Rosemarie Cooper

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.

RESNA Position on the Application of Tilt, Recline, and Elevating Legrests for Wheelchairs

ABSTRACT This document, approved by the Rehabilitation Engineering & Assistive Technology Society of North America (RESNA) Board of Directors on April 23, 2008, describes typical clinical applications and provides evidence from the literature supporting the application of tilt, recline, and elevating legrests for wheelchairs.

Investigating Neck pain in Wheelchair users

Boninger ML, Cooper RA, Fitzgerald SG, Lin J, Cooper R, Dicianno B, Liu B: Investigating neck pain in wheelchair users. Am J Phys Med Rehabil 2003;82:197–202. Objective Despite the fact that wheelchair users are exposed to risk factors for neck and upper back pain (NP), little is known about the impact and possible diagnoses associated with NP. The purpose of this study was to examine the significance of NP in wheelchair users and to determine if a portion of the NP may be myofascial in origin. Design Cross-sectional cohort study using questionnaires and physical exams to evaluate NP in a convenience sample of wheelchair users from the National Veteran’s Wheelchair Games. Main outcome measures included reported NP, visual analog scale of neck complaints, Neck Disability Index, and physical examination findings of trigger points. Results Sixty-six percent of subjects reported NP since becoming a wheelchair user and, 60% reported pain during the past month. Neither age nor length of time in a wheelchair was significantly different between those subjects who did and those subjects who did not report pain. Of those respondents who reported NP, 60% visited the doctor about the pain and 40% limited their daily activities due to the pain. Trigger-point palpation reproduced pain in 54% of those respondents who experienced pain in the past month (n = 34). Conclusion This study provides a first step in defining the prevalence and significance of NP among wheelchair users. Clinicians who work with this population need to ask subjects about symptoms and consider a myofascial origin for that pain when considering treatment.

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.

Trends and Issues in Wheelchair Technologies

There is an overwhelming need for wheelchairs and the research and development required to make them safer, more effective, and widely available. The following areas are of particular importance: practitioner credentials, accreditation, device evaluation, device user training, patient education, clinical prescribing criteria, national contracts, and access to new technology. There are over 170 U.S. wheelchair manufacturers with a total reported income of

Telerehabilitation: Expanding access to rehabilitation expertise

1.33 billion. However, of these companies, only five had sales in excess of

Tips and Falls During Electric-Powered Wheelchair Driving: Effects of Seatbelt Use, Legrests, and Driving Speed

100 million. Wheelchairs account for about 1% of Medicare spending. Use of assistive technology is an increasingly common way of adapting to a disability. The emergence of advanced mobility devices shows promise for the contribution of engineering to the amelioration of mobility impairments for millions of people who have disabilities or who are elderly. Some of the trends in wheelchairs are going to require new service delivery mechanisms, changes to public policy, and certainly greater coordination between consumers, policy makers, manufacturers, researchers, and service providers.