Powered wheelchair skills training for persons with stroke: a randomized controlled trial.

OBJECTIVE: The aims of this study were to test the hypothesis that people with stroke who receive formal powered wheelchair skills training improve their wheelchair skills to a significantly greater extent than participants in a control group who do not and to explore the influence of spatial neglect. DESIGN: Seventeen participants with stroke (including nine with spatial neglect) were randomly allocated to intervention (n = 9) or control (n = 8) groups. Those in the intervention group received up to five 30-min training sessions based on the Wheelchair Skills Training Program 4.1. The powered Wheelchair Skills Test version 4.1 was administered at baseline (T1) and after training (T2). RESULTS: A rank order analysis of covariance on the T2 Wheelchair Skills Test score, having adjusted for the T1 score, showed a significant effect caused by group (P = 0.0001). A secondary analysis showed no significant effect caused by spatial neglect (P = 0.923). CONCLUSIONS: People with stroke who receive formal powered wheelchair skills training improve their powered wheelchair skills to a significantly greater extent (30%) than participants who do not (0%). The extent of change was not affected by the presence of spatial neglect. These findings have significance for the wheelchair provision process and the rehabilitation of people with stroke.

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.

Are wheelchair-skills assessment and training relevant for long-standing wheelchair users? Two case reports.

PURPOSE: We present two case reports that shed light on the question of whether routine periodic wheelchair-skills assessment and training are relevant for long-standing wheelchair users. CASE 1: A 60-year-old man with a 15-year history of T12 complete paraplegia sustained an intertrochanteric fracture of his femur due to a tip-over accident that occurred 2 days after a follow-up clinic visit at which no limitations in wheelchair-skill performance were identified. If a procedure had been in place to identify and correct his wheelchair-skill deficiencies, this injury might have been prevented. CASE 2: A 34-year-old woman with spina bifida, whose wheelchair use had gradually increased, came to our attention during the provision of a new wheelchair. She was able to significantly improve her wheelchair abilities through training. The newly learned skills enhanced her community participation. CONCLUSIONS: These cases suggest that, even in long-standing wheelchair users, wheelchair skills should be routinely assessed as part of the periodic functional assessment and, when the skill level is determined to be less than appropriate for that person, formal training should be offered.

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.

The wheelchair skills test, version 2.4: Validity of an algorithm-based questionnaire version.

OBJECTIVE: To test the hypothesis that an algorithm-based questionnaire version of the Wheelchair Skills Test (WST) would provide a valid assessment of manual wheelchair skills. DESIGN: Within-participant comparisons. SETTING: Rehabilitation center in Nova Scotia, Canada. PARTICIPANTS: Twenty wheelchair users, 11 with musculoskeletal and 9 with neurologic disorders, with a wide range of wheelchair experience (1wk-20y). INTERVENTION: Each participant completed the questionnaire (WST-Q) and then the objective skills testing (WST, version 2.4). MAIN OUTCOME MEASURE: The WST-Q consisted of 3 components, reported as separate versions: the knowledge version (WST-Q [K]) (structured oral questions only); the visual-aid version (WST-Q [VA]) (visual aids added for 6 of the skills); and the categorical perceived-ability version (WST-Q [PA]). RESULTS: The mean total percentage scores for the WST-Q (K), WST-Q (VA), WST-Q (PA), and WST were 60.5%, 62.2%, 64.0%, and 59.8%, respectively. Only the WST-Q (PA) differed significantly from the WST (P<.05). Positive correlations existed between the objective WST and the WST-Q (K) (r=.91), WST-Q (VA) (r=.91), and WST-Q (PA) (r=.83). The percentage agreement on the individual skill scores ranged from 55% to 100%. CONCLUSIONS: The algorithm-based WST-Q has excellent concurrent validity in comparison with objective testing, when assessing the overall manual wheelchair skill levels of wheelchair users with a wide range of experience. It may be useful as a screening tool or when objective testing is impractical.