O.J.E. Kilkens

Relationship between manual wheelchair skill performance and participation of persons with spinal cord injuries 1 year after discharge from inpatient rehabilitation

This cross-sectional study describes the level of manual wheelchair skill performance and participation of persons with spinal cord injuries (SCIs) 1 year after discharge from inpatient rehabilitation and tests the hypothesis that wheelchair skill performance is positively related to participation. Participants included 81 persons with SCI from eight rehabilitation centers in the Netherlands. The Wheelchair Circuit consists of eight wheelchair skills and results in three test scores: ability, performance time, and physical strain. Participation was assessed with the sum of the subscales Mobility Range and Social Behavior of the 68-Item Sickness Impact Profile (SIPSOC). SIPSOC was moderately related to the ability score (the Spearman rank correlation [rS] = -0.49), the performance time score (rS = 0.54), and the physical strain score (rS = 0.38). The regression analyses showed that, after controlling for lesion and personal characteristics, manual wheelchair skill performance is positively related to participation, with the strongest association for the performance time score. In persons with SCI who are manual wheelchair users, wheelchair skill performance is moderately associated to participation. Training of wheelchair skills has to be an important goal of rehabilitation, and persons should be stimulated to maintain their wheelchair skills after discharge from rehabilitation.

Wheelchair skills tests: a systematic review

Objective: To describe and compare the content, feasibility, outcome parameters, and clinimetric properties of the manual wheelchair skills tests reported in the literature. Design: A systematic literature search was conducted in MEDLINE, EMBASE, PsychINFO and Current Contents. Tests were selected if they were observational tests, designed for subjects using hand-rim wheelchairs and were intended to assess wheelchair skill performance at the activity level. Results: The search resulted in 34 papers, in which 24 different wheelchair skills tests were described. The skill most frequently included was wheelchair propulsion, consecutively followed by transferring, negotiating kerbs, ascending slopes, traversing tracks, sprinting and performing a wheelie. The three most frequently used outcome parameters were task performance time, independency of task performance, and physical strain during skill performance. Sensitivity to change was evaluated in three tests, validity in 10 tests, and reliability in nine tests. Conclusions: Many tests are applied to measure wheelchair skill performance using different tasks and outcome measures. This makes it difficult to compare study results. Consensus among researchers as to which skills must be included as well as to standardization of the use of measurement instruments will reduce this problem and will additionally lead to a better insight in the quality of tests.

Hand-rim wheelchair propulsion capacity during rehabilitation of persons with spinal cord injury

This paper describes the course of wheelchair propulsion capacity (WPC) during rehabilitation of persons with spinal cord injury (SCI) and its relationship with personal and injury characteristics. We investigated 132 subjects with SCI (37 with tetraplegia) at the start of active rehabilitation (t1), 3 months later (t2), and at the end of clinical rehabilitation (t3). WPC was measured as the maximal power output that can be achieved in a maximal wheelchair exercise test on a treadmill. Results were analyzed with the use of generalized estimating equations, with time of measurement, lesion level, motor completeness of the lesion, age, and gender as independent variables. Overall, WPC increased from 30.5 W at t1, to 39.5 W at t2, and 44.2 W at t3. Persons with paraplegia, persons with incomplete lesions, men, and younger persons had higher values for WPC compared with persons with tetraplegia, persons with complete lesions, women, and older persons. Rate of improvement was lower in older persons and women compared with younger persons and men. This paper identifies factors that affect the level (lesion level, completeness of the lesion, age, gender) and rate of improvement (age, gender) of WPC during rehabilitation. These findings should be considered when wheelchair capacity training is applied in SCI rehabilitation.