Lucas H. V. van der Woude

A systematic review of wheelchair skills tests for manual wheelchair users with a spinal cord injury: towards a standardized outcome measure

Objective: To review, analyse, evaluate and critically appraise available wheelchair skill tests in the international literature and to determine the need for a standardized measurement tool of manual wheeled mobility in those with spinal cord injury. Data sources: A systematic review of literature (databases PubMed, Web of Science and Cochrane Library (1970-December 2009). Subjects: Hand rim wheelchair users, mainly those with spinal cord injury. Review methods: Studies’ content and methodology were analysed qualitatively. Study quality was assessed using the scale of Gardner and Altman. Results: Thirteen studies fell within the inclusion criteria and were critically reviewed. The 13 studies covered 11 tests, which involved 14 different skills. These 14 skills were categorized into: wheelchair manoeuvring and basic daily living skills; obstacle-negotiating skills; wheelie tasks; and transfers. The Wheelchair Skills Test version 2.4 (WST-2.4) and Wheelchair Circuit tests scored best on the Gardner and Altman scale, the Obstacle Course Assessment of Wheelchair User Performances (OCAWUP) test was found to be the most relevant for daily needs in a wheelchair. The different tests used different measurement scales, varying from binary to ordinal and continuous. Comparison of outcomes between tests was not possible because of differences in skills assessed, measurement scales, environment and equipment selected for each test. A lack of information regarding protocols as well as differences in terminology was also detected. Conclusion: This systematic review revealed large inconsistencies among the current available wheelchair skill tests. This makes it difficult to compare study results and to create norms and standards for wheelchair skill performance.

Life satisfaction in people with spinal cord injury during the first five years after discharge from inpatient rehabilitation

Purpose: To describe the course of life satisfaction in persons with spinal cord injury (SCI) during the first 5 years after discharge from inpatient rehabilitation and to examine its determinants. Methods: Multi-centre prospective cohort study with four measurements, the first at discharge from inpatient rehabilitation, the last 5 years after discharge. Data of 162 persons with SCI were analyzed. Life satisfaction was measured as the sum score of ‘current life satisfaction’ and ‘current life satisfaction compared to life satisfaction before SCI’. Lesion characteristics, functional independence, secondary impairments, pain, social support and self-efficacy were analyzed as possible determinants of life satisfaction. Random coefficient analysis was used for the analyses. Results: No significant changes in life satisfaction were found between discharge and 2 years later, however there were significant increases from two to 5 years post discharge. High functional independence, low pain, high everyday social support and high self-efficacy were significant determinants of a positive course of life satisfaction after discharge. Conclusions: Increases in life satisfaction were found in persons with SCI in the long run. High functional status, low pain, good social skills and high self-efficacy were related to high life satisfaction. Implications for Rehabilitation A spinal cord injury (SCI) is a major life event leading to serious physical disability and secondary medical problems, which has important consequences for the life satisfaction of the persons involved. No changes in mean life satisfaction ratings were found between discharge and two years later, but slight increases in life satisfaction were reported from two to five years post-discharge in persons with SCI. High functional independence, low pain, high everyday social support, and high self-efficacy were significant determinants of a positive course of life satisfaction after discharge. A combined model of physical (functional independence and pain) and psychosocial factors (social support and self-efficacy) explained 66% of the variance in life satisfaction.

Effectiveness of a Multidisciplinary Occupational Training Program for Chronic Low Back Pain

Koopman FS, Edelaar M, Slikker R, Reynders K, van der Woude LHV, Hoozemans MJM: Effectiveness of a multidisciplinary occupational training program for chronic low back pain: A prospective cohort study. Am J Phys Med Rehabil 2004;83:94–103. ObjectiveTo evaluate the effectiveness of a 12-wk multidisciplinary occupational training program for patients with chronic low back pain and to identify prognostic factors for treatment success. DesignA total of 51 participants were evaluated at baseline, at discharge, and at 1 yr after conclusion of the program. The evaluation included a physical examination and assessment of functional disability, psychological factors, and coping styles. The main target of the program is full work resumption. The central outcome measures therefore are three variables on return to work. ResultsAnalysis of variance for repeated measures revealed significant beneficial changes during the program for all measures except for several coping-style variables. The acquired level of maximum oxygen uptake, trunk flexibility, functional disability, and catastrophizing were maintained at 1-yr follow-up. At 1-yr follow-up, >60% of the participants had fully returned to work, which is an increase of >40% compared with baseline. Regression analyses showed that sex, age, the baseline values of reinterpretation of pain sensations, and functional disability and changes in trunk flexibility scores during the program are important prognostic factors for complete return to work. ConclusionsBased on the current findings, the program seems to be efficacious in the short term. Future attention must be directed toward maintaining these results, although work resumption rates improved considerably 1 yr after conclusion of the program.

Recommended measures for the assessment of cognitive and physical performance in older patients with dementia: a systematic review

Aim/Goal: To recommend a set of neuropsychological and physical exercise tests for researchers to assess cognition and physical fitness in clinical trials with older patients with dementia; to create consensus, decrease heterogeneity, and improve research quality. Methods: A literature search (2005–2011) yielded 89 randomized controlled trials. To provide information on test recommendations the frequency of test use, effect size of the test outcome, study quality, and psychometric properties of tests were analyzed. Results: Fifty-nine neuropsychological tests (cognitive domains: global cognition, executive functioning, memory, and attention) and 10 exercise tests (physical domains: endurance capacity, muscle strength, balance, and mobility) were found. Conclusion: The Severe Impairment Battery, Mini Mental State Examination, and Alzheimer Disease Assessment Scale – cognitive subscale were recommended to measure global cognition. The Verbal Fluency Test Category/Letters, Clock Drawing Test, and Trail Making Test-B were recommended to measure executive functioning. No specific memory test could be recommended. The Digit Span Forward, Digit Span Backward, and Trail Making Test-A were recommended to measure attention. As physical exercise tests, the Timed Up and Go and Six Meter Walk for mobility, the Six Minute Walk Distance for endurance capacity, and the Tinetti Balance Scale were recommended.

PRoSPECTIVE ANALYSIS oF BodY MASS INdEX duRING ANd uP To 5 YEARS AFTER dISCHARGE FRoM INPATIENT SPINAL CoRd INJuRY REHABILITATIoN

OBJECTIVE To investigate the prevalence of overweight/obesity and the course of the body mass index (BMI) in persons with spinal cord injury during and after inpatient rehabilitation. DESIGN Multi-centre longitudinal study. SUBJECTS A total of 184 persons with spinal cord injury. METHODS BMI was determined at the start of active rehabilitation, 3 months later, at discharge, and 1, 2 and 5 years after discharge. RESULTS The percentage of persons who were overweight/obese (BMI ≥ 22 kg/m2) increased over the years from 56% to 75%. The absolute BMI did not significantly increase during rehabilitation, but showed a significant increase the year after discharge from inpatient rehabilitation (p < 0.001). From examining the personal or lesion characteristics, age was the only factor that was related to the absolute BMI. BMI increased by 1 kg/m2 for each 10-year increase in age. Men, persons with paraplegia and older people had more chance of being overweight/obese compared with women, persons with tetraplegia and younger people. CONCLUSION The BMI of people with spinal cord injuries gradually increases during and after inpatient rehabilitation, with significant increases in the first year after discharge. It is recommended that emphasis is placed on weight-management protocols (diet and exercise) to encourage a healthy lifestyle.

Social support and life satisfaction in spinal cord injury during and up to one year after inpatient rehabilitation.

OBJECTIVE To describe the course of social support in persons with recently acquired spinal cord injury, and to examine direct and indirect relationships between social support and life satisfaction over time. DESIGN A multi-centre prospective cohort study with measurements at the start of active rehabilitation, at discharge from inpatient rehabilitation and one year after discharge. SUBJECTS One hundred and ninety individuals with spinal cord injury from 8 Dutch rehabilitation centres. METHODS Social support was measured with the Social Support List-12. Life satisfaction was measured as the sum score of current life satisfaction and current life satisfaction compared with life satisfaction before spinal cord injury. Distress was operationalized as functional dependence and measured with the Functional Independence Measure. Random coefficient analysis was used for the analyses. RESULTS Everyday social support and support in problem situations decreased, and esteem support remained stable over time. Everyday support and support in problem situations were directly associated with life satisfaction over time. Significant interaction effects between social support and distress on life satisfaction were found. CONCLUSION Different types of social support showed different courses over time. Social support was associated with life satisfaction after spinal cord injury, in particular in persons with relatively high levels of distress.

The Ergonomics of Wheelchair Configuration for Optimal Performance in the Wheelchair Court Sports

Optimizing mobility performance in wheelchair court sports (basketball, rugby and tennis) is dependent on a combination of factors associated with the user, the wheelchair and the interfacing between the two. Substantial research has been attributed to the wheelchair athlete yet very little has focused on the role of the wheelchair and the wheelchair-user combination. This article aims to review relevant scientific literature that has investigated the effects of wheelchair configuration on aspects of mobility performance from an ergonomics perspective. Optimizing performance from an ergonomics perspective requires a multidisciplinary approach. This has resulted in laboratory-based investigations incorporating a combination of physiological and biomechanical analyses to assess the efficiency, health/safety and comfort of various wheelchair configurations. To a lesser extent, field-based testing has also been incorporated to determine the effects of wheelchair configuration on aspects of mobility performance specific to the wheelchair court sports. The available literature has demonstrated that areas of seat positioning, rear wheel camber, wheel size and hand-rim configurations can all influence the ergonomics of wheelchair performance. Certain configurations have been found to elevate the physiological demand of wheelchair propulsion, others have been associated with an increased risk of injury and some have demonstrated favourable performance on court. A consideration of all these factors is required to identify optimal wheelchair configurations. Unfortunately, a wide variety of different methodologies have immerged between studies, many of which are accompanied by limitations, thus making the identification of optimal configurations problematic. When investigating an area of wheelchair configuration, many studies have failed to adequately standardize other areas, which has prevented reliable cause and effect relationships being established. In addition, a large number of studies have explored the effects of wheelchair configuration in either able-bodied populations or in daily life or racing wheelchairs. As such, the findings are not specific and transferable to athletes competing in the wheelchair court sports. This review presents evidence about the effects of wheelchair configuration on aspects of mobility performance specific to the wheelchair court sports to better inform athletes, coaches and manufacturers about the consequences of their selections. It also provides researchers with guidance on the design of future investigations into areas of wheelchair configuration, which are essential.

Physical capacity after 7 weeks of low-intensity wheelchair training

Purpose. To simulate the effect of low-intensity exercise in early rehabilitation, we investigated the effect of a 7-week low-intensity norm duration hand rim wheelchair training on the physical capacity in untrained able-bodied individuals. Method. Twenty-five able-bodied participants were randomly assigned to an experimental and control group: 10 participants exercised 7 weeks, three times a week at 30% heart rate reserve (HRR) for 30 min (experimental group). The control group consisted of 15 participants who did not receive training. Physical capacity (maximal isometric strength, sprint power, peak power output and peak oxygen uptake) and submaximal performance [heart rate (HR), oxygen uptake (VO2), mechanical efficiency (ME)] were assessed pre- and post-training. The levels of upper-body discomfort were determined with the use of a Local Perceived Discomfort scale. Results. Compared to the control group the experimental group significantly improved on sprint power (+31.2%), peak aerobic power output (+34%), submaximal HR, VO2 and ME (+16.9%). The participants did not experience high levels of local discomfort in the upper body during the training. Conclusions. Low-intensity norm duration hand rim wheelchair training which significantly improved peak aerobic and sprint power output, efficiency and physical strain in able-bodied untrained individuals. Training at 30% HRR (3 × /week, 30 min/session) may be appropriate in untrained individuals, such as novice wheelchair users at the start of their rehabilitation, to prevent early fatigue and overuse and enhance motivation. Please note that this article was published in error in a previous issue of the Journal. This paper was submitted and accepted as part of the Special Issue entitled 4th International State-of-the-art-Congress ‘Rehabilitation: Mobility, Exercise & Sports’ and has therefore been republished in this issue. The publisher apologises for this error.

Energy cost of balance control during walking decreases with external stabilizer stiffness independent of walking speed

Human walking requires active neuromuscular control to ensure stability in the lateral direction, which inflicts a certain metabolic load. The magnitude of this metabolic load has previously been investigated by means of passive external lateral stabilization via spring-like cords. In the present study, we applied this method to test two hypotheses: (1) the effect of external stabilization on energy cost depends on the stiffness of the stabilizing springs, and (2) the energy cost for balance control, and consequently the effect of external stabilization on energy cost, depends on walking speed. Fourteen healthy young adults walked on a motor driven treadmill without stabilization and with stabilization with four different spring stiffnesses (between 760 and 1820 Nm(-1)) at three walking speeds (70%, 100%, and 130% of preferred speed). Energy cost was calculated from breath-by-breath oxygen consumption. Gait parameters (mean and variability of step width and stride length, and variability of trunk accelerations) were calculated from kinematic data. On average external stabilization led to a decrease in energy cost of 6% (p<0.005) as well as a decrease in step width (24%; p<0.001), step width variability (41%; p<0.001) and variability of medio-lateral trunk acceleration (12.5%; p<0.005). Increasing stabilizer stiffness increased the effects on both energy cost and medio-lateral gait parameters up to a stiffness of 1260 Nm(-1). Contrary to expectations, the effect of stabilization was independent of walking speed (p=0.111). These results show that active lateral stabilization during walking involves an energetic cost, which is independent of walking speed.

Relation Between Aerobic Capacity and Walking Ability in Older Adults With a Lower-Limb Amputation

OBJECTIVES To determine the relative aerobic load, walking speed, and walking economy of older adults with a lower-limb prosthesis, and to predict the effect of an increased aerobic capacity on their walking ability. DESIGN Cross-sectional. SETTING Human motion laboratory at a rehabilitation center. PARTICIPANTS Convenience sample of older adults (n=36) who underwent lower-limb amputation because of vascular deficiency or trauma and able-bodied controls (n=21). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Peak aerobic capacity and oxygen consumption while walking were determined. The relative aerobic load and walking economy were assessed as a function of walking speed, and a data-based model was constructed to predict the effect of an increased aerobic capacity on walking ability. RESULTS People with a vascular amputation walked at a substantially higher (45.2%) relative aerobic load than people with an amputation because of trauma. The preferred walking speed in both groups of amputees was slower than that of able-bodied controls and below their most economical walking speed. We predicted that a 10% increase in peak aerobic capacity could potentially result in a reduction in the relative aerobic load of 9.1%, an increase in walking speed of 17.3% and 13.9%, and an improvement in the walking economy of 6.8% and 2.9%, for people after a vascular or traumatic amputation, respectively. CONCLUSIONS Current findings corroborate the notion that, especially in people with a vascular amputation, the peak aerobic capacity is an important determinant for walking ability. The data provide quantitative predictions on the effect of aerobic training; however, future research is needed to experimentally confirm these predictions.