Effect of respiration on the static rear stability of wheelchairs.

OBJECTIVE: To test the hypothesis that the static rear stability of an occupied wheelchair is greater during full inspiration than expiration. DESIGN: Within-subject comparisons. SETTING: Rehabilitation center. PARTICIPANTS: Able-bodied participants (N=10). INTERVENTION: None. MAIN OUTCOME MEASURES: We measured the static rear stability (brakes unlocked) of an occupied wheelchair on a test platform according to International Organization for Standardization standards. We also used the Exhalation Threshold Test. The Exhalation Threshold Test was positive if, having been positioned at the maximum degree of platform tilt needed to maintain stability during full inspiration, the wheelchair tipped backward when the participant exhaled. RESULTS: The mean static rear stability values at full inspiration and expiration +/- SD were 16.5 degrees +/-2.3 degrees and 16.1 degrees +/-2.4 degrees , with a mean difference of .46 degrees +/-.24 degrees (3%; P=.002). The Exhalation Threshold Test was positive in 19 (95%) of 20 trials. CONCLUSIONS: Respiration has a slight but statistically significant effect on the rear stability of occupied wheelchairs, with greater stability at full inspiration. This has potential clinical implications for stability testing and the training of wheelchair skills, but further study is needed.

Ability of people with stroke to learn powered wheelchair skills: a pilot study.

OBJECTIVES: Our primary objective was to test the hypothesis that people with stroke can learn to use powered wheelchairs safely and effectively. Our secondary objective was to explore the influence of visuospatial neglect on the ability to learn powered wheelchair skills. DESIGN: Prospective, uncontrolled pilot study using within-participant comparisons. SETTING: Rehabilitation center. PARTICIPANTS: Inpatients (N=10; 6 with visuospatial neglect), all with a primary diagnosis of stroke. INTERVENTIONS: Participants received 5 wheelchair skills training sessions of up to 30 minutes each using the Wheelchair Skills Training Program (version 3.2). MAIN OUTCOME MEASURES: Powered wheelchair skills were tested before and after training using the Wheelchair Skills Test, Power Mobility version 3.2 (WST-P). RESULTS: The group's total mean WST-P scores improved from 25.5% of skills passed at baseline to 71.5% posttraining (P=.002). The participants with neglect improved their WST-P scores to the same extent as the participants without neglect, although their pretraining and posttraining scores were lower. The training and testing sessions were well tolerated by the participants, and there were no serious adverse events. CONCLUSIONS: Many people with stroke, with or without visuospatial neglect, can learn to use powered wheelchairs safely and effectively with appropriate training.

Rates and predictors of manual and powered wheelchair use for persons with stroke: a retrospective study in a Canadian rehabilitation center.

OBJECTIVES: To determine the rates of manual and powered wheelchair use at discharge for people with stroke admitted to a rehabilitation center and to determine whether any predictors of wheelchair use at discharge could be identified. DESIGN: Retrospective cohort study. SETTING: Rehabilitation center. PARTICIPANTS: Consecutive former inpatients (N=100) with a primary diagnosis of stroke, a sample of convenience. INTERVENTIONS: None. MAIN OUTCOME MEASURES: We reviewed the inpatient health records to determine the rates of wheelchair use at discharge and to record some readily available demographic and clinical data that might serve as predictors of wheelchair use. RESULTS: At discharge, 40 people (40%) were using manual wheelchairs, 1 person (1%) was using a powered wheelchair, and 59 (59%) were not using a wheelchair. Of the patients who were walkers on admission (ie, walking FIM scores of 6 or 7), none (0%) used wheelchairs at discharge. Of those with nonwalking FIM scores (1-5) on admission, 56% were using wheelchairs at discharge. Multivariate analyses revealed that the adjusted odds ratios of using a wheelchair (manual or powered) were 3.33 (95% confidence interval [CI], 1.33-8.33) for those with left-hemisphere versus right-hemisphere strokes (P=.010), .94 (CI, .91-.96) for each point rise in the total raw FIM score on admission (P<.0001), and 19.46 (CI, 6.33-59.81) if the total admission FIM score was less than 80 versus greater than or equal to 80 (P<.0001). CONCLUSIONS: On discharge from our rehabilitation center, 40% of people with stroke were using manual wheelchairs and 1% powered wheelchairs. People who were not walking on admission, those with left-hemisphere strokes, and those with lower total admission FIM scores were more likely to use a wheelchair. These findings may permit clinicians to predict wheelchair use better early in the rehabilitation process, when it can affect rehabilitation planning.

Manual wheelchair-handling skills by caregivers using new and conventional rear anti-tip devices: a randomized controlled trial.

UNLABELLED: Kirby RL, Walker R, Smith C, Best K, MacLeod DA, Thompson K. Manual wheelchair-handling skills by caregivers using new and conventional rear anti-tip devices: a randomized controlled trial. OBJECTIVE: To test the hypothesis that, in comparison with caregivers handling manual wheelchairs equipped with conventional rear anti-tip devices (C-RADs), those using a new design (Arc-RADs) perform relevant wheelchair skills better and as safely. DESIGN: Randomized controlled trial. SETTING: Rehabilitation center. PARTICIPANTS: Caregivers (n=16) and the wheelchair users (n=16) for whom they cared. INTERVENTION: Participants were trained in wheelchair-handling skills for an average of 54 minutes each. MAIN OUTCOME MEASURES: Total percentage score on a set of 20 rear anti-tip device- and caregiver-relevant skills from the Wheelchair Skills Test, version 3.2, administered a minimum of 3 days after training. RESULTS: For the C-RAD and Arc-RAD groups, the mean +/- SD Wheelchair Skills Test scores were 40%+/-0% and 98.8%+/-3.5%, respectively (P<.001). Skills that required the wheelchair to be tipped back extensively (eg, for ascending a 15cm curb) accounted for the differences between the groups. There were no adverse effects in either group. CONCLUSIONS: The Arc-RAD design allows significantly better caregiver wheelchair-handling skills than the conventional design, without compromising safety.

Sitting pressure in the tilted position: manual tilt-in-space wheelchair vs. manual wheelchair with a new rear antitip device.

To test the hypothesis that, in comparison with a heavier, larger and more expensive manual tilt-in-space wheelchair, a lightweight manual wheelchair equipped with new rear antitip devices provides comparable mean sitting pressures in the tilted position, each of eight able-bodied participants sat for 8 mins in each wheelchair, upright, and tilted back (38-39 degrees). The mean (+/-SD) sitting pressures (of all active sensors in a force-sensing array) at the eighth minute in the upright and tilted positions with the new rear antitip device wheelchair were 58.6 (+/-14.0) and 45.8 (+/-9.3) mm Hg (a 20.7% reduction) (P = 0.005). For the tilt-in-space wheelchair, the mean values were 55.7 (+/-13.9) and 47.2 (+/-10.8) mm Hg (a 26.3% reduction) (P = 0.008). There were no significant differences between the wheelchairs in the upright (P = 0.843) or tilted (P = 0.624) positions. A lightweight manual wheelchair equipped with a new rear antitip device provides equivalent reductions of sitting pressures in the tilted position to a comparably tilted tilt-in-space wheelchair.

Comparison between a tilt-in-space wheelchair and a manual wheelchair equipped with a new rear anti-tip device from the perspective of the caregiver.

OBJECTIVE: To test the hypothesis that, in comparison with a commercially available tilt-in-space wheelchair, a lightweight manual wheelchair equipped with a new, rear anti-tip device (Arc-RAD) provides caregivers with improved wheelchair-handling performance, less exertion, and greater satisfaction. DESIGN: Within-participant comparisons. SETTING: Rehabilitation center. PARTICIPANTS: Able-bodied participants (n=19) simulating caregivers and simulating wheelchair users (n=7). INTERVENTION: Caregiver participants were trained (50-75 min) in wheelchair-handling skills. MAIN OUTCOME MEASURES: Each participant was tested in both wheelchairs, in random order. To evaluate wheelchair-handling skills, we used the total percentage score on the Wheelchair Skills Test (WST), version 3.2. For exertion, we used a visual analog scale (in percent). For satisfaction, we used the Quebec Users' Evaluation of Satisfaction with assistive Technology (QUEST; range of values, 8-40), version 2. RESULTS: Mean percentage WST scores +/- SD for the Arc-RAD and tilt-in-space wheelchairs were 95.9%+/-4.2%, and 91.9%+/-4.8%, respectively (P=.008). The mean perceived exertions during Arc-RAD and tilt-in-space wheelchair use were 26.1%+/-20.4% and 46.6%+/-23.2% (P=.003). The mean total QUEST satisfaction scores for the Arc-RAD and tilt-in-space wheelchairs were 35.1+/-3.8 and 28.4+/-4.7 (P=.002). CONCLUSIONS: In comparison with the larger and heavier tilt-in-space wheelchair, a lightweight manual wheelchair equipped with a new rear anti-tip design allows 4.4% better wheelchair-handling performance, 44% less exertion, and 23.6% greater wheelchair satisfaction.

Comparing performance of manual wheelchair skills using new and conventional rear anti-tip devices: randomized controlled trial.

OBJECTIVE: To test the hypotheses that, compared with participants using manual wheelchairs equipped with conventional rear anti-tip devices (C-RADs), those using a new RAD design that deploys through an arc (Arc-RAD) perform RAD-relevant wheelchair skills better and as safely. DESIGN: A randomized controlled study. SETTING: A rehabilitation center. PARTICIPANTS: Participants (N=30) including 16 able-bodied and 14 wheelchair users. INTERVENTION: Participants were provided with wheelchair skills training (up to 2.4h). MAIN OUTCOME MEASURES: Total percentage score on a set of 23 RAD-relevant skills of the Wheelchair Skills Test (WST, version 3.2) administered a minimum of 3 days after training. RESULTS: For the C-RAD and Arc-RAD groups, the mean +/- standard deviation RAD-relevant WST scores were 32.3%+/-8.5% and 85.1%+/-18.9% (Kruskal-Wallis, P<.001). Of the 23 RAD-relevant individual skills, the success rates for the Arc-RAD group were at least 20% higher (the criterion we set for clinical significance) in 17 (74%). For the C-RAD group, the success rate was 0% for the 12 wheelie-dependent skills, the 13-cm-high obstacle, and the 15-cm level change ascent. There were no serious adverse effects in either group. CONCLUSIONS: The new RAD design allows much better performance on relevant wheelchair skills than the conventional design without compromising safety.

Effect of a shock-absorbing pylon on transmission of heel strike forces during the gait of people with unilateral trans-tibial amputations: a pilot study.

The primary objective was to test the hypothesis that walking with a shock-absorbing pylon (SAP) decreases the peak magnitude and frequency content of the heel-strike-initiated shock wave transmitted to the stump. The secondary hypotheses were that walking with a SAP decreases the heel-strike transient force between the ground and the foot and increases function as measured by walking velocity and subjective assessments. Seven people with unilateral trans-tibial amputations walked at self-selected speeds without and with a SAP. As the primary outcome measure, accelerometers were used mounted proximally and distally along the prosthetic pylon to measure the transmitted shock wave. Secondary measures included ground reaction forces from a force plate, a ten-minute walking test to determine walking speed and a questionnaire to evaluate gait function and subjective preference. The SAP provided no significant shock absorption as indicated by either the mean peak proximal accelerations of 3.19 g and 2.82 g (p = 0.28) without and with the SAP respectively or the mean difference between the peak proximal and distal accelerometers, 0.16 g and 0.19 g (p = 0.58). No significant change in the frequency content was found. Variances were high. There were no significant differences noted in the secondary measures. Although this study failed to identify any statistically significant effects due to the SAP, the magnitude and variance of the data will permit an accurate estimation of the appropriate sample size for future studies required to determine the efficacy of SAPs.

The effect of rolling resistance on stationary wheelchair wheelies.

OBJECTIVE: To test the hypotheses that increased rolling resistance (RR) reduces rear-wheel displacement and perceived difficulty during the takeoff and balance phases of stationary wheelchair wheelies. DESIGN: We carried out within-subject comparisons of 20 participants as they each performed, in random order, two 30-sec stationary wheelies in three RR settings (tile, 5-cm-thick foam, and 12.5-cm-high blocks in front of and behind the rear wheels). The main outcome measures were rear-wheel displacement (in centimeters for the takeoff phase and centimeters per second for the balance phase) from a spring-loaded potentiometer and Likert scales of perceived difficulty. RESULTS: For rear-wheel displacement, all six of the pairwise comparisons (three terrains x two phases (takeoff and balance)) showed a significant statistical difference (P < 0.002). In each of the six pairwise comparisons, displacement was less for the higher of the two RR conditions. For perceived difficulty, during the balance phase, participants perceived tile to be significantly more difficult than either foam (P = 0.0067) or blocks (P = 0.0002). The other pairwise comparisons were not statistically significant. CONCLUSION: In conditions of increased RR, rear-wheel displacement and perceived difficulty are reduced during stationary wheelchair wheelies. These findings have implications for teaching wheelchair users to perform wheelies, a foundation of many advanced wheelchair skills.

Wheeling à petit pas: Parkinsonism detected by observation of wheelchair propulsion.

We present a man with parkinsonism detected by the observation of wheelchair propulsion. His manual wheelchair propulsion technique was observed to include rapid, brief, low-power strokes resembling the marche à petit pas (walking with tiny steps) phenomenon of parkinsonism. We videotaped his wheelchair propulsion and compared him with ten age-, gender-, and diagnosis-matched controls. The patient had a propulsion velocity of 0.14 m/sec compared with a mean (+/- standard deviation) of 0.73 (+/- 0.16) m/sec for the controls, a cadence of 209 strokes/min vs. 60 (+/- 12) strokes/min for the controls, and a mechanical efficiency of 0.04 m/stroke compared with 0.75 (+/- 0.25) m/stroke for the controls. This observation shifted the course of his medical investigations and management as well as his rehabilitation care. This is the first detailed report of how parkinsonian features may affect manual wheelchair propulsion. It suggests that observation of wheelchair mobility should be a routine component of the physical examination of wheelchair users.

Comparison between performance with a pushrim-activated power-assisted wheelchair and a manual wheelchair on the Wheelchair Skills Test.

PURPOSE: To test the hypothesis that people using a pushrim-activated power-assisted wheelchair (PAPAW) can accomplish a wider range of wheelchair skills than when using a manual wheelchair (MWC). METHODS: We studied 30 able-bodied participants, using within-participant comparisons. Participants used a manual wheelchair equipped with both PAPAW and regular MWC rear wheels, and rear anti-tip devices (Arc-RADs) that permitted wheelie-like function. We trained participants to perform the wheelchair skills of the Wheelchair Skills Training Program (WSTP, Version 2.4). From the Wheelchair Skills Test (WST, Version 2.4), we calculated pass-fail success rates for the 50 individual skills and a total percentage WST score. RESULTS: The mean (+/-SD) total WST scores were 89.3 (+/-7.0)% for the PAPAW and 88.8 (+/-8.4)% for the MWC, with a mean difference of 0.6 (+/-5.6)% (p = 0.59). Qualitative observations suggested that skills requiring a higher force on the pushrim (e.g., incline ascent) were performed more easily with the PAPAW, whereas skills requiring greater control of the wheelchair (e.g., wheelie-dependent skills) were performed more easily with the MWC. CONCLUSION: Overall wheelchair skill performance with the PAPAW is not superior to that when using the MWC. The PAPAW may be helpful for specific skills that require more wheel torque, but the additional torque appears to be disadvantageous when performing skills that require greater control.

The manual wheelchair wheelie: a review of our current understanding of an important motor skill.

PURPOSE: To review the current understanding of the manual wheelchair wheelie. METHOD: Review of the literature. RESULTS: A rear wheelchair wheelie occurs when the front wheels, ordinarily in contact with the support surface, are intentionally caused, by means of a transient or sustainable rear pitch, to lift from the surface while the rear wheels remain on the surface. Pitch control (partial or full) is the foundation of many wheelchair skills (e.g., negotiating thresholds, potholes, curbs, steep inclines and gravel). Yet, most wheelchair users never learn to perform this valuable skill. Wheelie capability is affected by the characteristics of the clinician, the wheelchair user, the wheelchair and the environment. Although our understanding of wheelie biomechanics and training methods is evolving, much remains to be learned. Three recent wheelchair developments have wheelie-related implications: a new type of rear anti-tip device (Arc-RAD) that permits wheelie-like function, pushrim-activated power-assisted wheelchairs (PAPAWs) that make wheelie-dependent skills more dangerous and difficult, and a powered wheelchair that has robotic wheelie capabilities (the IBOT). CONCLUSIONS: Improvements in our understanding of the nature of wheelies, formalization of training protocols and innovations in wheelchair design hold promise for improved activities and participation by wheelchair users.

Wheelchair skills training for community-based manual wheelchair users: a randomized controlled trial.

OBJECTIVE: To test the hypotheses that wheelchair skills training of community-based manual wheelchair users is efficacious, safe, and practical. DESIGN: Randomized controlled trial. SETTING: Rehabilitation center and community. PARTICIPANTS: Twenty community-based manual wheelchair users (15 men, 5 women; age range, 21-77 y), half with musculoskeletal and half with neurologic disorders. INTERVENTION: Participants were randomly allocated to the Wheelchair Skills Training Program (WSTP) or control groups. In 1-hour individualized sessions, the WSTP group participants received a mean +/- standard deviation of 4.5+/-0.7 hours of training. Caregivers participated whenever possible. In addition to training at the rehabilitation center, the trainer traveled to administer training in the community. MAIN OUTCOME MEASURES: Using the Wheelchair Skills Test (WST, version 3.1), an objective test of 57 skills, we calculated total and subtotal percentage scores (percentage number of skills passed of those possible) and individual skill success rates. RESULTS: The WSTP group's improvement in total WST score was significantly greater than the control group's (P<.005). The mean total WST score for the WSTP group increased from a pretraining value of 63.3%+/-6.0% to 78.5%+/-8.3% posttraining, a relative improvement of 24.0% (P=.002). The control group increased from a baseline value of 70.8%+/-14.0% to 74.2%+/-11.8% at follow-up, a relative improvement of 4.8% (P=.03). The WSTP group had clinically significant pre- and posttraining improvements (> or = 20%) in the success rates of 25 of the 57 individual WST skills, compared with only 5 skills for the control group. There were no adverse incidents, and the WSTP participants' comments were all positive. CONCLUSIONS: Wheelchair skills training of community-based manual wheelchair users is efficacious, safe, and practical. These findings have implications for the standard of rehabilitation care.

Wheelchair-skill performance: controlled comparison between people with hemiplegia and able-bodied people simulating hemiplegia.

OBJECTIVE: To test the hypothesis that able-bodied people simulating hemiplegia (using the hemiplegic-propulsion pattern [1 arm and 1 leg]) have as much difficulty performing wheelchair skills as people with hemiplegia. DESIGN: Single-blind, controlled comparison of 2 groups. SETTING: Kinesiologic laboratory in a rehabilitation center. PARTICIPANTS: Twenty wheelchair users with hemiplegia (HP group) (median age, 68y; 80% men) and 20 able-bodied participants (AB group) (median age, 67y; 75% men). INTERVENTIONS: The participants in the AB group simulated hemiplegia and received a brief period of wheelchair skills training. Participants in both groups were asked to attempt the 50 skills of the Wheelchair Skills Test, version 2.4 (WST 2.4). MAIN OUTCOME MEASURES: Total and subtotal percentage scores on the WST 2.4 and success rates for the 50 individual skills. RESULTS: The mean percentage WST scores for the AB group were significantly greater than those for the HP group for the total WST scores ( P <.001), the indoor skill level ( P <.001), and the community skill level ( P <.001), but the advanced skill level scores were 0% for both groups. On the individual skills, the AB group had success rates at least 25% higher than the HP group for 13 (26%) of the skills. Both groups were generally successful (>/=75% success rate) on 21 skills (42%). Both groups experienced difficulties (

The manual wheelchair-handling skills of caregivers and the effect of training.

OBJECTIVE: To test the hypothesis that the Wheelchair Skills Training Program (WSTP) is effective in improving the wheelchair-handling skills of untrained caregivers. DESIGN: Within-participant comparisons. SETTING: Rehabilitation center and community. PARTICIPANTS: Twenty-four caregivers of manual wheelchair users. INTERVENTIONS: Caregiver participants underwent the WSTP, version 2.4, adapted for caregivers. Training was individualized on the basis of an integrated testing-and-training protocol that took place on a single occasion (total, approximately 50 min). MAIN OUTCOME MEASURES: Total percentage scores on the objective Wheelchair Skills Test (WST), version 2.4, for the pretraining (N=24), posttraining (N=24), and retention (n=9) evaluations. For the skill-transfer evaluation (n=10), we used the questionnaire version (WST-Q), administered by telephone to participants after return to their communities. RESULTS: There were no serious adverse incidents. The mean pretraining total WST score +/- standard deviation was 77.8%+/-12.0%. Posttraining, this increased to 94.7%+/-7.1% (P <.001), a 22% relative increase. At retention testing, a median latency of 7 days later, the mean value, 94.2%+/-7.1%, did not decrease significantly from the posttraining level (P =.38). At skill-transfer testing, a median latency of 179 days posttraining, the mean value, 92.5%+/-8.7%, did not decrease significantly from the posttraining level (P =.73). The greatest improvements were at the advanced skill level. CONCLUSIONS: The WSTP is a safe, practical, and effective method of improving the wheelchair-handling skills of untrained caregivers. Skill improvements are generally well retained and transfer well to the community. Such training could play an important role in the rehabilitation process.

Wheelchair skills training program for clinicians: a randomized controlled trial with occupational therapy students.

OBJECTIVE: To test the hypothesis that a brief formalized period of wheelchair skills training, added to the standard curriculum, results in significantly greater overall improvements in wheelchair skills than a standard undergraduate occupational therapy (OT) curriculum alone. SETTING: Rehabilitation center. DESIGN: Randomized controlled trial. PARTICIPANTS: Eighty-two students in a university undergraduate OT program. INTERVENTIONS: All students received the standard university curriculum. The 22 second-year students, randomly allocated to the Wheelchair Skills Training Program (WSTP) group, were also trained (on a single occasion each, in groups of 1-3 at a time) on the 50 skills that make up the WSTP. The mean +/- standard deviation (SD) training time was 121.2+/-33.5 minutes per group. MAIN OUTCOME MEASURE: Total percentage score on the Wheelchair Skills Test (WST), Version 2.4. RESULTS: From before to after intervention, second-year students in the WSTP group increased their mean percentage WST scores +/- SD from 64.8%+/-9.0% to 81.0%+/-5.2%, a 25% improvement (P<.001). Over a comparable period, the 18 students in the second-year control group increased from 66.0%+/-8.0% to 72.4%+/-7.1%, a 9.7% improvement (P=.015). The WSTP group improved to a significantly greater extent (P=.005). For a subset of 8 students in the WSTP group who were retested 9 to 12 months later, the mean WST score was 79.7%+/-4.1%, not significantly less than their WST 2 scores (P=.29). The mean WST score for the 42 students in the fourth-year control group was 73.9%+/-4.1%, significantly lower than the mean postintervention WST score of the second-year students in the WSTP group (P< .0001) and not different from the second-year control group (P=.58). CONCLUSIONS: The WSTP is an effective way to improve the wheelchair-skills performance of OT students. This has implications for the education of all rehabilitation clinicians.

Learning to perform wheelchair wheelies: comparison of 2 training strategies.

OBJECTIVE: To test the hypotheses that, during wheelie training, adding the proactive balance strategy (PBS) to the conventional reactive balance strategy (RBS) increases the success rate, decreases training time, and lessens postural sway during the wheelie. DESIGN: Randomized controlled trial. SETTING: Kinesiologic laboratory in a rehabilitation center. PARTICIPANTS: Twenty-two participants (12 wheelchair users, 10 able-bodied) randomly assigned to the RBS group or to the PBS+RBS group; the groups were balanced according to gender, age, and diagnostic category. INTERVENTION: Participants were trained to perform stationary wheelies in 2 highly structured settings. MAIN OUTCOME MEASURES: Success rate in achieving wheelie competence, training time, and postural sway on a force platform. RESULTS: Success rate was 100% for both groups. The RBS group required a mean +/- standard deviation of 43+/-31 minutes of training time and the PBS+RBS group required 45+/-28 minutes (P=.54). There was no significant difference between training groups with respect to postural sway measures (P=.50). Age correlated with both training time (r=.70, P=.001) and postural sway (r=.52, P=.03). Qualitatively, we identified 3 take-off patterns and confirmed the use of the 2 balance patterns. CONCLUSIONS: The addition of the PBS to RBS training did not improve wheelie success rate, training time, or postural sway. Although older wheelchair users require more training time, many such users can learn this useful skill if given the opportunity.

The wheelchair skills test (version 2.4): measurement properties.

OBJECTIVE: To evaluate the measurement properties of the Wheelchair Skills Test (WST), version 2.4. DESIGN: Cohort study. SETTING: Rehabilitation center. PARTICIPANTS: A total of 298 subjects (169 wheelchair users, 129 able-bodied subjects) ranging in age from 17 to 88 years. INTERVENTION: We videotaped subjects as they attempted the 50 skills of the WST 2.4. MAIN OUTCOME MEASURES: The test-retest, intrarater, and interrater reliabilities were determined on a subset of 20 wheelchair users. We assessed construct validity by evaluating whether the WST detected expected changes and concurrent validity by seeing how well total WST scores correlated with criterion measures. RESULTS: The mean time +/- standard deviation taken to administer the WST was 27.0+/-9.3 minutes. There were no serious adverse incidents, and the test was well tolerated. For the test-retest, intrarater and interrater reliabilities, the intraclass correlation coefficients for the total scores were.904,.959, and.968. For individual skills, the percentage concordance ranged from 73% to 100%. Regarding construct validity, there was a slightly negative Pearson correlation between total WST score and age (-.434). Gender was identified as a significant factor on multiple regression analysis (P<.001). Wheelchair users with more than 21 days of experience scored higher than those with less experience (65.0% vs 59.6%; P=.01). Participants with stroke and related disorders had a mean score (55.0%+/-13.9%) that was significantly lower than those in other diagnostic categories (P<.05). Participants using conventional wheelchairs had lower scores than those in lightweight ones (66.4% vs 75.1%; P<.001). Regarding concurrent validity, Spearman rank correlations between total WST scores and the global assessments of the wheelchair users' therapists and admission and discharge FIM instrument scores were.394,.38, and.31. CONCLUSIONS: The WST 2.4 is practical and safe, and its measurement properties are very good to excellent. Further study is needed to determine its usefulness in various clinical settings.

Wheelchair skills training program: A randomized clinical trial of wheelchair users undergoing initial rehabilitation.

OBJECTIVE: To test the hypothesis that a brief, formalized period of additional wheelchair skills training is safe and results in significantly greater improvements in wheelchair skills performance than a standard rehabilitation program. DESIGN: Randomized controlled trial. SETTING: Rehabilitation center. PARTICIPANTS: Thirty-five wheelchair users (20 with musculoskeletal disorders, 15 with neurologic disorders) admitted for initial rehabilitation. Subjects' mean age +/- standard deviation (SD) was 59+/-18.3 years. INTERVENTION: Subjects randomly allocated to the treatment group participated in the Wheelchair Skills Training Program (WSTP), averaging 4.5+/-1.5 training sessions, each 30 minutes long. Subjects in the control group did not receive any wheelchair skills training beyond that given in a typical rehabilitation stay. MAIN OUTCOME MEASURES: Wheelchair Skills Test (WST), version 2.4, before and after training. Changes in total percentage WST score and individual skill scores were examined. RESULTS: There were no adverse incidents. The control group's mean percentage score +/- SD increased from 60.1%+/-14.4% to 64.9%+/-13.3%, an 8% improvement of the posttest relative to the pretest (P=.01). The WSTP group's mean score increased from 64.9%+/-9.4% to 80.9%+/-5.6%, a 25% improvement of the posttest relative to the pretest (P<.000). The WSTP group showed significantly greater improvements than the control group (P<.000). Among the specific skills, significantly greater improvements were seen in the WSTP group for the gravel and high-curb descent skills (P<.001). CONCLUSIONS: The WSTP is safe and practical and has a clinically significant effect on the independent wheeled mobility of new wheelchair users. These findings have implications for the standards of care in rehabilitation programs.

Neck discomfort of wheelchair users: effect of neck position.

PURPOSE: To test the hypothesis that wheelchair users experience more discomfort when holding their necks in extended and/or rotated positions than when in their self-selected most comfortable positions (MCPs). METHODS: We studied 20 wheelchair users, first determining their MCPs with the eyes closed. Then, subjects assumed and maintained (for 5 min each) four neck positions in random order: level (L) and elevated (E), both straight ahead of the subject (S) and with the neck rotated (R). We measured neck extension angles (from digital photographs) and neck discomfort (using visual analogue scales [VAS], in %). RESULTS: The mean neck-extension angles were MCP - 2.6 degrees, LS 9.5 degrees, LR 8.1 degrees, ES 23.9 degrees and ER 25.4 degrees (ANOVA p < 0.0001). The mean VAS neck discomfort scores were LS 5.7%, LR 17.4%, ES 24.0% and ER 34.1% (ANOVA p < 0.0001). CONCLUSIONS: Sustained extension and rotation of the neck, alone or in combination, increase the neck discomfort of wheelchair users. The MCP for most wheelchair users is straight ahead with the neck slightly flexed, about 11 degrees and 27 degrees more flexed, respectively, than when looking at an average-height sitting or standing person. These findings have implications for wheelchair design, the behaviour of clinicians and wheelchair users, and the built environment.