Clinical associations with telomere length in chronic spinal cord injury.

STUDY DESIGN: Cross-sectional study OBJECTIVES: To determine clinical factors associated with telomere length in persons with chronic spinal cord injury (SCI). SETTING: Veterans Affairs Medical Center, Boston, MA. METHODS: Two hundred seventy-eight participants with chronic SCI provided blood samples for measurement of C-reactive protein (CRP), interleukin-6 (IL-6), and telomere length, completed respiratory health questionnaires, underwent dual X-ray absorptiometry (DXA) to assess body fat, and completed spirometry. High-throughput real-time PCR assays were used to assess telomere length in leukocyte genomic DNA. Linear regression models were used to assess cross-sectional associations with telomere length. RESULTS: Telomere length was inversely related to age (p < 0.0001). In age-adjusted models, gender, race, injury duration, %-total and %-trunk fat, body mass index (BMI), %-predicted forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), chronic cough or phlegm, CRP, IL-6, wheeze, smoking, diabetes, heart disease, chronic obstructive pulmonary disease (COPD), skin ulcer, urinary tract infection (UTI), or chest illness history were not significantly associated with telomere length. There was a suggestive age-adjusted association between persons with the most severe SCI (cervical motor complete and AIS C) and shorter telomere length (p = 0.055), an effect equivalent to ~8.4 years of premature aging. There were similar age-adjusted associations with telomere length between persons using a wheelchair (p = 0.059) and persons with chronic urinary catheter use (p = 0.082) compared to persons without these characteristics. CONCLUSIONS: Our results suggest that clinical characteristics such as decreased mobility and bladder dysfunction that are common in individuals with more severe SCI are associated with shorter telomere length.

Comparison of different wheelchair seating on thermoregulation and perceptual responses in thermoneutral and hot conditions in children.

We examined the effects of 4 different wheelchair seatings on physiological and perceptual measures in 21 healthy, pre-pubertal children (9 ±â€¯2 years). Participants were able-bodied and did not regularly use a wheelchair. Participants sat for 2 h in Neutral (∼22.5 °C, ∼40%RH) and Hot (∼35 °C, ∼37%RH) conditions. Four seating technologies were: standard incontinent cover and cushion (SEAT1); standard incontinent cover with new cushion (SEAT2) were tested in Neutral and Hot; new non-incontinent cover with new cushion (SEAT3); new incontinent cover and new cushion (SEAT4) were tested in Neutral only. Measurements included skin blood flow (SkBF), sweating rate (SR) and leg skin temperature (TlegB) on the bottom of the leg (i.e. skin-seat interface), heart rate (HR), mean skin temperature, tympanic temperature, thermal comfort, and thermal sensation. During Neutral, SkBF and TlegB were lower (∼50% and ∼1 °C, respectively) and SR higher (∼0.5 mg cm-2·min-1) (p < 0.05) with SEAT3 compared to all other seats. SkBF was ∼30% lower (p < 0.05) for SEAT2 and SEAT4 compared to SEAT1. No other differences were observed between SEATs (all p > 0.05). During Hot, HR and temperatures were higher than in Neutral but there were no differences (p > 0.05) between SEATs. New cover and cushion improved thermoregulatory responses during Neutral but not Hot. An impermeable incontinent cover negated improvements from cushion design. Seat cover appears more important than seat cushion during typical room conditions.

Accessible machining for people who use wheelchairs.

Despite the Americans with Disabilities Act mandate for reasonable accommodations, wheelchair users are often placed in the role of observer and note-taker when learning machining and fabrication skills due to a lack of accessibility. The focus of this case study report is to identify and develop reasonable accommodations for wheelchair users in an academic machine shop environment to address accessibility limitations of original equipment manufacturer (OEM) machines. Individual wheelchair users working and learning within the Human Engineering Research Laboratories (HERL) were observed and interviewed about their experiences using the machine shop equipment without modifications, followed by further observations after accommodations were implemented.

Development of a Hybrid Course on Wheelchair Service Provision for clinicians in international contexts.

INTRODUCTION: Wheelchair users worldwide are at high risk of developing secondary health conditions and premature death due to inappropriate wheelchair provision by untrained providers. The International Society of Wheelchair Professionals (ISWP) has developed a Hybrid Course based on the World Health Organization's Wheelchair Service Training Package-Basic Level. The Hybrid Course leverages online modules designed for low-bandwidth internet access that reduces the in-person training exposure from five to three and a half days, making it less expensive and more convenient for both trainees and trainers. METHODS: The Hybrid Course was designed using a systematic approach guided by an international group of stakeholders. The development followed the Quality Matters Higher Educational Rubric, web design guidelines for low bandwidth, experts' opinions, and the best practices for blended course design. A quasi-experimental approach was used to evaluate the effectiveness of the Hybrid Course taken by six graduate students in Rehabilitation Sciences at the University of Pittsburgh by measuring pre- and post knowledge using the validated ISWP Wheelchair Service Provision-Basic Test. The outcome measure was assessed using a paired sample t-test between pretest and posttest scores. The quality of the Hybrid Course was evaluated by three external reviewers using the Quality Matters Higher Educational Rubric who were blind to each others' evaluation and the results of the training intervention. RESULTS: Hybrid Course participants reported significant increases in scores on the ISWP Wheelchair Service Provision-Basic Test after participating in the training, with an average increase of 10.84±5.42, p = 0.004, Cohen's d = 1.99. In addition, the Hybrid Course met the Quality Matters Standards in two out of three evaluations and reported a percentage of agreement between evaluators of 84%. CONCLUSIONS: The Hybrid Course met quality standards and proved to be effective in increasing basic level wheelchair knowledge in a group of Rehabilitation Science graduate students.

Review of real brain-controlled wheelchairs.

This paper presents a review of the state of the art regarding wheelchairs driven by a brain-computer interface. Using a brain-controlled wheelchair (BCW), disabled users could handle a wheelchair through their brain activity, granting autonomy to move through an experimental environment. A classification is established, based on the characteristics of the BCW, such as the type of electroencephalographic signal used, the navigation system employed by the wheelchair, the task for the participants, or the metrics used to evaluate the performance. Furthermore, these factors are compared according to the type of signal used, in order to clarify the differences among them. Finally, the trend of current research in this field is discussed, as well as the challenges that should be solved in the future.

Navigating uncharted territory: a qualitative study of the experience of transitioning to wheelchair use among older adults and their care providers.

BACKGROUND: An increasing number of older adults are procuring a wheelchair for mobility; however, the corresponding impact on related injuries, caregiver burden, and participation restriction is concerning. To inform the development of a wheelchair training program, we pursued a clearer understanding of the experience transitioning to wheelchair use for older adult users and their care provider. METHODS: Six focus groups were conducted with older experienced wheelchair users (n = 10) and care providers (n = 4). Transcripts were analyzed using a Conventional Content approach; a coding framework enabled inductive theming and summary of the data. RESULTS: Three themes emerged from the user group: On My Own reflected both limited training and the necessity of venturing out, More Than Meets the Eye addressing barriers to use, and Interdependence between wheelchair users and the ambulatory community. Care provider responses fell into two themes: the All Encompassing impact of assumed responsibilities and Even the Best Laid Plans, where unpredictable and inaccessible environments sabotaged participation. CONCLUSIONS: The transition from ambulatory to wheelchair mobility can feel like uncharted territory. Balanced support and appropriate mentorship are fundamentally important and real-world encounters optimize independence and proficiency with skills. The impact on care providers is extensive, highlighting the importance of skills training.

Exploring powered wheelchair users and their caregivers' perspectives on potential intelligent power wheelchair use: a qualitative study.

Power wheelchairs (PWCs) can have a positive impact on user well-being, self-esteem, pain, activity and participation. Newly developed intelligent power wheelchairs (IPWs), allowing autonomous or collaboratively-controlled navigation, could enhance mobility of individuals not able to use, or having difficulty using, standard PWCs. The objective of this study was to explore the perspectives of PWC users (PWUs) and their caregivers regarding if and how IPWs could impact on current challenges faced by PWUs, as well as inform current development of IPWs. A qualitative exploratory study using individual interviews was conducted with PWUs (n = 12) and caregivers (n = 4). A semi-structured interview guide and video were used to facilitate informed discussion regarding IPWs. Thematic analysis revealed three main themes: (1) "challenging situations that may be overcome by an IPW" described how the IPW features of obstacle avoidance, path following, and target following could alleviate PWUs' identified mobility difficulties; (2) "cautious optimism concerning IPW use revealed participants" addresses concerns regarding using an IPW as well as technological suggestions; (3) "defining the potential IPW user" revealed characteristics of PWUs that would benefit from IPW use. Findings indicate how IPW use may help overcome PWC difficulties and confirm the importance of user input in the ongoing development of IPWs.

A review of assistive devices for arm balancing.

Due to neuromuscular disorders (e.g., Duchenne Muscular Dystrophy) people often loose muscle strength and become wheelchair bound. It is important to use muscles as much as possible. To allow this, and to increase independency of patients, an arm orthosis can be used to perform activities of daily life. The orthosis compensates for the gravity force of the arm, allowing people to perform movements with smaller muscle forces. For patients, the aesthetics of the orthosis is one of the critical issues. This paper presents the state-of-the-art in passive and wearable active arm orthoses, and investigates how to proceed towards a suitable structure for a wearable passive arm orthosis, that is able to balance the arm within its natural range of motion and is inconspicuous; in the ideal case it fits underneath the clothes. Existing devices were investigated with respect to the body interface, the volume, and the workspace. According to these evaluation metrics it is investigated to what extent the devices are wearable and inconspicuous. Furthermore, the balancing principle of the devices, the architecture, force transmission through the devices, and alignment with the body joints are investigated. It appears that there is only one wearable passive orthosis presented in literature. This orthosis can perform throughout the natural workspace of the arm, but is still too bulky to be inconspicuous. The other passive orthoses were conspicuous and mounted to the wheelchair. Except one, the wearable active orthoses were all conspicuous and heavy due to a large backpack to enclose the actuators. They also could not achieve the entire natural workspace of the human arm. A future design of an inconspicuous, wearable, passive arm orthoses should stay close to the body, be comfortable to wear, and supports pronation and supination.

mobilityRERC state of the science conference: Considerations for developing an evidence base for wheeled mobility and seating service delivery.

PURPOSE: This article, developed as background content for discussion during the Mobility Rehabilitation Engineering Research Center State of the Science Conference, reviews research surrounding wheeled mobility and seating (WMS) service delivery, discusses the challenges of improving clinical decision-making, and discusses research approaches used to study and improve health services in other practice areas that might be leveraged to develop the evidence base for WMS. METHODS: Narrative literature review. RESULTS AND CONCLUSIONS: An overview of existing research found general agreement across models of WMS service delivery but little high quality evidence to support the recommended approaches and few studies of the relationship between service delivery steps and individual patient outcomes. The definition of successful clinical decision-making is different for different stakeholders. Clinical decision-making should incorporate the best available evidence along with patient values, preferences, circumstances, and clinical expertise. To advance the evidence base for WMS service delivery, alternatives to randomized controlled trials should be considered and reliable and valid outcome measures developed. Technological advances offer tremendous opportunities for individuals with complex rehabilitation technology needs. However, with ongoing scrutiny of WMS service delivery there is an increased need for evidence to support the clinical decision-making process and to support evidence-based coverage policies for WMS services and technologies. IMPLICATIONS FOR REHABILITATION: An evidence base for wheeled mobility and seating services is an important component of the clinical decision-making process. At present, there is little evidence regarding essential components of the wheeled mobility and seating evaluation or the relationship between the evaluation process and patient outcomes. Many factors can confound this relationship and present challenges to research in this area. All stakeholders (i.e. clinicians, rehabilitation technology suppliers, manufacturers, researchers, payers, policy makers, and wheelchair users) need to work together to develop and support an evidence base for wheeled mobility and seating service delivery.

Problemas con el uso de sillas de ruedas y otras ayudas técnicas y barreras sociales a las que se enfrentan las personas que las utilizan. Estudio cualitativo desde la perspectiva de la ergonomía en personas discapacitadas por enfermedades reumáticas y otras condiciones / Usage problems and social barriers faced by persons with a wheelchair and other aids. Qualitative study from the ergonomics perspective in persons disabled by rheumatoid arthritis and other conditions

Objetivos. Identificar los problemas de uso y accesibilidad a los que se enfrentan las personas discapacitadas (presenten dolor o no) usuarias de ayudas técnicas (sillas de ruedas convencionales); reconocer las barreras físicas que limitan su autonomía, y registrar cuáles son las prácticas socioculturales que los excluyen del proceso de diseño de dichas ayudas. Materiales y método. Participaron 15 pacientes con alguno de los siguientes diagnósticos: espondilitis anquilosante, artritis reumatoide, o amputados que utilizarán sillas de ruedas en México y Colombia. Estudio cualitativo. Análisis: temático y con aproximación teórica del diseño industrial utilizando pruebas de uso para análisis ergonómicos. Resultados. Se identificaron 6 temas asociados a los problemas de uso desde la perspectiva del paciente: barreras que limitan el empleo de las sillas de ruedas (uso y aceptabilidad), adaptaciones creativas, independencia, potencial de uso de las ayudas técnicas (silla de ruedas y/o andaderas), percepción del cuerpo y ayudas técnicas, y barreras arquitectónicas. Las necesidades ergonómicas y de uso, así como el nivel de independencia resultante, son diferentes entre los usuarios de sillas de ruedas que sufren dolor crónico y aquellos cuya discapacidad no involucra dolor. Estos últimos tienen más independencia en sus movimientos y decisiones. Conclusiones. La propuesta del «diseño desde y para el usuario» debe involucrar tanto las perspectivas del técnico en ergonomía y del médico como la interpretación que el usuario hace de su entorno y de la vivencia de la enfermedad (AU)

Objective: The objective of this study was to identify the usage and accessibility problems faced by the disabled (whether in pain or not) users of assistive devices (conventional wheelchairs), identify physical barriers that limit their mobility, and recognize the socio-cultural practices excluding them from the design process of such devices. Another main purpose of this paper is to improve the ergonomic criteria that influence the design and manufacture of assistive devices. Materials and method: Study population: 15 patients with any of the following diagnoses: ankylosing spondylitis, rheumatoid arthritis, or amputees using wheelchairs in Mexico and Colombia. Design: Qualitative study. Thematic analysis with a theoretical industrial design approach to employing usability testing for ergonomic analysis. Results: We identified 6 issues associated with usability problems from the patient’s standpoint: barriers for use of wheelchairs (usability and acceptability), creative adaptations, potential use of technical devices, independence, body perception and assistive devices, and architectural barriers. The ergonomic and usability requirements and the resulting level of independence vary across wheelchair users with chronic pain and those whose disability does not involve pain. The latter are more independent in their movements and decisions. Conclusions: User input is essential in the design of assistive devices. The proposal of “design from and for the user” must rely on both engineering and medical perspective on the ergonomy as well as the user interpretation of the environment and the experience of the disease. Thus we can arrive at a “user-centered design” (AU)

The accuracy of new wheelchair users' predictions about their future wheelchair use.

OBJECTIVE: This study examined the accuracy of new wheelchair user predictions about their future wheelchair use. DESIGN: This was a prospective cohort study of 84 community-dwelling veterans provided a new manual wheelchair. RESULTS: The association between predicted and actual wheelchair use was strong at 3 mos (ϕ coefficient = 0.56), with 90% of those who anticipated using the wheelchair at 3 mos still using it (i.e., positive predictive value = 0.96) and 60% of those who anticipated not using it indeed no longer using the wheelchair (i.e., negative predictive value = 0.60, overall accuracy = 0.92). Predictive accuracy diminished over time, with overall accuracy declining from 0.92 at 3 mos to 0.66 at 6 mos. At all time points, and for all types of use, patients better predicted use as opposed to disuse, with correspondingly higher positive than negative predictive values. Accuracy of prediction of use in specific indoor and outdoor locations varied according to location. CONCLUSIONS: This study demonstrates the importance of better understanding the potential mismatch between the anticipated and actual patterns of wheelchair use. The findings suggest that users can be relied upon to accurately predict their basic wheelchair-related needs in the short-term. Further exploration is needed to identify characteristics that will aid users and their providers in more accurately predicting mobility needs for the long-term.

Measurement properties of the wheelchair outcome measure in individuals with spinal cord injury.

STUDY DESIGN: One-week retest methodological study. OBJECTIVES: To assess the reliability and validity of the wheelchair outcome measure (WhOM) in a sample of individuals with spinal cord injury (SCI). SETTING: Vancouver, British Columbia, Canada. METHODS: The WhOM measures the impact of wheelchair interventions on a user's self-selected participation outcomes. The WhOM was administered to 50 participants on two occasions by the same rater, 1 week apart, to assess test-retest reliability. To determine inter-rater reliability, the WhOM was administered a third time approximately 72 h later by a different rater. Validity was evaluated by correlating scores from the WhOM with scores from the Assessment of Life Habits (LIFE-H). RESULTS: The test-retest intraclass correlation coefficients (ICC(2, 2)) for the WhOM satisfaction (Sat) and WhOM importance (Impt) × Sat scores were 0.83 (95% confidence interval (CI), 0.72-0.90) and 0.88 (95% CI, 0.79-0.93), respectively. The inter-rater ICC for the WhOM Sat and WhOM Impt × Sat scores were 0.91 (95% CI, 0.85-0.95) and 0.90 (95% CI, 0.83-0.94), respectively. As hypothesized, most scores on the WhOM were fair to moderate (r=0.3-0.5) and positively correlated with scores on the LIFE-H. CONCLUSION: The WhOM is a new outcome measure that demonstrates good reliability and validity among individuals with SCI. It is designed to assist wheelchair users identify and evaluate the impact of wheelchair interventions on participation level outcomes. The WhOM may be applicable for clinical- or research-oriented purposes.

Is manual wheelchair satisfaction related to active lifestyle and participation in people with a spinal cord injury?

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To describe the satisfaction of the manual wheelchair user with hand rim wheelchair-related aspects (for example, dimensions, weight and comfort) and wheelchair service-related aspects and to determine the relationship between wheelchair users' satisfaction, personal and lesion characteristics, and active lifestyle and participation in persons with a spinal cord injury (SCI). SETTING: Eight Dutch rehabilitation centers with a specialized SCI unit. METHODS: The Dutch version of the Quebec user evaluation of satisfaction with assistive technology (D-QUEST) was filled out by 109 participants 1 year after discharge from inpatient SCI rehabilitation. Relationships between the D-QUEST scores and personal and lesion characteristics, and active lifestyle and participation (physical activity scale for individuals with physical disabilities (PASIPD), Utrecht activity list (UAL), mobility range and social behavior subscales of the SIP68 (SIPSOC)) were determined. RESULTS: A high level of satisfaction was found with wheelchair-related aspects. The participants were less satisfied with the service-related aspects. Participants with an incomplete lesion were slightly more satisfied regarding both aspects than those with a complete lesion. A higher satisfaction regarding wheelchair dimensions and a higher overall satisfaction were related to a more active lifestyle. Persons who were more satisfied with the simplicity of use of the wheelchair had a better participation score. CONCLUSION: Dutch persons with SCI are in general quite satisfied with their hand rim wheelchair. Some aspects of the wheelchair (dimensions and simplicity of use) are important to optimize as these are related to an active lifestyle and participation.

Manual wheeled mobility--current and future developments from the human engineering research laboratories.

Medical rehabilitation and assistive technology are immersed in a world transitioning to a basis in evidence-based practice. Fortunately, there is a growing body of knowledge related to manual wheelchair mobility to form a basis for clinical decision making. The results from research studies are useful for designing better wheelchairs, fitting and training people appropriately, contributing to evidence-based-medicine and guiding future research. This review describes some of the work related to manual wheelchairs that has and is being conducted within the University of Pittsburgh and the Human Engineering Research Laboratories of the United States Department of Veterans Affairs, and its application.

La selección de la silla de ruedas y la satisfacción de indivíduos con lesión medular / The selection of the wheelchair and the satisfaction of individuals with spinal cord injury with your device

Objetivos. Evaluar la satisfacción de individuos con lesión de la médula espinal con su silla de ruedas, tanto como para conocer los aspectos relevantes en el proceso de selección y adquisición de este dispositivo. Material y métodos. Se trata de un estudio de evaluación. Se invitó a participar en el estudio 25 individuos parapléjicos o tetrapléjicos por lesión de la médula espinal, usuarios de silla de ruedas, que realizan la terapia física en el ambulatorio de fisioterapia da Universidad Estatal de Londrina. Todos aceptaron participar siendo sometidos a una entrevista para aplicación de un cuestionario hecho por los autores de este estudio, con preguntas referentes al proceso de selección y adquisición de la silla de ruedas, así como a la satisfacción con su equipo. Resultados. En el proceso de selección y adquisición de la silla de ruedas, la mayor parte de las personas hizo referencia al peso (52%) y a la manejabilidad (32%). La mayoría (66,4%) de los pacientes mostró estar totalmente satisfecho con su equipo. Los aspectos en los cuales hubo mayor predominancia de satisfacción total o parcial fueron: durabilidad (84%) y la facilidad para montar y desmontar la silla (96%). Conclusión. La satisfacción del usuario con su equipo es un factor importante que debe ser considerado en el proceso de rehabilitación del individuo con lesión de la médula espinal (AU)

Objective. Evaluate the spinal cord injuried individuals’ with their wheelchair, and identify the relevant points of the selection and acquiring process of the equipament. Materials and methods. This is an evaluation study. Twenty-five spinal cord injuried individuals with paraplegia or quadriplegia, who use wheelchair for mobility and receive physical therapy treatment at the Physiotherapy's Ambulatory of the Londrina State University, were invited to participate in this study. All them agreed to participate and underwent an interview for administering a questionnaire made by the authors of this study, with questions about the selection and acquisition of the wheelchair, as well as satisfaction with their device. Results. At the time of choosing and acquiring the wheelchair, the aspects taken into consideration of most of the individuals were weight (52%) and praticity (32%). The majority (66.4%) of patients were totally satisfied with their wheelchair. The aspects in which there was greater prevalence of total or partial satisfaction were: durability (84%) and praticity for mounting and dismounting the device (96%). Conclusion. User satisfaction with his wheelchair is an important factor to be considered in the rehabilitation process of individuals with spinal cord injury (AU)

Demographics and trends in wheeled mobility equipment use and accessibility in the community.

This article presents a profile of household-resident U.S. adults using wheeled mobility equipment (WME) in 2005, trends in WME use from 1990 to 2005, and data on accessibility features and problems from 1994-97. Data were obtained from the Survey of Income and Program Participation (SIPP) and the National Health Interview Survey on Disability (NHIS-D). Compared to the general population, WME users are more likely to be older, female, and in poor health. Forty-four percent are working-aged, with twice the rate of poverty of the general population, and only 17% are employed. Mobility difficulty is the most significant predictor of WME use, but gender, race, poverty, and educational attainment are also significant predictors. From 1990-2005, WME use grew 5% per year, while mobility difficulty declined among the elderly and remained steady among working-age persons. This contrast suggests a reduction in unmet need for WME. In 1994-97, more than half of WME users had difficulty entering or exiting their homes, and one-third had accessibility problems outside their homes. Usage of home modification was low, with substantial unmet need. Regular national data collection on the use of WME and other mobility aids, their financing, and accessibility issues is warranted.

Beyond the wheelchair: development of motorised transport for people with severe mobility impairments in developing countries.

PURPOSE: In developing countries, lack of over-the-road transportation reduces a vast number of disabled people to a life of begging, dependency and social isolation. Although there have been some excellent efforts to provide low-cost wheelchairs and hand-powered tricycles, little has been done to further provide transport for disabled people. METHODS: To address this problem directly we devised a low-cost motorised wheelchair transporter prototype (the Skeeter) using a combination of bicycle parts, a custom built frame, and an inexpensive small engine for propulsion. RESULTS: The Skeeter can provide independent operation and travel by a wheelchair user. It is an economically feasible solution to the lack of over-the-road transportation for people with mobility impairments in developing countries. CONCLUSIONS: The Skeeter has the potential to provide a major enhancement in the quality of life for people with disabilities in developing countries around the world.