Padmaja Kankipati

The Relationship Between Quality of Life and Change in Mobility 1 Year Postinjury in Individuals With Spinal Cord Injury

OBJECTIVE To examine quality-of-life (QOL) factors and change in mobility in individuals with traumatic spinal cord injury (SCI) 1 year after injury. DESIGN Retrospective case study of National SCI Database data. SETTING SCI Model Systems (SCIMS) sites (N=18). PARTICIPANTS Subjects (N=1826; age >18y) who presented to an SCIMS site after traumatic SCI between June 2004 and July 2009 and returned for 1-year follow-up. All subjects had FIM mobility data for both assessments. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Assessment of impairment based on Lower-Extremity Motor Score. Assessment of QOL based on Craig Handicap Assessment and Reporting Technique, Patient Health Questionnaire, Satisfaction With Life Scale, Self-perceived Health Status, and pain severity scores. RESULTS Of the sample, 55 individuals transitioned from walking to wheelchair use within 1 year of discharge. This group had the highest number of individuals from minority groups (52.8%) and the lowest employment rate (7.3%). Compared with individuals who transitioned from wheelchair use to walking or maintained wheelchair use or ambulation, the walking-to-wheelchair transition group had significantly lower QOL scores (P<.01), including higher depression (P<.01) and higher pain severity (P<.001). CONCLUSIONS Individuals with SCI who transitioned from walking at discharge to wheelchair use within 1 year had low QOL factors, including high pain and depression scores. Rehabilitation professionals should consider encouraging marginal ambulators to work toward functional independence from a wheelchair, rather than primary ambulation during acute inpatient rehabilitation.

Design features that affect the maneuverability of wheelchairs and scooters

OBJECTIVE To determine the minimum space required for wheeled mobility device users to perform 4 maneuverability tasks and to investigate the impact of selected design attributes on space. DESIGN Case series. SETTING University laboratory, Veterans Affairs research facility, vocational training center, and a national wheelchair sport event. PARTICIPANTS The sample of convenience included manual wheelchair (MWC; n=109), power wheelchair (PWC; n=100), and scooter users (n=14). INTERVENTION A mock environment was constructed to create passageways to form an L-turn, 360 degrees -turn in place, and a U-turn with and without a barrier. Passageway openings were increased in 5-cm increments until the user could successfully perform each task without hitting the walls. Structural dimensions of the device and user were collected using an electromechanical probe. Mobility devices were grouped into categories based on design features and compared using 1-way analysis of variance and post hoc pairwise Bonferroni-corrected tests. MAIN OUTCOME MEASURE Minimum passageway widths for the 4 maneuverability tasks. RESULTS Ultralight MWCs with rear axles posterior to the shoulder had the shortest lengths and required the least amount of space compared with all other types of MWCs (P<.05). Mid-wheel-drive PWCs required the least space for the 360 degrees -turn in place compared with front-wheel-drive and rear-wheel-drive PWCs (P<.01) but performed equally as well as front-wheel-drive models on all other turning tasks. PWCs with seat functions required more space to perform the tasks. CONCLUSIONS Between 10% and 100% of users would not be able to maneuver in spaces that meet current Accessibility Guidelines for Buildings and Facilities specifications. This study provides data that can be used to support wheelchair prescription and home modifications and to update standards to improve the accessibility of public areas.

Upper limb kinetic analysis of three sitting pivot wheelchair transfer techniques

BACKGROUND The objective of this study was to investigate differences in shoulder, elbow and hand kinetics while performing three different SPTs that varied in terms of hand and trunk positioning. METHODS Fourteen unimpaired individuals (8 male and 6 female) performed three variations of sitting pivot transfers in a random order from a wheelchair to a level tub bench. Two transfers involved a forward flexed trunk (head-hips technique) and the third with the trunk remaining upright. The two transfers involving a head hips technique were performed with two different leading hand initial positions. Motion analysis equipment recorded upper body movements and force sensors recorded hand reaction forces. Shoulder and elbow joint and hand kinetics were computed for the lift phase of the transfer. FINDINGS Transferring using either of the head hips techniques compared to the trunk upright style of transferring resulted in reduced superior forces at the shoulder (P<0.002), elbow (P<0.004) and hand (P<0.013). There was a significant increase in the medial forces in the leading elbow (P=0.049) for both head hip transfers and the trailing hand for the head hip technique with the arm further away from the body (P<0.028). The head hip techniques resulted in higher shoulder external rotation, flexion and extension moments compared to the trunk upright technique (P<0.021). INTERPRETATION Varying the hand placement and trunk positioning during transfers changes the load distribution across all upper limb joints. The results of this study may be useful for determining a technique that helps preserve upper limb function overtime.

Development of custom measurement system for biomechanical evaluation of independent wheelchair transfers.

This study describes a new custom measurement system designed to investigate the biomechanics of sitting-pivot wheelchair transfers and assesses the reliability of selected biomechanical variables. Variables assessed include horizontal and vertical reaction forces underneath both hands and three-dimensional trunk, shoulder, and elbow range of motion. We examined the reliability of these measures between 5 consecutive transfer trials for 5 subjects with spinal cord injury and 12 nondisabled subjects while they performed a self-selected sitting pivot transfer from a wheelchair to a level bench. A majority of the biomechanical variables demonstrated moderate to excellent reliability (r > 0.6). The transfer measurement system recorded reliable and valid biomechanical data for future studies of sitting-pivot wheelchair transfers.We recommend a minimum of five transfer trials to obtain a reliable measure of transfer technique for future studies.

An expert review of the scientific literature on independent wheelchair transfers

Purpose. The purpose of this study was to perform a literature review and seek expert opinion on the relevance and strength of the evidence concerning setup and transfer performance. Methods. Scientific literature databases were searched until June 2009 using 43 keywords resulting in 339 articles. These were internally reviewed and narrowed to 41 articles which were formally assessed by 13 external experts. Articles that 80% or more of the reviewers scored as moderately or highly relevant were included in the final results. Results. Nineteen articles met the relevancy criteria. The aspects of setup that experts felt were addressed to some degree included vertical transfer distance, transferring across a gap and position of the mobility device relative to target destination. None of the 19 articles were scored as having strong to very strong resulting evidence. Conclusions. There is a consensus among studies that transferring to a higher surface implies greater exertion of the upper limb. However, there is no evidence concerning how high or low, how close, and how much space is needed next to the target surface so it can be accessible by a majority of wheelchair users.

Upper limb joint kinetics of three sitting pivot wheelchair transfer techniques in individuals with spinal cord injury

Abstract Study design Repeated measures design. Objective This study compared the upper extremity (UE) joint kinetics between three transfer techniques. Setting Research laboratory. Methods Twenty individuals with spinal cord injury performed three transfer techniques from their wheelchair to a level tub bench. Two of the techniques involved a head–hips method with leading hand position close (HH-I) and far (HH-A) from the body, and the third technique with the trunk upright (TU) and hand far from body. Motion analysis equipment recorded upper body movements and force sensors recorded their hand and feet reaction forces during the transfers. Results Several significant differences were found between HH-A and HH-I and TU and HH-I transfers indicating that hand placement was a key factor influencing the UE joint kinetics. Peak resultant hand, elbow, and shoulder joint forces were significantly higher for the HH-A and TU techniques at the trailing arm (P < 0.036) and lower at the leading arm (P < 0.021), compared to the HH-I technique. Conclusion Always trailing with the same arm if using HH-A or TU could predispose that arm to overuse related pain and injuries. Technique training should focus on initial hand placement close to the body followed by the amount of trunk flexion needed to facilitate movement.

Controllability of manual and powered wheelchairs for spinal cord injury users

This study investigates wheelchair maneuvering control for persons with a spinal cord injury across two protocols, path control and terminal aiming. Thirty-one participants using either a manual or powered wheelchair, performed self-paced longitudinal movements (path control) as well as self-paced stopping actions (terminal aiming) across multiple trials. Results show performance differences across both protocols for manual and power wheelchair user groups. This study exemplifies the use of model-based data for clinical applications. Further research using this approach may help to identify individual control settings for optimal maneuvering performance.

A conceptual framework to assess effectiveness in wheelchair provision

Background Currently, inadequate wheelchair provision has forced many people with disabilities to be trapped in a cycle of poverty and deprivation, limiting their ability to access education, work and social facilities. This issue is in part because of the lack of collaboration among various stakeholders who need to work together to design, manufacture and deliver such assistive mobility devices. This in turn has led to inadequate evidence about intervention effectiveness, disability prevalence and subsequent costeffectiveness that would help facilitate appropriate provision and support for people with disabilities. Objectives In this paper, we describe a novel conceptual framework that can be tested across the globe to study and evaluate the effectiveness of wheelchair provision. Method The Comparative Effectiveness Research Subcommittee (CER-SC), consisting of the authors of this article, housed within the Evidence-Based Practice Working Group (EBP-WG) of the International Society of Wheelchair Professionals (ISWP), conducted a scoping review of scientific literature and standard practices used during wheelchair service provision. The literature review was followed by a series of discussion groups. Results The three iterations of the conceptual framework are described in this manuscript. Conclusion We believe that adoption of this conceptual framework could have broad applications in wheelchair provision globally to develop evidence-based practices. Such a perspective will help in the comparison of different strategies employed in wheelchair provision and further improve clinical guidelines. Further work is being conducted to test the efficacy of this conceptual framework to evaluate effectiveness of wheelchair service provision in various settings across the globe.

Design and Development of the Single Motor Propelled Drive-Train (SiMPl-D)

Mobile robotic devices and other mobility related drive systems are often relegated to one of the two classes of devices available today: wheeled devices or tracked devices. Wheeled systems are more energy efficient and reliable than tracked systems, but existing designs have drawbacks related to rough-terrain driving and maneuvering in tight spaces.In this paper we describe the design and development of a drive system named the Single Motor Propelled Drive-train (SiMPl-D), which can potentially improve maneuvering over rough terrain and in tight spaces compared to traditional wheeled robots. SiMPl-D has two prominent features: a single drive motor, which provides both propulsion and turning, and is suspended under the center of mass of the device on a swingarm, which is linked through a suspension system to caster wheels; and it has reconfigurable drive wheel, which changes the turning radius of the device.Due to these features, SiMPl-D can traverse a wide range of terrain while remaining energy and cost efficient. SiMPl-D has been successfully used in an indoor/outdoor low-cost personal mobility device and is currently being implemented in other robotic mobility applications.Copyright