Wheelchair Axle Position Effect on the Propulsion Performance of Persons With C7 Tetraplegia: A Repeated-Measures Study.

Objectives: To assess the changes in speed, stroke frequency, acceleration, and shoulder range of motion (ROM) associated with different wheelchair axle positions in people with chronic C7 tetraplegia. Methods: This repeated-measures study was conducted at the Chronic Spinal Cord Injury Unit, FLENI Escobar, Argentina. The speed, stroke frequency, acceleration, and shoulder ROM during wheelchair propulsion were measured in nine participants with C7 spinal cord injury (SCI) in four different axle positions (forward and up, forward and down, backward and down, backward and up). Two strokes performed at maximum speed were analyzed on a smooth level vinyl floor in a motion analysis laboratory. Data were analyzed for significant statistical differences using the Friedman test and the Wilcoxon signed rank test. Results: Our study showed significant differences in the speed with axle position 1 (1.57 m/s) versus 2 (1.55 m/s) and position 2 (1.55 m/s) versus 4 (1.52 m/s). The shoulder ROM showed a significant difference in the sagittal plane in position 2 (59.34 degrees) versus 3 (61.64 degrees), whereas the stroke frequency and the acceleration parameters showed no statistically significant differences with the different rear axle positions. Conclusions: Our study showed that modifying the rear axle position can improve the propulsion speed and produce changes in the shoulder ROM in the wheelchair propulsion of individuals with C7 SCI.

[Participation in the community after the rehabilitation: multi-center study in Argentina] / Participación en la comunidad en personas con patologías neurológicas luego de la rehabilitación: estudio multicéntrico en Argentina

Introduction: Introduction: Participation is the dynamic and complex interaction between the individual's health condition, bodily functions, activities that can be carried out and environmental factors. Measuring it helps to understand the impact of disability. Objectives: Describe the activities and participation in subjects with neurological pathologies, discharged from hospitalization for rehabilitation. Secondly, to compare the clinical-demographic characteristics and the participation among wheelchair users with respect to non-users. Material and method: Observational, prospective, cross-sectional, multicenter study. Based on a survey of people over 18 years of age with pathologies of neurological origin discharged from rehabilitation from 6 centers in Argentina. Results: 282 people responded, 69% men with an average age of 50 years and discharged 22 months ago. The most common diagnosis was cerebrovascular accident. The self-perception of participation was 49 out of 90, and those who do not use a wheelchair report a higher level of participation. The greatest satisfaction was in areas of interpersonal relationships. 50% require assistance to use transportation in the community. 61% neither work nor study, nor do they engage in sports activities (65%). 61% of wheelchair users cannot go to places in the community because they are inaccessible. Conclusion: Less participation in community activities was observed, mainly due to architectural barriers and difficulties in using transport in wheelchair users. The family occupies a central place so that they can integrate into the community.

Introducción: La participación es la interacción dinámica y compleja entre la condición de salud del individuo, las funciones corporales, las actividades que puede realizar y los factores ambientales. Medirla ayuda a comprender el impacto de la discapacidad. Objetivos: Describir las actividades y participación en sujetos con patologías neurológicas, dados de alta de internación para rehabilitación. Secundariamente comparar las características clínico-demográficas y la participación entre usuarios de silla de ruedas respecto a personas no usuarias. Material y método: Estudio observacional, prospectivo, transversal, multicéntrico. Basado en una encuesta a mayores de 18 años con patologías de origen neurológico dados de alta de rehabilitacion de 6 centros de Argentina. Resultados: Respondieron 282 personas, 69% hombres con una media de edad de 50 años y dados de alta hace 22 meses. El diagnóstico más frecuente fue el accidente cerebrovascular. La autopercepción de la participación fue de 49 sobre 90, y los que no utilizan silla de ruedas refieren mayor nivel de participación. La mayor satisfacción fue en áreas de relaciones interpersonales. El 50% requiere de asistencia para utilizar los transportes en la comunidad. El 61% no trabaja ni estudia, así como tampoco realizan actividades deportivas (65%). Al 61% de los usuarios de silla de ruedas no pueden ir a lugares de la comunidad por ser inaccesibles. Conclusión: Se observó menor participación en actividades comunitarias, principalmente por barreras arquitectónicas y por dificultades para usar el transporte en usuarios de silla de ruedas. La familia ocupa un lugar central para que puedan integrarse en la comunidad.

Berg Balance Scale: inter-rater and intra-rater reliability of the Spanish version with incomplete spinal cord injured subjects.

STUDY DESIGN: Cross sectional. OBJECTIVES: To determine the inter-rater and intra-rater reliability of the Spanish version of the Berg Balance Scale with incomplete spinal cord injured subjects. SETTING: CINER Rehabilitation Center. METHODS: We administered and video recorded the Spanish version of the Berg Balance Scale to 20 incomplete SCI patients. Two raters scored the videos on two different occasions at least three weeks apart. We used intraclass correlation coefficient (ICC) and a confidence interval (CI) of 95% to evaluate the inter-rater and intra-rater (test-retest) reliability of the BBS total scores. RESULTS: ICC values for inter-rater reliability at first and second observation were 0.99 (95% CI 0.97-1.00) and 0.99 (95% CI 0.99-1.00), respectively. Intra-rater ICC for rater 1 was 1.00 (95% CI 1.00-1.00) and for rater 2 was 1.00 (95% CI 0.99-1.00). All of them were excellent. CONCLUSIONS: The results indicate that the Spanish version of the Berg Balance Scale is a reliable tool to evaluate spinal cord injured patients' balance.

Reliability of the Spanish version of the wheelchair skills test 4.2 for manual wheelchair users with spinal cord injury.

Study design: Cross-sectional.Objectives: The majority of people with a spinal cord injury (SCI) are dependent on wheelchair for their mobility. Approximately, 36% of wheelchair users reported that obstacles such as curbs, uneven terrain, flooring surfaces and thresholds were barriers to mobility. Several studies have shown that assessment and training of wheelchair skills leads to improvements in those skills. The purpose of our study was to translate the Wheelchair Skill Test (4.2) and its report form into Spanish and then determine the inter-rater reliability of the WST 4.2 for manual wheelchairs operated by their users.Setting: Rehabilitation Unit, FLENI Institute, Buenos Aires, Argentina.Methods: The translation was performed by a physical therapist with advanced English language skills and specialized in the treatment of SCI subjects. We administrated and video-recorded the WST 4.2 manual Spanish version in 11 SCI subjects. Two physical therapists received specific training for administering the test and scoring the record. The reliability of the total percentage WST score were statistically quantified by intraclass correlation coefficient (ICC).Results: ICC values for Interrater were 0.998 (p < .0001). 17 out of the 32 skills had a 100 percentage of agreement. Percentage of agreement in the three skills that presented less rating agreement was 73%, 81 % and 82 %, respectively.Conclusion: The results show that the Spanish version of WST 4.2 is a reliable assessment tool to evaluate the skills capacity of spinal cord manual wheelchair users.Implications for rehabilitationWheelchair users require a proficient management of various wheelchair skills to achieve maximum independence in daily life. Determining which wheelchair skills should be addressed during the rehabilitation process is of great importance for their correct training. The WST 4.2 is an appropriate assessment tool to determine the functional capacity of wheelchair users.Making available the WST 4.2 in the Spanish language and demonstrating its reliability in this language allows its use in the Spanish-speaking world. A reliable wheelchair skills test is needed in the Spanish language.