Energy cost of propulsion in standard and ultralight wheelchairs in people with spinal cord injuries.

BACKGROUND AND PURPOSE: Wheelchair- and subject-related factors influence the efficiency of wheelchair propulsion. The purpose of this study was to compare wheelchair propulsion in ultralight and standard wheelchairs in people with different levels of spinal cord injury. SUBJECTS: Seventy-four subjects (mean age=26.2 years, SD=7.14, range=17-50) with spinal cord injury resulting in motor loss (30 with tetraplegia and 44 with paraplegia) were studied. METHOD: Each subject propelled standard and ultralight wheelchairs around an outdoor track at self-selected speeds, while data were collected at 4 predetermined intervals. Speed, distance traveled, and oxygen cost (VO2 mL/kg/m) were compared by wheelchair, group, and over time, using a Bonferroni correction. RESULTS: In the ultralight wheelchair, speed and distance traveled were greater for both subjects with paraplegia and subjects with tetraplegia, whereas VO2 was less only for subjects with paraplegia. Subjects with paraplegia propelled faster and farther than did subjects with tetraplegia. CONCLUSION AND DISCUSSION: The ultralight wheelchair improved the efficiency of propulsion in the tested subjects. Subjects with tetraplegia, especially at the C6 level, are limited in their ability to propel a wheelchair.

Prosthetic use in elderly patients with dysvascular above-knee and through-knee amputations.

Fifty-five patients with vascular insufficiency resulting in above-knee (AK) and through-knee (TK) amputations were studied to determine factors related to prosthetic candidacy and functional outcome. Chart review showed that the only difference between patients who were fitted with prostheses and those who were not fitted with prostheses was their respective number of medical complications. Twenty-three of 31 patients with prostheses were evaluated 7 to 35 months after receiving the prostheses. Ten (44%) of these patients wore their prostheses all day every day and used wheelchairs minimally or not at all. Over half of the patients evaluated used their wheelchairs most of the time. Two (9%) of the 23 patients had stopped wearing their prostheses. Patients who demonstrated increased walking distances and velocities at follow-up used their prostheses more and their wheelchairs less than did the other patients. Neither gait factors nor hip range of motion at discharge was predictive of continued prosthetic use. Functional outcome and prosthetic use were limited in this group of elderly patients with dysvascular AK and TK amputations. The results of this study may serve as a basis for clinical determination of prosthetic candidacy and functional goals.

Ambulation, activity level, and pain. Outcomes of a program for spinal pain.

The purpose of this study was to investigate changes in ambulation distance, activity level, medical care sought, and perceived pain in 49 patients with chronic spinal pain who completed an inpatient rehabilitation program. Therapy included patient education, reduction in pain medications, increased quotas for activity and ambulation, and reinforcement of nonpain behaviors. Change was measured by a 12-minute walk, an activity check list, and pain and activity self-ratings. Tests were administered at admission and discharge and at one, three, and six months after discharge. Patients improved significantly in walking distance, frequency of both exercises and physical conditioning activities performed, and pain self-rating. Medical care sought decreased. Activity self-rating on a 10-point scale was unchanged. This program had a positive effect on a number of factors and warrants consideration for patients with chronic spinal pain.