Results The mean ± SD total percentage scores for WST and WST-Q were 79.5%±14.4% and 83.0%±12.1% for capacity and 99.4%±1.5% and 98.9%±2.5% for safety, respectively. The correlations between the WST and WST-Q scores were ρ=.89 ( P =.000) for capacity and ρ=.12 ( P =.251) for safety. WST-Q total score mean differences were an average of 3.5%±6.5% higher than WST scores for capacity ( P =.000) and .52%±2.8% lower for safety ( P =.343). For the 32 individual skills, the percentage agreement between the WST and WST-Q scores ranged from 82% to 100% for capacity and from 90% to 100% for safety. Conclusion WST and WST-Q version 4.1 capacity scores are highly correlated although the WST-Q scores are slightly higher. Decisions on which of these assessments to use can safely be based on the circumstances and objectives of the evaluation.
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Manual Wheelchair skills capacity predicts quality of life and community integration in persons with spinal cord injury
Archives of Physical Medicine and Rehabilitation, 2012Co-Authors: Shahla M Hosseini, Lee R Kirby, Michelle L Oyster, Amanda Harrington, Michael L BoningerAbstract:Abstract Hosseini SM, Oyster ML, Kirby RL, Harrington AL, Boninger ML. Manual Wheelchair skills capacity predicts quality of life and community integration in persons with spinal cord injury. Objectives To determine Wheelchair (WC) skills success rates for Manual WC users with spinal cord injury (SCI), to determine subject characteristics associated with the lowest success rates of WC skills, and to characterize the relationship between WC skills and measures of community integration and quality of life (QOL). Design Cross-sectional multisite study. Setting Six Spinal Cord Injury Model Systems (SCIMS) centers. Participants Individuals with SCI (N=214) who were at least 11 months postinjury, treated at an SCIMS center, and who used a Manual WC as their primary means of mobility. Intervention Not applicable. Main Outcome Measures Wheelchair Skills Test (WST) and questionnaires of demographics and characteristics, QOL, and community participation. Results Of the 31 skills in the WST assessed, success rates ranged from 19.6% to 100%. Eight skills had success rates of ≤75%: folding/unfolding the WC (71.5%), ascending (19.6%) and descending (47.2%) a 15-cm curb, ascending (23.2%) and descending (26.5%) stairs, transferring from ground to WC (40.6%), turning 180° in wheelie position (55.2%), and holding a 30-second stationary wheelie (59.9%). Male sex, paraplegia, employed status, lower education, younger age at injury, and white race were among the participant characteristics bivariately associated with higher success rates of several WC skills. After controlling for covariates, higher success rates of several WC skills and a higher total WST score predicted better self-perceived health, higher life satisfaction, and more community participation. Conclusions For people with SCI who use a Manual WC as their primary means of mobility, their ability to perform Manual WC skills is associated with higher community participation and life satisfaction. Factors contributing to low success rates need to be investigated, and interventions to improve these rates are needed.
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Manual Wheelchair skills capacity predicts quality of life and community integration in persons with spinal cord injury
Archives of Physical Medicine and Rehabilitation, 2012Co-Authors: Shahla M Hosseini, Michael L Boninger, Lee R Kirby, Michelle L Oyster, Amanda L HarringtonAbstract:Abstract Hosseini SM, Oyster ML, Kirby RL, Harrington AL, Boninger ML. Manual Wheelchair skills capacity predicts quality of life and community integration in persons with spinal cord injury. Objectives To determine Wheelchair (WC) skills success rates for Manual WC users with spinal cord injury (SCI), to determine subject characteristics associated with the lowest success rates of WC skills, and to characterize the relationship between WC skills and measures of community integration and quality of life (QOL). Design Cross-sectional multisite study. Setting Six Spinal Cord Injury Model Systems (SCIMS) centers. Participants Individuals with SCI (N=214) who were at least 11 months postinjury, treated at an SCIMS center, and who used a Manual WC as their primary means of mobility. Intervention Not applicable. Main Outcome Measures Wheelchair Skills Test (WST) and questionnaires of demographics and characteristics, QOL, and community participation. Results Of the 31 skills in the WST assessed, success rates ranged from 19.6% to 100%. Eight skills had success rates of ≤75%: folding/unfolding the WC (71.5%), ascending (19.6%) and descending (47.2%) a 15-cm curb, ascending (23.2%) and descending (26.5%) stairs, transferring from ground to WC (40.6%), turning 180° in wheelie position (55.2%), and holding a 30-second stationary wheelie (59.9%). Male sex, paraplegia, employed status, lower education, younger age at injury, and white race were among the participant characteristics bivariately associated with higher success rates of several WC skills. After controlling for covariates, higher success rates of several WC skills and a higher total WST score predicted better self-perceived health, higher life satisfaction, and more community participation. Conclusions For people with SCI who use a Manual WC as their primary means of mobility, their ability to perform Manual WC skills is associated with higher community participation and life satisfaction. Factors contributing to low success rates need to be investigated, and interventions to improve these rates are needed.