Annmarie Kelleher

Assessing mobility characteristics and activity levels of manual wheelchair users

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.

Multiple sclerosis and mobility-related assistive technology: Systematic review of literature

Multiple sclerosis (MS) causes a wide variety of neurological deficits, with ambulatory impairment the most obvious cause of disability. Within 10 to 15 years of disease onset, 80% of persons with MS experience gait problems due to muscle weakness or spasticity, fatigue, and loss of balance. To facilitate mobility, persons with MS frequently use mobility assistive technology (MAT), such as canes, crutches, walkers, wheelchairs, and scooters. We systematically reviewed the published literature on MAT use among persons with MS. We used electronic reference lists such as Ovid MEDLINE and PubMed to search the literature. We located 50 articles that met the initial criteria of providing good evidence of the types of MAT devices and their benefits for individuals with MS. A limited number of articles with higher levels of evidence was found regarding benefits of MAT use specifically for persons with MS. Evidence-based literature provides the basis for the strongest method of measurable clinical performance; therefore, having a strong research study design is vital to the justification of MAT prescription and reimbursement decisions. However, a paucity of studies with higher levels of evidence-based practice exists.

Engineering Better Wheelchairs to Enhance Community Participation

With about 2.2 million Americans currently using wheeled mobility devices, wheelchairs are frequently provided to people with impaired mobility to provide accessibility to the community. Individuals with spinal cord injuries, arthritis, balance disorders, and other conditions or diseases are typical users of wheelchairs. However, secondary injuries and wheelchair-related accidents are risks introduced by wheelchairs. Research is underway to advance wheelchair design to prevent or accommodate secondary injuries related to propulsion and transfer biomechanics, while improving safe, functional performance and accessibility to the community. This paper summarizes research and development underway aimed at enhancing safety and optimizing wheelchair design

Quantification of activity during wheelchair basketball and rugby at the National Veterans Wheelchair Games: A pilot study.

To date, no published data exists on distances and speeds traveled by rugby or basketball players during game play. The purpose of this study was to provide quantitative information of selected characteristics of wheelchair basketball and rugby game play. A miniaturized data logger was used to collect the distance traveled, average velocity, activity time, and number of starts and stops during basketball and rugby games. Participants were recruited prior to wheelchair basketball and rugby tournaments during the 2007 and 2008 National Veterans Wheelchair Games. Inclusion criteria were age 18 years or older and been participating in wheelchair basketball or rugby. The wheelchair rugby athletes on average traveled 2364.78 ± 956.35 meters at 1.33 ± 0.25 m/sec with 242.61 ± 80.31 stops and starts in 29.98 ± 11.79 min of play per game. The wheelchair basketball athletes on average traveled 2679.52 ± 1103.66 m at 1.48 ± 0.13 m/sec with 239.78 ± 60.61 stops and starts in 30.28 ± 9.59 min of play per game. Previous research has not reported basketball or rugby game play variables such as these, making this data set unique. The information could be used by players and coaches to create training protocols to better prepare for game conditions.

Usage of tilt-in-space, recline, and elevation seating functions in natural environment of wheelchair users.

This study examined the usage of powered seating functions, including tilt-in-space, backrest recline, and seat elevation, among a group of wheelchair users during their typical daily activities. Twelve individuals who used a power wheelchair with seating functions participated in the study. They drove their own wheelchair and used the seating functions as needed in their community environment for about 2 weeks while the seating function usage was recorded with a portable device. We found that subjects occupied their wheelchair for 11.8 +/- 3.4 hours a day (all data shown as mean +/- standard deviation). While occupying their wheelchairs, they accessed tilt-in-space, backrest recline, and seat elevation 19 +/- 14 times a day for 64.1% +/- 36.8%, 12 +/- 8 times for 76.0% +/- 29.8%, and 4 +/- 4 times for 22.5% +/- 34.9%, respectively. Subjects chose to stay in tilted and reclined positions in their wheelchair for 39.3% +/- 36.5% of their time each day. They spent little time in a fully upright position. Subjects changed their seating positions every 53.6 +/- 47.0 minutes. Time spent in positions of different seating pressures varied among subjects. The information collected could enhance clinical practice of wheelchair provision, resulting in better compliance with clinical instructions and appropriate use of seating functions among wheelchair users.

A Preliminary Study on the Impact of Pushrim-Activated Power-Assist Wheelchairs Among Individuals with Tetraplegia

Ding D, Souza A, Cooper RA, Fitzgerald SG, Cooper R, Kelleher A, Boninger ML: A preliminary study on the impact of pushrim-activated power-assist wheelchairs among individuals with tetraplegia. Objectives:This preliminary study was to evaluate the impact of pushrim- activated power-assist wheelchairs (PAPAWs) on mobility, community participation, satisfaction, and psychosocial impact among individuals with tetraplegia. Design:Fifteen manual wheelchair users with tetraplegia completed a 4-wk protocol including a 2-wk trial where they used their personal wheelchairs for mobility and a 2-wk trial where they were provided with a PAPAW and could choose either wheelchair for mobility. The mobility levels with both wheelchairs were recorded by a datalogger. Participants completed daily questionnaires regarding community participation and their satisfaction with the wheelchair used. The Psychosocial Impact of Assistive Devices Scale was used to compare the psychosocial impact of PAPAWs with their personal wheelchairs. Results:Participants chose to use PAPAWs and their personal wheelchairs at a similar frequency in the PAPAW trial. The distances traveled with both wheelchairs were not statistically different (P = 0.09). Participants traveled significantly faster with PAPAWs (P = 0.03). PAPAWs did not result in significantly greater community participation, satisfaction, and psychosocial impacts than the personal wheelchairs. Conclusions:PAPAWs could be a viable mobility option for individuals with tetraplegia, which can provide independent mobility especially for outdoor activities. A users preference, life style, physical conditions, transportation issues, and environmental factors should be considered in prescribing such a device.

Personal Mobility and Manipulation Appliance—Design, Development, and Initial Testing

The ability to perform activities of daily living and mobility-related activities of daily living are substantial indicators of ones ability to live at home and to participate in ones community. Technologies to assist with mobility and manipulation are among the most important tools that clinicians can provide to people with disabilities to promote independence and community participation. For people with severe disabilities involving both the upper and lower extremities, there are few systems that provide practical and coordinated assistance with mobility and manipulation tasks. The personal mobility and manipulation appliance (PerMMA) was created in response to goals set forth by a team of clinicians and people with disabilities.

Longitudinal assessment of vibrations during manual and power wheelchair driving over select sidewalk surfaces

Wheelchair users rely on their wheelchairs for mobility for extended periods of time every day. According to the International Standards Organization 2631-1 standard on human vibration, individuals in a seated position when exposed to whole-body vibrations (WBV) are at risk of injury. This study evaluated vibration exposure during manual and power wheelchair driving over nine sidewalk surfaces and differences in vibration exposure over 3 years. Ten nondisabled subjects were asked to drive a manual wheelchair at 1 m/s and a power wheelchair at 1 m/s and 2 m/s over nine sidewalk surfaces while WBV were measured at the seat and footrest of the wheelchair. At 1 m/s, significant differences existed between surfaces and years at both the seat and the footrest for the manual and power wheelchair users. At 2 m/s, significant differences existed between surfaces and years at the seat and the footrest for power wheelchair users. Our results show that both manual and power wheelchair users may be at risk for secondary injuries from WBV when traveling over certain surfaces.

Development and qualitative assessment of the GAME/sup Cycle/ exercise system

Increased physical activity is important for reducing the risk of cardiovascular disease. However, among people with disabilities, inactivity is prevalent. In order to encourage exercise among members of this group, an exercise system combining arm ergometry with video gaming, called the GAME/sup Cycle/ was previously developed. User input was received through an arm crank ergometer on a swivel, with the angular velocity of the ergometer resistance wheel controlling one axis and rotation of ergometer about the swivel controlling the other. The purpose of this study was to detail the algorithms used in this device and present novel features included in a second generation of the GAME/sup Cycle/. The features include a wheel on base, a steering return mechanism, and wireless fire buttons. A focus group of clinicians (n=8), wheelchair users (n=8), and clinician wheelchair users (n=2) was conducted to evaluate the features of the GAME/sup Cycle/. The focus group suggested improvements to the steering mechanism and to reduce vibration in the system. However, the focus group enjoyed the GAME/sup Cycle/ and felt that it would encourage exercise among persons with disabilities.

Vibration exposure of individuals using wheelchairs over sidewalk surfaces

According to the International Standards Organization 2631-1 standard on human vibration, individuals in a seated position are at risk of injury due to whole-body vibrations when exposed for long periods of time. Wheelchair users fit this description perfectly; however, little research has been conducted to evaluate the amount of vibration transmitted to a wheelchair user. The vibration exposure produced by traversing nine surfaces was evaluated by having 10 individuals without disabilities propel over them in both a manual wheelchair at 1 m/s and a powered wheelchair at 1 and 2 m/s. Root-mean squared (RMS) vertical vibration was examined to determine if differences existed between surfaces. At 1 m/s for both the manual and the powered wheelchair the 8-mm bevel interlocking concrete surface produced significantly higher RMS vertical vibration than the other surfaces. At 2 m/s in the powered wheelchair, the poured concrete surface (control) produced the significantly highest RMS vertical vibration. Based on the manual and power wheelchair results of this study, use of selected ICPI pavers would be acceptable for any route traveled by individuals using wheelchair. Furthermore, a 90° herringbone pattern is preferred over the 45° pattern, and it is recommended that for safety reasons regarding vibration exposure a bevel of less than 6 mm should be used.