Standing power wheelchairs and their use by children and youth with mobility limitations: an interrupted time series.

: Standing power wheelchairs (PWSDs) expand positioning and mobility options for individuals with motor impairments. Although more available, little is known about how PWSDs are used in everyday life. PURPOSE: to describe children's use of PWSDs in the first three months post-wheelchair delivery and the impacts on satisfaction with participation in daily life. MATERIALS AND METHODS: An interrupted time series of purposefully sampled children aged 5-18 years who were receiving a PWSD. The Wheelchair Outcome Measure for Young People (WhOM-YP) documented satisfaction with patient-reported meaningful participation outcomes. Data loggers objectively measured wheelchair mobility outcomes including distance travelled, bouts of mobility, and duration. Data were measured over two sessions pre-wheelchair-delivery and at one week, one month and three months post-wheelchair-delivery. RESULTS: Six children aged 7-18 years participated, four diagnosed with cerebral palsy, two with spina bifida. Analyses of individual data illustrated positive change in overall WhOM-YP satisfaction scores after PWSD provision though change varied across time, as did, distance, bouts of mobility and duration of use. Participants identified 14 in-home and 16 out-of-home unique participation outcomes, although several commonalities existed. CONCLUSION: PWSDs hold promise for increasing children's satisfaction with participation in daily life, in addition to possibly increasing mobility outcomes. IMPLICATIONS FOR REHABILITATIONFor children with mobility limitations, PWSDs may promote participation in daily life and increased mobility.Data logger technology provides valuable information about children's PWSD use and how this varies over time.Benefits and challenges exist with implementing PWSD and data logger technologies.When implementing PWSD use, it is critical to consider context, training and support needs of clients and caregivers.

Physical activity measurement in people with spinal cord injury: comparison of accelerometry and self-report (the Physical Activity Recall Assessment for People with Spinal Cord Injury).

Purpose: To (1) evaluate the level of agreement between individually calibrated accelerometers and the self-reported Physical Activity Recall Assessment for People with Spinal Cord Injury when assessing moderate-vigorous physical activity; and (2) qualitatively examine the different components of physical activity each measure assesses.Materials/methods: Nineteen manual wheelchair users with chronic spinal cord injury (19.0 ± 12.9 years post injury, C5-L2 injury level) wore a wrist and spoke accelerometer for one week then returned to the lab and completed the Physical Activity Recall Assessment for People with Spinal Cord Injury for their last 3 days of accelerometer wear.Results: Bland-Altman plots revealed low levels of agreement between the two measures when measuring total (bias = -5.6 ± 70.41 min/d, 95% agreement limits = -143.6-132.4 min/d), wheeled (bias = -9.7 ± 30.2 min/d, 95% agreement limits = -69.0-49.5 min/d), and non-wheeled (bias =12.3 ± 53.8 min/d, 95% agreement limits = -93.1-117.6 min/d) moderate-vigorous physical activity. The accelerometer was beneficial for detecting intermittent or brief activities while the self-report measure was useful for measuring lifting activities (e.g., resistance training) and wheeling on inclined surfaces.Conclusion: Total and wheeled moderate-vigorous physical activity measured by an accelerometer and a self-report measure showed low agreement at the individual level. Additional research is needed to examine whether physical activity may be best measured using accelerometers and a self-report measure concurrently.Implications for RehabilitationAccurate physical activity measurement has important implications for understanding the relationship between physical activity and health outcomes.Many limitations exist to accurately measuring physical activity in people with spinal cord injury.The most commonly used measures of physical activity in spinal cord injury are accelerometers and the self-reported Physical Activity Recall Assessment for People with Spinal Cord Injury.Accelerometers and the Physical Activity Recall Assessment for People with Spinal Cord Injury show low levels of agreement, highlighting that there are differences in the specific physical activity patterns that each measure is able to capture.

Patterns of community participation across the seasons: A year-long case study of three Canadian wheelchair users.

PURPOSE: The aim of this study was to explore the patterns of wheelchair users' community participation across a one-year period, including periods with substantial differences in weather conditions. We sought to develop a detailed understanding of the patterns of, and influences on, wheelchair use and participation within wheelchair users' own communities. METHOD: We conducted an instrumental case study of three purposefully selected individuals who use a wheelchair. Participants' wheelchairs were instrumented with a GPS data logger and data were collected for one week per month across a year. A prompted recall interview was conducted with participants each month, in order to gain an understanding of the influences on their community participation patterns. RESULTS: For each participant, the percent of trips taken at various trip distance ranges and the mean trips/days and overall distance traveled at or above 0 °C and below 0 °C are reported. Three distinct patterns were identified in response to variations in weather conditions: (1) season and transportation options are linked: winter limits community participation; (2) winter conditions are surmountable: with the right supports year-round participation is maintained; and (3) pre-planning is the key: winter conditions affects ease, choices and options but not overall participation. CONCLUSIONS: While winter weather conditions created community participation challenges, individuals responded differently based on their unique circumstances. The findings highlight the importance of policy that addresses the dynamic nature of weather and the needs of people with disabilities as specific individuals. Implications for rehabilitation Wheelchair users experience both similar and unique challenges regarding seasonal weather conditions that influence their community participation patterns. While some individual wheelchair users effectively maintain their community participation patterns across the year, they employ their own specific strategies in response to winter weather challenges. Ready access to vehicular transportation that is accessible regardless of weather condition is a key factor in promoting community participation across the year for wheelchair users. Accessible community environments can become inaccessible with the addition of winter weather conditions and thus the changing nature of community participation across the seasons should be considered.

Wrist Accelerometry for Physical Activity Measurement in Individuals With Spinal Cord Injury-A Need for Individually Calibrated Cut-Points.

OBJECTIVE: To create and compare individual and group-based cut-points for wrist accelerometry that correspond to moderate-to-vigorous physical activity (MVPA) in people with spinal cord injury (SCI). DESIGN: Participants completed a graded treadmill-wheeling test while being assessed for oxygen consumption, wrist-acceleration vector magnitude, and spoke acceleration. Oxygen consumption was converted to SCI metabolic equivalents (METs), and linear regression was applied to determine an individualized vector magnitude cut-point (counts per minute, VM-CPM) corresponding with MVPA (≥3 SCI METs). Multilevel linear regression was applied to determine a group MVPA cut-point. Participants then completed a 6-day monitoring period while wearing the accelerometers. SETTING: A local SCI research center. PARTICIPANTS: Manual wheelchair users (N=20; aged 31-64y; injury levels, C5 to L2) with chronic (>1y) SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mean total daily MVPA, wheeled MVPA, and nonwheeled MVPA were calculated using both the individual and group cut-points. Agreement on measures of minutes per day of MVPA between the individual and group mean cut-point method was assessed using Bland-Altman plots. RESULTS: Individual cut-points for MVPA ranged from 6040 to 21,540 VM-CPM, with a group cut-point of 11,652 (95% confidence interval, 7395-15,909). For total daily MVPA, Bland-Altman analysis revealed a bias of .22±33.0 minutes, with 95% limits of agreement from -64.5 to 64.9 minutes, suggesting a large discrepancy between total MVPA calculated from individual and group mean cut-points. CONCLUSIONS: Individual calibration of wrist-worn accelerometry is recommended for effective habitual PA monitoring in this population.

The effect of caster types on global rolling resistance in manual wheelchairs on indoor and outdoor surfaces.

An important aspect of reducing the strain of wheeling is to decrease rolling resistance. Previous laboratory research, using a treadmill, determined that smaller casters significantly increased rolling resistance. The purpose of this study was to determine the effect of caster size on various indoor and outdoor surfaces on global wheelchair rolling resistance. Three caster types with sizes 4 in, 5 in, and 6 in, three indoor surfaces, and three outdoor surfaces were studied. A manual wheelchair was passively pulled along each surface at 1.11 m/s (3.64 ft/s) by a power wheelchair, and the global rolling resistance of the manual wheelchair was measured using a calibrated force transducer. A 3×3 repeated measures analysis of variance (ANOVA) was conducted for both indoor and outdoor environments. The 4-in casters resulted in the highest global rolling resistance on most surfaces. The 5-in casters had the least rolling resistance on most indoor surfaces, and the 6-in casters had the least rolling resistance on most outdoor surfaces. Although 4-in casters are more popular among active wheelchair users, larger casters were shown to have lower rolling resistance on most surfaces. This study may help users select the best caster size depending upon their daily activities and lifestyle.