Sonja de Groot

Wheelchair propulsion technique and mechanical efficiency after 3 wk of practice

PURPOSE Differences in gross mechanical efficiency between experienced and inexperienced wheelchair users may be brought about by differences in propulsion technique. The purpose of this experiment was to study changes in propulsion technique (defined by force application, left-right symmetry, intercycle variability, and timing) and gross mechanical efficiency during a 3-wk wheelchair practice period in a group of novice able-bodied nonwheelchair users. METHODS Subjects were randomly divided over an experimental group (N = 10) and a control group (N = 10). The experimental group received a 3-wk wheelchair practice period (3.wk-1, i.e., 9 practice trials) on a computer-controlled wheelchair ergometer, whereas the control group only participated in trials 1 and 9. During all nine practice trials, propulsion technique variables and mechanical efficiency were measured. RESULTS No significant differences between the groups were found for force application, left-right symmetry, and intercycle variability. The push frequency and negative power deflection at the start of the push phase diminished significantly in the experimental group in contrast to the control group (P < 0.05). Work per cycle, push time, cycle time, and mechanical efficiency increased. CONCLUSION The practice period had a favorable effect on some technique variables and mechanical efficiency, which may indicate a positive effect of improved technique on mechanical efficiency. Although muscle activation and kinematic segment characteristics were not measured in the present study, they may also impact mechanical efficiency. No changes occurred over time in most force application parameters, left-right symmetry, and intercycle variability during the 3-wk practice period; however, these variables may change on another time scale.

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.

Changes and Determinants of Life Satisfaction After Spinal Cord Injury: A Cohort Study in The Netherlands

OBJECTIVE To determine the impact of spinal cord injury (SCI) on life satisfaction of persons with SCI 1 year after discharge of inpatient rehabilitation. DESIGN A cohort study. Life satisfaction before SCI was retrospectively measured at the start of active rehabilitation. One year after discharge from inpatient rehabilitation, current life satisfaction was measured. SETTING Eight rehabilitation centers in The Netherlands. PARTICIPANTS Persons (N=147) aged 18 to 65 and wheelchair-dependent at least for long distances. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The Life Satisfaction Questionnaire. RESULTS Mean satisfaction with life +/- SD as a whole was 5.3+/-0 before SCI and 4.3+/-1.3 one year after inpatient rehabilitation. Sexual life, self-care, and vocational situation showed the largest impact of SCI (P<.05), whereas the social relationships domains appeared to be the least affected. Decrease of life satisfaction after SCI was larger when using the retrospective ratings than when using general population scores. Significant determinants of life satisfaction after SCI were high lesion level (beta=.31, P<.05), pain (beta=.19, P<.05), and secondary impairments (beta=.22, P<.05). CONCLUSIONS Life satisfaction decreased in persons with SCI. Level of lesion and suffering secondary impairments or pain were associated with low life satisfaction 1 year after discharge from inpatient rehabilitation.

Validity of the Life Satisfaction Questions, the Life Satisfaction Questionnaire, and the Satisfaction With Life Scale in Persons With Spinal Cord Injury

OBJECTIVE To assess and compare the validity of 3 life satisfaction instruments in persons with spinal cord injury (SCI). DESIGN Cross-sectional study 5 years after discharge from inpatient rehabilitation. SETTING Eight rehabilitation centers with specialized SCI units. PARTICIPANTS Persons (N=225) with recently acquired SCI between 18 and 65 years of age were included in a cohort study. Data were available for 145 persons 5 years after discharge. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The Life Satisfaction questions (LS Questions), the Life Satisfaction Questionnaire (LiSat-9), and the Satisfaction With Life Scale (SWLS). RESULTS There were no floor or ceiling effects. Cronbach α was questionable for the LS Questions (.60), satisfactory for the LiSat-9 (.75), and good for the SWLS (.83). Concurrent validity was shown by strong and significant Spearman correlations (.59-.60) between all 3 life satisfaction instruments. Correlations with measures of mental health and participation were .52 to .56 for the LS Questions, .45 to .52 for the LiSat-9, and .41 to .48 for the SWLS. Divergent validity was shown by weak and in part nonsignificant correlations between the 3 life satisfaction measures and measures of functional independence and lesion characteristics. CONCLUSIONS Overall, the validity of all 3 life satisfaction measures was supported. Despite questionable internal consistency, the concurrent and divergent validity of the LS Questions was at least as good as the validity of the LiSat-9 and the SWLS.

SECONDARY HEALTH CONDITIONS IN PERSONS WITH SPINAL CORD INJURY: A LONGITUDINAL STUDY FROM ONE TO FIVE YEARS POST-DISCHARGE

OBJECTIVE To assess the occurrence of secondary health conditions and their potential risk factors in persons with spinal cord injury from 1 to 5 years after discharge from initial inpatient rehabilitation. DESIGN Multicentre longitudinal study. SUBJECTS A total of 139 wheelchair-dependent persons with spinal cord injury. METHODS The occurrence of secondary health conditions and their potential risk factors were assessed in a clinical interview with a rehabilitation physician at 1 and 5 years after discharge from inpatient rehabilitation and by a telephone interview 2 years after discharge. Self-report questionnaires were used for the assessment of musculoskeletal and neuropathic pain. RESULTS Neuropathic pain (83.7-92.1%), musculoskeletal pain (62.3-87.1%) and urinary tract infection (56.5-58.9%) were the most frequently reported secondary health conditions. The occurrence of several secondary health conditions was higher among women and individuals with a complete lesion, tetraplegia, and with a higher body mass index. CONCLUSION Secondary health conditions are common in the first years post-discharge following spinal cord injury, and their course seems to be relatively stable. These results emphasize the number of health issues that must be considered during post-injury care of persons with spinal cord injury living in the community, and the importance of a well-coordinated interdisciplinary approach from specialized rehabilitation centres.

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.

Return to Work After Spinal Cord Injury : Is It Related to Wheelchair Capacity at Discharge from Clinical Rehabilitation?

van Velzen JM, de Groot S, Post MWM, Slootman JR, van Bennekom CAM, van der Woude LHV: Return to work after spinal cord injury: is it related to wheelchair capacity at discharge from clinical rehabilitation? Am J Phys Med Rehabil 2009;88:47–56. Objectives:To describe the number of people with spinal cord injury who returned to work (RTW) 1 yr after discharge from inpatient rehabilitation and to investigate whether RTW can be predicted from wheelchair capacity at discharge from inpatient rehabilitation, after correction for confounders. Design:Prospective cohort study in which 118 subjects with spinal cord injury (age 18–65 yrs) of eight Dutch rehabilitation centers participated. Main outcome measure was RTW for at least 1 hr/wk. The outcome variables of wheelchair capacity were peak oxygen uptake, peak aerobic power output, and wheelchair skill scores (ability, performance time, and physical strain). Possible confounders were age, gender, lesion level, and lesion completeness. Where necessary, corrections were made for education level. Results:Thirty-three percent of the subjects RTW. Peak aerobic power output (persons with a 10-W higher peak aerobic power output were 1.37 times more likely to RTW), ability score (persons with a one-point higher ability score were 2.22 times more likely to RTW), and performance time (an increase, or worsening, of 1 sec on the performance time gave an odds ratio of 0.87, so persons with lower, or better, performance time scores were more likely to RTW) were significant predictors of RTW after correction for confounders and education level. Conclusions:RTW was successful in 33% of the subjects. Wheelchair capacity was independently related to RTW. Therefore, it is recommended to train wheelchair capacity in the context of RTW.

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.

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.