Kerri A. Morgan

A subjective measure of environmental facilitators and barriers to participation for people with mobility limitations

Purpose. The aim of this paper is to describe the development and psychometric properties of a self-report survey of environmental facilitators and barriers to participation by people with mobility impairments. Method. A measure called the Facilitators And Barriers Survey of environmental influences on participation among people with lower limb Mobility impairments and limitations (FABS/M) was developed using items based on focus groups to ensure content validity. Discriminant validity was assessed on 604 individuals who completed the FABS/M once. Internal consistency and test-retest reliabilities were based on 371 individuals who completed two surveys. Results. The FABS/M includes 61 questions, 133 items and six domains including the type of primary mobility device; built features of homes; built and natural features in the community; community destination access; community facilities access; community support network. Environmental items are scored for the frequency of encounter and the magnitude of influence on their participation. The internal consistencies and the test-retest reliabilities of the domains of the FABS/M ranged from low to moderate. The discriminant validity of domains differed for device and diagnostic groups. Conclusion. The FABS/M joins the MQE and the CHIEF as another subjective measure for use in assessing environmental features important for understanding participation. The FABS can be used to assess the influence of environmental interventions at the individual and community levels of analysis. The type of primary mobility device that is used can be related to reported environmental barriers. Community-based improvements in built features, access to destinations, access to facilities and augmented support networks can be tracked through the reports of people with mobility impairments.

Development of a measure of receptivity of the physical environment

Purpose. New models of disability identify the importance of measuring the influence of the environment (environmental barriers) on the performance of persons with disabilities. The objective of this paper is to present a new measure of the receptivity of the physical environment for persons with mobility impairments and to offer preliminary information about its psychometric properties. Methods. The measure, The Community Health Environment Checklist (CHEC), was developed and validated in a community setting with a group of persons with mobility impairments. Sixty-three destinations (buildings, recreational areas or facilities) were assessed using the CHEC. Results. Using Cronbachs alpha, the CHEC was found to have an internal consistency reliability of 0.95. The content validity of the CHEC was assured by the development procedure. Conclusion. The CHEC offers a brief, easily administered measure of receptivity of the physical environment for persons with mobility impairments that is psychometrically sound.

People with mobility impairments: Physical activity and quality of participation.

BACKGROUND we sought to describe the characteristics of physical activity levels, health, community integration, and social participation of people with mobility impairments. METHODS based on responses to a participation survey, respondents, located primarily in the Midwestern United States, were divided into 3 physical activity groups: high, low, and inactive. We chose a purposeful sample of 604 people with mobility limitations who had a diagnosis of spinal cord injury, multiple sclerosis, cerebral palsy, stroke, or poliomyelitis. The Participation Survey/Mobility (PARTS/M) was used to measure participation in 6 domains and 20 different activities, the Physical Activity and Health Status (SF-36) was used to measure health and quality of life, and the Reintegration to Normal Living Index (RNL) was used to measure integration into the community. RESULTS people with mobility impairments who were identified as having a high level of physical activity reported greater participation, better health, and a higher level of reintegration to normal community living compared with participants who described their physical activity level as low or inactive. CONCLUSION positive health status and superior community participation were found in a high physical activity group compared with low active or inactive groups of people with mobility impairments and limitations.

The influence of verbal training and visual feedback on manual wheelchair propulsion

Purpose. To determine if verbal training with visual feedback improved manual wheelchair propulsion; to examine propulsion differences between an individual with paraplegia and an individual with tetraplegia. Method. Quasi-experimental study: Nine manual wheelchair-using adults participated in propulsion assessments and training. Baseline propulsion performance was measured on several tasks on different surfaces. Participants were trained on a wheelchair treadmill with verbal and visual feedback to increase push length, reduce push frequency and to modify propulsion pattern. Handrim biomechanics were measured with an instrumented wheel. Changes in propulsion were assessed. Differences in propulsion characteristics between a participant with paraplegia and a participant with tetraplegia were examined. Results. Push length increased (p < 0.05), push frequency decreased (p < 0.01) and peak (p < 0.05) and average (p < 0.01) forces increased immediately after training. These changes were not sustained over time. Graphic representations showed differences in propulsion characteristics between a participant with paraplegia and a participant with tetraplegia. Conclusions. Verbal training may produce changes in push biomechanics of manual wheelchair users. Longer training periods may be needed to sustain propulsion changes. Findings from this study support other studies that have shown propulsion differences between people with tetraplegia and paraplegia. Propulsion training for populations with upper-extremity impairments warrants further study.

The Interrater Reliability of the Community Health Environment Checklist

OBJECTIVE The purpose of this preliminary study was to examine the interrater reliability of the Community Health Environment Checklist. DESIGN Thirty buildings were randomly selected. Three trained raters assessed each destination with the Community Health Environment Checklist. SETTING All buildings assessed during this study were located in an urban community in St. Louis, Missouri. PARTICIPANTS Buildings represent 13 categories of building type from a defined geographic region. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The outcome measure in this study was the Community Health Environment Checklist, which is used to quantify the receptivity of public buildings from the perspectives of people with mobility impairments. RESULTS The findings suggest that the subscales of the Community Health Environment Checklist have excellent interrater reliability coefficients, (intraclass correlation coefficient, .76-.99). CONCLUSIONS The findings of this study provide preliminary data to support the clinical utility of the Community Health Environment Checklist as a measure of the receptivity of the physical environment for persons with mobility impairments.

Trunk and neck kinematics during overground manual wheelchair propulsion in persons with tetraplegia.

Abstract Purpose: To test the hypothesis that movement of the head and trunk increases as a consequence of speed during manual wheelchair propulsion over the ground in individuals with tetraplegia. Methods: Seven adult participants with tetraplegia who used manual wheelchairs (5 men and 2 women, aged 33.0 ± 10.2) were selected for the study. Participants propelled over the ground at three different speeds while video motion capture methods collected kinematic data. Variables investigated were forward flexion, lateral flexion and axial rotation for both the head and trunk. Repeated measures ANOVA were used to determine effects of speed on head and trunk movements. Results: Both neck and trunk forward flexion significantly increased as a result of speed (p = 0.034, p = 0.031), with a large effect size (r = 0.6, r = 0.6) between slow and fast speeds. Lateral flexion and axial rotation were minimal for the neck and trunk and did not significantly increase with speed. Conclusions: Results suggest that manual wheelchair users with tetraplegia compensate for trunk muscle weakness by flexing the upper trunk and neck forward during manual wheelchair propulsion and that these movements increase with speed. Further studies should examine if these movements relate to overuse injuries and interventions that focus on improving manual wheelchair biomechanics of individuals with tetraplegia. Implications for Rehabilitation Individuals who use manual wheelchairs utilize their upper extremities almost exclusively for both everyday mobility and participation in daily life activities which can often lead to overuse injuries and pain. Despite having a lack of trunk muscle innervation, manual wheelchair users with tetraplegia are able to compensate for this weakness by using the upper trunk and neck. The way in which force is translated from the trunk through the upper extremities to the pushrim may impact propulsion biomechanics, and ultimately the extent in which upper extremity pain and injury develops. A better understanding of how individuals with trunk impairments propel a manual wheelchair will help clinicians determine optimal wheelchair positioning and training during rehabilitation for individuals with tetraplegia. Clinicians can determine ways in which they can support manual wheelchair users to allow for most efficient biomechanics.

A motor learning approach to training wheelchair propulsion biomechanics for new manual wheelchair users: A pilot study

Context/Objective: Developing an evidence-based approach to teaching wheelchair skills and proper propulsion for everyday wheelchair users with a spinal cord injury (SCI) is important to their rehabilitation. The purpose of this project was to pilot test manual wheelchair training based on motor learning and repetition-based approaches for new manual wheelchair users with an SCI. Design: A repeated measures within-subject design was used with participants acting as their own controls. Methods: Six persons with an SCI requiring the use of a manual wheelchair participated in wheelchair training. The training included nine 90-minute sessions. The primary focus was on wheelchair propulsion biomechanics with a secondary focus on wheelchair skills. Outcome Measures: During Pretest 1, Pretest 2, and Posttest, wheelchair propulsion biomechanics were measured using the Wheelchair Propulsion Test and a Video Motion Capture system. During Pretest 2 and Posttest, propulsion forces using the WheelMill System and wheelchair skills using the Wheelchair Skills Test were measured. Results: Significant changes in area of the push loop, hand-to-axle relationship, and slope of push forces were found. Changes in propulsion patterns were identified post-training. No significant differences were found in peak and average push forces and wheelchair skills pre- and post-training. Conclusions: This project identified trends in change related to a repetition-based motor learning approach for propelling a manual wheelchair. The changes found were related to the propulsion patterns used by participants. Despite some challenges associated with implementing interventions for new manual wheelchair users, such as recruitment, the results of this study show that repetition-based training can improve biomechanics and propulsion patterns for new manual wheelchair users.

Elbow kinematics during overground manual wheelchair propulsion in individuals with tetraplegia

Purpose. The purpose of this study was to describe horizontal and vertical translation of the elbow and elbow angle in two planes and three speeds during manual wheelchair overground propulsion in individuals with tetraplegia. Methods. Seven individuals with tetraplegia who used manual wheelchairs wheeled overground at three different speeds were recruited for the study. Video motion capture methods quantified their movements. Video data were tracked and used to calculate variables describing three-dimensional elbow translation and angular orientation. Repeated measures ANOVA were used to determine effects of speed on elbow translation and elbow angle. Paired t-tests were used to evaluate left to right differences. Results. Right elbow anterior-posterior translation was found to be significantly different during slow and fast and slow and normal speeds. Vertical and medial-lateral translation of the right elbow was significantly different between slow and fast speeds. No significant effects for speed during left elbow movement or side-to-side movement were found. No significant effects were found for elbow angle across speeds or from side-to-side. Three patterns of elbow movement emerged for anterior-posterior and medial-lateral translation and for elbow angle. Conclusions. Results indicated that elbow translation was related to propulsion speed. Work involving this population is needed for further understanding of upper extremity kinematic patterns.

Reliability and validity of the Microsoft Kinect for assessment of manual wheelchair propulsion

Concurrent validity and test-retest reliability of the Microsoft Kinect in quantification of manual wheelchair propulsion were examined. Data were collected from five manual wheelchair users on a roller system. Three Kinect sensors were used to assess test-retest reliability with a still pose. Three systems were used to assess concurrent validity of the Kinect to measure propulsion kinematics (joint angles, push loop characteristics): Kinect, Motion Analysis, and Dartfish ProSuite (Dartfish joint angles were limited to shoulder and elbow flexion). Intraclass correlation coefficients revealed good reliability (0.87-0.99) between five of the six joint angles (neck flexion, shoulder flexion, shoulder abduction, elbow flexion, wrist flexion). ICCs suggested good concurrent validity for elbow flexion between the Kinect and Dartfish and between the Kinect and Motion Analysis. Good concurrent validity was revealed for maximum height, hand-axle relationship, and maximum area (0.92-0.95) between the Kinect and Dartfish and maximum height and hand-axle relationship (0.89-0.96) between the Kinect and Motion Analysis. Analysis of variance revealed significant differences (p < 0.05) in maximum length between Dartfish (mean 58.76 cm) and the Kinect (40.16 cm). Results pose promising research and clinical implications for propulsion assessment and overuse injury prevention with the application of current findings to future technology.

Person factors and work environments of workers who use mobility devices

BACKGROUND Nearly 25% of people with mobility impairments and limitations who are of working age are employed, yet few studies have examined their perspectives on their jobs or work environments required to complete job tasks. OBJECTIVE The purpose of this study was to describe the factors that contribute to successful employment for those who use mobility devices. PARTICIPANTS A convenience sample of 132 workers who use power wheelchairs, manual wheelchairs, canes, crutches or walkers. METHOD Participants completed an online version of the Mobility Device User Work Survey (MWS). A multivariate analysis and a two-step multiple linear regression analysis were used. RESULTS Study participants had few secondary health conditions that influenced their work. Employee satisfactoriness to their employers was high. Accessibility of worksites was high. Assistive technologies were inexpensive, and personal assistance was used infrequently and usually was unpaid. Co-worker communications were very positive. Flexible work rules and supportive managers were highly valued. Job satisfaction positively correlated with accessibility, work tasks, co-worker communication and work support. CONCLUSION The description of work environments of successfully employed mobility device users can provide some useful guidance to employers, vocational rehabilitation (VR) counselors and unemployed mobility device users to balance employee abilities and preferences with the needs of employers.