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Purpose. The purpose of this study was to determine the characteristics of individuals who participate in the National Veterans Wheelchair Games (NVWG) and the Winter Sports Clinic (WSC) for veterans with disabilities. In addition, it was of interest to determine how these events had impacted their lives. Method. Participants were recruited at the 20th Winter Sports Clinic, held in Snowmass Colorado and the 26th National Veterans Wheelchair Games held in Anchorage, Alaska. Data of interest included demographic, sport participation information, community integration, self-esteem, and quality of life. A secondary data analysis was completed to determine how comparable individuals who attended the NVWG/WSC were to individuals who did not participate in these events. Results. The 132 participants were a mean age of 47.4 + 13.4 and lived with a disability for an average of 13.4 + 12.1. Participants felt that the NVWG/WSC increased their knowledge of sports equipment (92%), learning sports (89%), mobility skills (84%), and acceptance of disability (84%). The majority of participants stated that the NVWG/WSC improved their life. Of those who participated at the NVWG/WSC, they tended to be more mobile, but have increased physical and cognitive limitations as measured by the CHART when compared to the non-attendees. Conclusions. Recommending veterans participate in events such as the NVWG and WSC can provide psychosocial benefits to veterans with disabilities. [ABSTRACT FROM AUTHOR]

This study investigated the relationship between quality-adjustability, thus capacity to customize-manual and power wheelchairs and health-related Quality of Life, as measured by the SF-36V. Using a retrospective design, Veterans Administration databases were merged to create a data set of 61,428 veterans who received a wheelchair. ANCOVA, ANOVA and logistic regressions were used to analyze data. Results suggest, when adjusting for clinical and demographic factors, veterans who received higher-quality manual wheelchairs had significantly lower physical function and significantly higher mental function, general health, and mental component summary scores than veterans who received nonadjustable, depot chairs. [ABSTRACT FROM AUTHOR]

Little is known about the reasoning process clinicians use when prescribing wheeled mobility equipment (WME) or about the outcomes of this process, i.e., how many devices are prescribed, to whom, how often, and at what cost. This study characterized veterans who received WME from the Veterans Health Administration. We analyzed variance in wheelchair provision based on sex, race/ethnicity, diagnosis, and age. Three years of data from the National Prosthetics Patient Database and the National Patient Care Database were merged, yielding more than 77,000 observations per fiscal year. Logistic regression analysis revealed associations between WME provision and age, sex, and race/ethnicity, when analysis was controlled for diagnosis and number of comorbidities. Hispanics (odds ratio [OR] = 1.864), African Americans (OR = 1.360), and American Indians/Asians (OR = 1.585) were more likely than Caucasians to receive standard wheelchairs. Hispanics (OR = 0.4), African Americans (OR = 0.7), and American Indians/Asians (OR = 0.4) were less likely than Caucasians to receive scooters. [ABSTRACT FROM AUTHOR]

Purpose. Training of appropriate wheelchair propulsion methods may be beneficial to the individual who uses wheelchair by reducing the incidence of pain and improving one's quality of life. This paper discusses the development and initial testing of training device that was developed to aid in wheelchair propulsion techniques: GAME[Wheels] System. Methods. Two separate models of GAME[Wheels] have been developed: GAME[Wheels] Clinical and GAME[Wheels] Trainer. Details of the development process and the refinement have been included in this manuscript. To verify and compare the practicality and functionality of the two GAME[Wheels] systems, several focus groups were conducted: first to determine whether the systems could be set-up with informational materials and second to determine if the systems could be taught to novice users. Results. Results from the focus group indicate that the overall impressions of the systems were that they were 'fun' to play. Suggestions were raised to improve the design, which have been incorporated into further refinement of the GAME eels systems.Conclusions. This paper provides an overview of the development of wheelchair-training device. Valuable information was gained to improve the design of the GAME[Wheels] systems. [ABSTRACT FROM AUTHOR]

According to the International Standards Organization 2631-1 standard on human vibration, individuals in a seated position are at risk of injury due to whole-body vibrations when exposed for long periods of time. Wheelchair users fit this description perfectly; however, little research has been conducted to evaluate the amount of vibration transmitted to a wheelchair user. The vibration exposure produced by traversing nine surfaces was evaluated by having 10 individuals without disabilities propel over them in both a manual wheelchair at 1 m/s and a powered wheelchair at 1 and 2 m/s. Root-mean squared (RMS) vertical vibration was examined to determine if differences existed between surfaces. At 1 m/s for both the manual and the powered wheelchair the 8-mm bevel interlocking concrete surface produced significantly higher RMS vertical vibration than the other surfaces. At 2 m/s in the powered wheelchair, the poured concrete surface (control) produced the significantly highest RMS vertical vibration. Based on the manual and power wheelchair results of this study, use of selected ICPI pavers would be acceptable for any route traveled by individuals using wheelchair. Furthermore, a 90 degrees herringbone pattern is preferred over the 45 degrees pattern, and it is recommended that for safety reasons regarding vibration exposure a bevel of less than 6 mm should be used. [ABSTRACT FROM AUTHOR]

Inthis pilot study, we assessed wheelchair durability and its effect on user satisfaction. Specifically, we examined the characteristics of the participants' wheelchairs, the types of maintenance and repairs completed, and whether the participants' satisfaction was affected by problems with their wheelchairs. A convenience sample of 130 participants who used wheelchairs as their primary means of mobility was recruited. Participants completed a questionnaire about their wheelchairs, the maintenance and repair history, and their satisfaction levels. Results showed that 26% of the participants had completed a wheelchair repair in the past 6 months, 16% had completed general maintenance, and 27% had completed tire repairs. Neither hours of wheelchair use nor wheelchair age affected repair or maintenance frequency. Participants were generally satisfied with their wheelchairs. Better understanding of wheelchair maintenance and repair issues will guide improvements in wheelchair design and enhance the community participation of individuals who use wheelchairs. [ABSTRACT FROM AUTHOR]

For individuals with a spinal cord injury or dysfunction (SCI/D), opportunities to exercise are limited and are usually not highly motivating experiences. Exercise programs or extracurricular activities may help increase or maintain the cardiovascular fitness level of individuals with SCI/D. The GAMEWheels system, an interface between a portable roller system and a computer, enables an individual to control a video game by propelling his or her wheelchair. The purpose of this study was to investigate whether the propulsive forces used during video play, both with and without the GAMEWheels system, were different. A secondary purpose was to examine differences in metabolic parameters during exercise under these two conditions. Ten manual wheelchair users exercised on the GAMEWheels system with and without controlling a video game. Physiological and kinetic data were collected six times during two exercise trials. Kinetic data were recorded with the SMARTWheel and used to investigate propulsion forces. No significant differences were found in the resultant force, rate of rise, or number of hand contacts with the pushrims. This study showed that propulsion pattern did not change significantly when wheelchair users exercised while playing a computer video game. Oxygen consumption, ventilation, and heart rate were significantly different (p < 0.05) between the two groups during the last three exercise intervals and cooldown. Playing a video game while exercising may help to motivate manual wheelchair users to exercise longer and regularly, something that was reported by this study's subjects; likewise, exercising while playing a video game may not be associated with higher pushrim forces and stroke frequencies. [ABSTRACT FROM AUTHOR]

Objective: Several of the casualties from Operation Iraqi Freedom arriving at one Veterans Administration (VA) polytrauma rehabilitation center (PRC) were noted to have occipital pressure ulcers or hair loss. The objective of this study was to determine the prevalence and severity of pressure-related injuries in VA PRC admissions.Methods: A retrospective review of admissions from active duty from 2004 to 2006 was performed.Results: Thirty-eight percent of admissions to this VA PRC had pressure-related injuries on the day of admission. Casualties from Iraq had a higher rate of pressure ulcers (53%) than did those from elsewhere (22%). Occipital lesions constituted 50% of non-stage I pressure ulcers and were more severe than those of the sacrum or extremities.Conclusions: Further epidemiological research should be performed to identify risk factors for pressure injury in the military continuum of care, by linking specific military medical evacuation and treatment processes and characteristics of casualties with outcomes. [ABSTRACT FROM AUTHOR]

Individuals with multiple sclerosis (MS) report decreased satisfaction with their mobility devices compared with individuals with spinal cord injuries (SCIs). This study (1) investigated the demographic differences between veterans with MS (V-MS) and veterans with SCI (V-SCI) who were issued a wheelchair by the Veterans Health Administration (VHA) and (2) described differences in mobility device prescription. We merged two VHA databases to obtain demographic and wheelchair information for all V-MS and V-SCI in 2000 and 2001. Descriptive information for issued wheelchairs was available for 2,154 V-MS and V-SCI. We found that V-MS were significantly less likely to receive higher quality wheelchairs (manual or power) compared with V-SCI (p < 0.001). The disparity in VHA wheelchair prescription between these two groups indicates a need for further research regarding the assistive device prescription process in these populations. [ABSTRACT FROM AUTHOR]

This study examined the usage of powered seating functions, including tilt-in-space, backrest recline, and seat elevation, among a group of wheelchair users during their typical daily activities. Twelve individuals who used a power wheelchair with seating functions participated in the study. They drove their own wheelchair and used the seating functions as needed in their community environment for about 2 weeks while the seating function usage was recorded with a portable device. We found that subjects occupied their wheelchair for 11.8 +/DS 3.4 hours a day (all data shown as mean +/DS standard deviation). While occupying their wheelchairs, they accessed tilt-in-space, backrest recline, and seat elevation 19 +/DS 14 times a day for 64.1% +/DS 36.8%, 12 +/DS 8 times for 76.0% +/DS 29.8%, and 4 +/DS 4 times for 22.5% +/DS 34.9%, respectively. Subjects chose to stay in tilted and reclined positions in their wheelchair for 39.3% +/DS 36.5% of their time each day. They spent little time in a fully upright position. Subjects changed their seating positions every 53.6 +/DS 47.0 minutes. Time spent in positions of different seating pressures varied among subjects. The information collected could enhance clinical practice of wheelchair provision, resulting in better compliance with clinical instructions and appropriate use of seating functions among wheelchair users. [ABSTRACT FROM AUTHOR]

We compared differences in isometric strength between older adults who have undergone elective unilateral total hip arthroplasty (THA) and completed rehabilitation with a population of community-dwelling older adults who have not had THA. The study was a cross-sectional design, and 22 unilateral THA subjects and 38 community-dwelling older adults participated. THA subjects received on average 13 outpatient or home-based physical therapy sessions before evaluation. THA subjects were evaluated 4 to 5 months postsurgery. We assessed isometric muscle strength by measuring peak hip torque per body weight with a robotic dynamometer during abduction, flexion, and extension. No significant performance differences were observed between operated and nonoperated hips of THA subjects. THA subject operated and nonoperated hips generated significantly less peak torque per body weight during flexion (p = 0.03) compared with community-dwelling older adult hips (THA subject operated hips = 6.96 ft-lb/lb, THA subject nonoperated hips = 8.26 ft-lb/lb, community-dwelling older adult hips = 11.56 ft-lb/lb). No significant differences were observed between THA subjects and community- dwelling older adults during hip extension (p = 0.55) or abduction (p = 0.17). At 4 to 5 months postsurgery, THA subjects were not at the same level of biomechanical performance as community-dwelling older adults. Significant strength deficits were found in THA subject operated versus nonoperated hips during isometric flexion. Additional or modified physical therapy that targets the hip flexors is recommended after THA. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To predict successful prosthetic ambulation for patients immediately transferred to an inpatient rehabilitation facility after amputation surgery. METHODS: Seventy-five individuals with lower-limb amputation were studied at a tertiary acute care and rehabilitation facility. Successful prosthetic ambulation, defined as the ability to ambulate with a prosthesis at least 45 m, was measured in addition to other key demographic and medical factors. RESULTS: Sixty-eight percent were successful prosthetic ambulators at rehabilitation discharge. The absence of residual-limb contracture and a longer length of stay during rehabilitation showed a significant relationship to successful prosthetic ambulation with regression analysis. Younger age was modestly correlated to outcome. There were no significant differences when comparing success of the early rehabilitation program with surgical level or etiology of amputation. For successful prosthetic users, mean wear time at rehabilitation discharge was 5.7 hours with a mean distance walked of 67 m. Of those who failed this approach, 70% were related to a failure of wound healing. CONCLUSIONS: In this cohort, 68% of patients who were selected for a trial of early prosthetic rehabilitation ambulated using a prosthesis at rehabilitation discharge. This approach appears to be more effective for younger patients without contractures who are medically stable to participate in the rehabilitation process. [ABSTRACT FROM AUTHOR]

Objectives: To examine variation in provision of assistive technology (AT) devices and the extent to which such variation may be explained by patient characteristics or Veterans Health Administration (VHA) administrative region., Design: Retrospective population-based study., Setting: VHA., Participants: Veterans poststroke in fiscal years 2001 and 2002 (N=12,046)., Interventions: Not applicable., Main Outcome Measure: Provision of 8 categories of AT devices., Results: There was considerable regional variation in provision of AT. For example, differences across administrative regions in the VHA ranged from 5.1 to 28.1 standard manual wheelchairs per 100 veterans poststroke. Using logistic regression, with only demographic variables as predictors of standard manual wheelchair provision, the c statistic was .62, and the pseudo R(2) was 2.5%. Adding disease severity increased the c statistic to .67 and the pseudo R(2) to 6.2%, and adding Veteran Integrated Network System further increased the c statistic to .72 and pseudo R(2) to 9.8%., Conclusions: Our research showed significant variation in the provision of AT devices to veterans poststroke, and it showed that patient characteristics accounted for only 6.2% of the variation. VHA administrative region and disability severity accounted for equivalent amounts of the variation. Our findings suggest the need for improvements in the process for providing AT and/or provider education concerning device provision., (Published by Elsevier Inc.)

Objectives: Considerable morbidity persists among survivors of breast cancer (BC) including high levels of psychological stress, anxiety, depression, fear of recurrence, and physical symptoms including pain, fatigue, and sleep disturbances, and impaired quality of life. Effective interventions are needed during this difficult transitional period., Methods: We conducted a randomized controlled trial of 84 female BC survivors (Stages 0-III) recruited from the H. Lee Moffitt Cancer and Research Institute. All subjects were within 18 months of treatment completion with surgery and adjuvant radiation and/or chemotherapy. Subjects were randomly assigned to a 6-week Mindfulness-Based Stress Reduction (MBSR) program designed to self-regulate arousal to stressful circumstances or symptoms (n=41) or to usual care (n=43). Outcome measures compared at 6 weeks by random assignment included validated measures of psychological status (depression, anxiety, perceived stress, fear of recurrence, optimism, social support) and psychological and physical subscales of quality of life (SF-36)., Results: Compared with usual care, subjects assigned to MBSR(BC) had significantly lower (two-sided p<0.05) adjusted mean levels of depression (6.3 vs 9.6), anxiety (28.3 vs 33.0), and fear of recurrence (9.3 vs 11.6) at 6 weeks, along with higher energy (53.5 vs 49.2), physical functioning (50.1 vs 47.0), and physical role functioning (49.1 vs 42.8). In stratified analyses, subjects more compliant with MBSR tended to experience greater improvements in measures of energy and physical functioning., Conclusions: Among BC survivors within 18 months of treatment completion, a 6-week MBSR(BC) program resulted in significant improvements in psychological status and quality of life compared with usual care.

The purpose of this study was to develop the scoring system for the Seating and Mobility Script Concordance Test (SMSCT), obtain and appraise internal and external structure evidence, and assess the validity of the SMSCT. The SMSCT purpose is to provide a method for testing knowledge of seating and mobility prescription. A sample of 106 therapists and 15 spinal cord injury experts contributed to the development of the scoring system. Validity evidence was obtained using 15 seating and mobility experts, 10 orthopedic experts, and 66 therapists with varying levels of seating and mobility expertise. Proxy measures of clinical expertise were used for external validity evidence since no criterion measures exist. The SMSCT was found to differentiate between seating and mobility experts' and orthopedic experts' intervention subtest scores (p = 0.04). The proxy measure of clinical expertise, seating and mobility hours/week, was found to predict SMSCT intervention scores (p = 0.002). The internal structure of the SMSCT may include evidence of reduced item performance but satisfactory convergent and discriminate evidence by construct definition. Although the SMSCT may be a promising approach for measuring seating and mobility expertise, limitations exist in the corrected content. Future application of the SMSCT should only be used after further development of the tool occurs.

We determined the demographic, health, functional, and satisfaction factors related to lower-limb prosthesis or wheelchair use among veterans with lower-limb amputation. Forty-two veterans were recruited from the 20th National Disabled Veterans Winter Sports Clinic and the 26th National Veterans Wheelchair Games. Participants were at least 18 years of age, had a lower-limb amputation, and were either prosthesis or wheelchair users. Level of amputation was the most significant health-related characteristic determining the veterans' use of a prosthesis versus a wheelchair (p = 0.02). Veterans who had a higher level of amputation and used a prosthesis reported significantly greater difficulty navigating a ramp (p = 0.03), getting in and out of cars and buses (p = 0.03), carrying 10 lb of groceries (p = 0.02), and participating in sports and leisure activities (p = 0.03). The parameter "satisfaction related to prosthesis" did not determine selection of mobility device type. The interaction of demographics, health-related characteristics, and mobility device characteristics affects functional performance and influences the use of prostheses, wheelchairs, or both in persons with lower-limb amputation. Long-term outcome assessments may help determine factors associated with either transition from one device to another or combined use of the devices over time.

Objective: Women with systemic lupus erythematosus (SLE) are at high risk of cardiovascular disease (CVD). The goals of this study were to determine the extent of atherosclerotic progression among women with SLE compared with a group of healthy controls and to determine whether factors attributed to SLE or its treatment were associated with atherosclerotic progression independent of traditional CVD risk factors., Methods: A longitudinal study of women with SLE from the Pittsburgh Lupus Registry was conducted. Women 18 years of age and older (n = 217) underwent carotid ultrasound at baseline and at followup, an average of 4.19 years later. Clinical, serologic, and SLE-related factors, and disease treatment were evaluated. Outcomes were changes in carotid intima-media thickness (IMT) and plaque. Progression of CVD in a sample of women without lupus was used for comparison., Results: The patients' mean +/- SD age at baseline was 45.1 +/- 10.3 years, and the mean +/- SD IMT progression rate was 0.011 +/- 0.03 mm per year. After controlling for traditional CVD risk factors, higher serum creatinine levels were associated with IMT progression (P = 0.0006). Plaque prevalence was 31% at baseline and 40% at followup; plaque progression occurred in 27% of the patients. Higher serum C3 levels and immunosuppressant use at baseline were related to plaque progression (P = 0.04 and P = 0.02, respectively) independent of traditional CVD risk factors. The plaque progression rate was higher than, and the IMT progression rate was similar to, those in the control group., Conclusion: SLE patients have accelerated plaque progression compared with controls. SLE-related risk factors are associated with the progression of IMT and plaque after controlling for traditional CVD risk factors. Carotid B-mode ultrasound may serve as a surrogate end point in SLE intervention trials and clinically to track SLE management.

A variety of external hip protectors are available on the market but no standards for their performance exist and it is unknown if their properties change after repeated fall impacts. The purpose of this study was to determine if protective properties change in different types of new (unused) hip protectors after repeated, simulated falls. Five hip protector brands were chosen to represent different products available on the market and the two mechanisms employed in reducing the force of an impact (shunting or absorbing). Ten pairs of each type (20 pads for each brand) were tested using a 1.8-m Instron Dynatup 9250 HV vertical impact testing tower. The impact testing system was specifically designed for this study by creating a simulated trochanter to provide more accurately a impact area similar to that of a real hip bone. The hip protectors were impacted once a day for 3 consecutive days. Repeated impacts demonstrated the pads' decreased ability to either absorb or shunt force in all types of hip protectors. However, the mean forces were still in the protective range (force below fracture threshold of 3100 N) for 3 of the 5 brands tested after 3 impacts. The protective properties of external hip protectors do degrade after repeated impacts. The degree of degradation differs from brand to brand. Regardless of type, most pads were still able to bring the force of impact below the fracture threshold of 3100 N. Future studies need to address the issue of durability of different types/brands of hip protectors after repeated laundering and fall impacts to determine when should they be replaced. Additionally, a national or international standard needs to be developed against which the performance of different brands of hip protectors can be compared.

For the 2.2 million people who use wheelchairs in the United States, transportation is often needed for independence in the community. The purpose of this study was to investigate the characteristics of transportation use in a population of wheelchair users and to examine the motor vehicle crash involvement and injury frequency of these users. Responses were collected from 596 individuals from June 2002 to November 2003. Approximately 20% of the sample population was involved in a motor vehicle crash in the previous 3 years, resulting in a rate of 3.6 accidents/incidents per 100,000 miles traveled. Crashes were defined as any motor vehicle accident that the person was involved in during the previous 3 years. Persons who did not transfer from their wheelchair were more likely to be involved in a crash than those individuals who transferred to vehicle seats. Eighteen percent of the population reported involvement in a non-crash-related incident during the previous 3 years. Passengers reported a greater frequency of non-crash-related injuries than did drivers. The results of this study provide documentation of transportation use and safety in people who use wheelchairs. It provides insight into the risk of crash and injury in this population.

A total of 283 wheelchair-seated bus riders responded to a 35-item Web-based survey investigating their experiences on public, fixed-route buses. The survey addressed the use of wheelchair tiedowns and occupant restraint systems (WTORS), the attitudes and behaviors of wheelchair users toward the use of this equipment, and the transit experience. Results indicate that consistent use of four-point tiedown and occupant restraint systems is fairly low. Only 33.2% of the participants reported always securing their wheelchair, and 62.2% reported using occupant restraints consistently. A preference for fixed-route over para-transit was related to larger city size. Implementation of transit agency policy regarding WTORS was found to be inconsistent. Easier-to-use WTORS and improved operator training in larger transit agencies would likely increase the correct use of safety equipment and improve wheelchair users' bus-riding experiences.

This paper provides an overview of the development of a wheelchair users registry and subsequently describes a population of individuals who use wheelchairs. The characteristics of Americans who permanently use wheelchairs and scooters are currently unknown. As the result of developing a Registry of individuals who use wheeled mobility devices for systematic recruitment for research studies, this study provides a description of a nationwide sample of over 1000 individuals who used wheelchairs or scooters for their daily mobility. The Registry is predominantly Caucasian (83%), 63% male, with a mean age of 50 years. Some 54% used manual wheelchairs for an average of 16 years. When quality of wheelchairs was compared, results indicated those in more customizable manual wheelchairs were significantly more likely to be younger. Males were significantly more likely to receive more customizable, heavy duty power wheelchairs than females. The Wheelchair Users Registry provides an organized and systematic way to maintain contact with previous research participants. Expected to grow in size, the Registry may enable an even more diverse pool of subjects interested in participating in research studies.

With about 2.2 million Americans currently using wheeled mobility devices, wheelchairs are frequently provided to people with impaired mobility to provide accessibility to the community. Individuals with spinal cord injuries, arthritis, balance disorders, and other conditions or diseases are typical users of wheelchairs. However, secondary injuries and wheelchair-related accidents are risks introduced by wheelchairs. Research is underway to advance wheelchair design to prevent or accommodate secondary injuries related to propulsion and transfer biomechanics, while improving safe, functional performance and accessibility to the community. This paper summarizes research and development underway aimed at enhancing safety and optimizing wheelchair design.

Increased physical activity is important for reducing the risk of cardiovascular disease. However, among people with disabilities, inactivity is prevalent. In order to encourage exercise among members of this group, an exercise system combining arm ergometry with video gaming, called the GAME(Cycle) was previously developed. User input was received through an arm crank ergometer on a swivel, with the angular velocity of the ergometer resistance wheel controlling one axis and rotation of ergometer about the swivel controlling the other. The purpose of this study was to detail the algorithms used in this device and present novel features included in a second generation of the GAME(Cycle). The features include a wheel on base, a steering return mechanism, and wireless fire buttons. A focus group of clinicians (n = 8), wheelchair users (n = 8), and clinician wheelchair users (n = 2) was conducted to evaluate the features of the GAME(Cycle). The focus group suggested improvements to the steering mechanism and to reduce vibration in the system. However, the focus group enjoyed the GAME(Cycle) and felt that it would encourage exercise among persons with disabilities.

Purpose: This cross-sectional study examined whether partnering with service dogs influenced psychosocial well-being and community participation of adult individuals using wheelchairs or scooters., Method: One hundred and fifty-two people were recruited and group-matched, resulting in 76 participants with and 76 without service dogs. Standardized scale scores for affect, depressive symptoms, self-esteem, and loneliness were used to operationally define psychosocial well-being. Community participation was assessed with the 'Social Integration' domain of the Craig Handicap Assessment and Reporting Technique., Results: Psychosocial characteristics did not differ significantly between those partnered with and without service dogs overall. However, of participants with progressive conditions, those with service dogs demonstrated significantly higher positive affect scores than comparison group participants. Among those with clinical depression, service dog partners scored significantly higher in positive affect. Finally, regardless of whether individuals had service dogs, fewer depressive symptoms and being female or married were predictors of greater community participation., Conclusion: Select individuals may experience psychosocial benefits from partnering with service dogs. However, it is unclear if these benefits might also be derived from companion dogs. Further research is needed to substantiate the findings of this study.

Some aspects of assistive technology can be enhanced by the application of virtual reality. Although virtual simulation offers a range of new possibilities, learning to navigate in a virtual environment is not equivalent to learning to navigate in the real world. Therefore, virtual reality simulation is advocated as a useful preparation for assessment and training within the physical environment. We are engaged in several efforts to develop virtual environments and devices for mobility skills assessment and training, exercise training, and environment assessment. Virtual reality offers wheelchair users a training tool in different risk-free environments without any indoor (e.g., walls, furniture, and stairs) and outdoor (e.g., curb cuts, uneven terrain, and street traffic) physical constraints. Virtual reality technology will probably become more common in the field of assistive technology, especially given the rapid expansion of gaming technology and the continued exponential growth of computing power.

The appropriateness of a consumer's seating and mobility system varies considerably depending on the competence, proficiency, and experience of the professionals assisting the user. At present, there is a scarcity of skilled and knowledgeable therapists to evaluate and recommend seating and mobility devices. There is also a lack of measurement tests available to evaluate the impact of educational experiences or clinical practice on the ability to make specialized clinical decisions about seating and mobility needs. The Seating and Mobility Script Concordance Test (SMSCT) is a new assessment tool, grounded in the hypothetico-deductive and schema theories of clinical reasoning. The test is designed to assess therapists by examining the organization of their knowledge, associations between items of their knowledge, and the adequacy of their clinical decisions as compared to expert consensus. This article describes the interview, test development, and content/item review processes used for the collection of content validity evidence. The iterative process employed and the appraisal of the content validity evidence that resulted in the final version of the SMSCT are presented. The SMSCT appears to be a promising assessment tool representing content within the domain of seating and mobility for individuals with spinal cord injuries. The process utilized to develop the SMSCT in spinal cord injury can be replicated for other diagnoses and domains.

Objectives: To test the differences between a pushrim-activated power-assisted wheelchair (PAPAW) and a traditional manual wheelchair while performing common driving activities and to assess their relative merits for people with tetraplegia., Design: Repeated measures., Setting: An activities of daily living (ADL) laboratory within a rehabilitation research center., Participants: Fifteen full-time manual wheelchair users with tetraplegia due to a spinal cord injury., Interventions: Participants propelled both their own manual wheelchairs and a PAPAW 3 times over an ADL course. The order in which the 2 different wheelchairs were presented to the participants was randomized., Main Outcome Measures: Each participant's heart rate was monitored throughout testing by a digital, wireless heart-rate monitor. Time to complete the course was recorded, and participants were surveyed with a visual analog scale after the first, third, fourth, and sixth trials to determine the ease of completing each obstacle and their ergonomic preferences between the 2 wheelchairs. Participants also were observed throughout the trials to determine how much assistance they needed to complete each obstacle course., Results: After using a Bonferroni adjustment, 4 obstacles (carpet, dimple strips, up a ramp, up a curb cut) were rated as being significantly easier ( P <.001) to complete when using the PAPAW. Participants also showed a significant decrease in mean heart rate throughout all 3 trials ( P =.015, P =.001, P =.003, respectively) when using a PAPAW. The amount of assistance needed by participants, the responses to ergonomic questions, and the overall time to complete the ADL course did not differ significantly between the 2 wheelchairs., Conclusions: For subjects with tetraplegia, PAPAWs have the potential to improve functional capabilities during certain ADLs, especially when propelling up ramps, over uneven surfaces, and over thick carpet.

Introduction: Manual wheelchair users have been found to be at risk for secondary upper extremity injuries., Purpose: The primary goal of this study was to compare shoulder strength and muscle imbalance of individuals with paraplegia to case-wise matched unimpaired controls (UC). A secondary goal was to evaluate the impact of age and neurologic level of injury (NLI) on weight-normalized strength (WNS)., Methods: The SCI group (n = 28) and the UC group (n = 28) completed bilateral shoulder isokinetic strength testing in the sagittal, frontal, and horizontal plane at 60 degrees/second using the BioDex system. Strength ratios, an indicator of muscle imbalance, were also calculated., Results: No significant difference was seen in shoulder strength or strength ratios between the SCI group and the UC group. However, NLI was significantly related to WNS on several planes in the SCI group. Therefore, we dichotomized the SCI group into equal groups based on an NLI. The Low-SCI group was significantly stronger than the High-SCI group in most planes (P < 0.05). The High-SCI group was significantly weaker than the UC in extension (P < 0.01) and a trend (P < 0.01) was seen in flexion, abduction, and external rotation. The Low-SCI group was significantly stronger in abduction than the UC., Conclusion: WNS at the shoulder correlated with NLI. It is likely that this is related to contributions of the trunk and abdominal muscles during testing, since proximal trunk strength aids in generating forces distally. This study and others of strength in individuals with paraplegia may overestimate shoulder strength.

Objectives: To evaluate the durability and value of 3 common suspension manual wheelchairs and to compare the results with those of previously tested lightweight and ultra-lightweight folding-frame wheelchairs., Design: Standardized fatigue testing and cost analysis of 3 suspension manual wheelchairs from 3 different manufacturers., Setting: A rehabilitation engineering center., Specimens: Nine suspension manual wheelchairs., Interventions: Wheelchairs were fitted with a standardized wheelchair test dummy and tested on a series of fatigue tests, consistent with those developed by the International Organization for Standardization. Main outcome measures Fatigue life (measured as the number of equivalent cycles completed) and value (equivalent cycles divided by cost) were compared among all wheelchairs., Results: Analysis of variance revealed significant differences (P< or =.05) in the number of equivalent cycles among the suspension wheelchairs tested. When compared with previously tested ultra-lightweight and lightweight wheelchairs, the suspension wheelchairs failed to show significant improvements; however, significant improvements were found between individual suspension and lightweight wheelchairs., Conclusions: We found little evidence to suggest that suspension manual wheelchairs provide advantages in terms of durability or value over standard lightweight and ultra-lightweight folding-frame wheelchairs.

Background/objective: Previous investigations have identified muscular imbalance in the shoulder as a source of pain and injury in manual wheelchair users. Our aim was to determine whether a correlation exists between strength and pushrim biomechanical variables including: tangential (motive) force (Ft), radial force (Fr), axial force (Fz), total (resultant) force (FR), fraction of effective force (FEF), and cadence., Methods: Peak isokinetic shoulder strength (flexion [FLX], extension [EXT], abduction [ABD], adduction [ADD], internal rotation [IR], and external rotation [ER]) was tested in 22 manual wheelchair users with a BioDex system for 5 repetitions at 60 degrees/s. Subjects then propelled their own manual wheelchair at 2 speeds, 0.9 m/s (2 mph) and 1.8 m/s (4 mph), for 20 seconds, during which kinematic (OPTOTRAK) and kinetic (SMARTWHEEL) data were collected. Peak isokinetic forces in the cardinal planes were correlated with pushrim biomechanical variables., Results: All peak torque strength variables correlated significantly (P < or = 0.05) with Ft, Fr, and FR, but were not significantly correlated with Fz, FEF, or cadence. Finally, there were no relationships found between muscle strength ratios (for example, FLX/EXT) and Ft, Fr, FR, Fz, or FEF., Conclusion: There was a correlation between strength and force imparted to the pushrim among wheelchair users; however, there was no correlation found in wheelchair propulsion or muscle imbalance. Clinicians should be aware of this, and approach strength training and training in wheelchair propulsion techniques separately.

Objectives: To determine differences in metabolic demands, stroke frequency, and upper-extremity joint range of motion (ROM) during pushrim-activated power-assisted wheelchair (PAPAW) propulsion and traditional manual wheelchair propulsion among subjects with tetraplegia., Design: Repeated measures., Setting: A biomechanics laboratory within a Veterans Affairs medical center., Participants: Fifteen full-time manual wheelchair users who had sustained cervical-level spinal cord injuries., Interventions: Participants propelled both their own manual wheelchairs and a PAPAW through 3 different resistances (slight, 10W; moderate, 12W; high, 14W) on a wheelchair dynamometer. Each propulsion trial was 3 minutes long., Main Outcome Measures: Primary variables that were compared between the 2 wheelchairs were participants mean steady-state oxygen consumption, ventilation, heart rate, mean stroke frequency, and maximum upper-extremity joint ROM., Results: When using the PAPAW, participants showed a significant ( P <.05) decrease in mean oxygen consumption and ventilation throughout all trials. Mean heart rate was significantly lower when using the PAPAW for the high resistance trial. Stroke frequency was significantly lower when using the PAPAW for the slight and moderate resistances. Overall joint ROM was significantly lower when using the PAPAW., Conclusions: For subjects with tetraplegia, PAPAWs reduce the energy demands, stroke frequency, and overall joint ROM when compared with traditional manual wheelchair propulsion.

Objective: To investigate factors related to the wheelchair, impairment, and environment that affect perception of participation of persons with spinal cord injury (SCI) in activities performed in 3 settings: in the home, in the community, and during transportation., Design: Cross-sectional study., Setting: Research centers and a specialized assistive technology (AT) clinic in Pittsburgh (Pitt). Research centers and community-based rehabilitation technology suppliers in Saint Louis (SL)., Participants: Seventy wheelchair users with SCI., Interventions: Subjects from Pitt and SL completed a written survey of AT usage in daily activities., Main Outcome Measures: Subjects were asked 5 questions within each setting (home, community, transportation) related to their perceived reason for functional limitations., Results: The wheelchair was the most commonly cited factor limiting participation, followed by physical impairment and physical environment. Twenty-one percent of subjects with paraplegia reported pain as a limiting factor for their transportation use, significantly more (P=.047) than subjects with tetraplegia (3%). A trend (P=.099) was seen toward a higher percentage of subjects with tetraplegia (tetraplegia, 7%; paraplegia, 3%) reporting lack of equipment as a limiting factor for use of transportation. Differences were also seen across sites., Conclusions: The wheelchair was the most commonly cited limiting factor, followed by physical impairment and physical environment. The wheelchair is the most important mobility device used by persons with SCI and the one that users most associate with barriers.

Objectives: To determine if a standard of care for wheelchair provision exists within the participating centers and if there is disparity in wheelchair customizability among the study sample., Design: Convenience sample survey., Setting: Thirteen Model Spinal Cord Injury Systems that provide comprehensive rehabilitation for people with traumatic spinal cord injury (SCI) and that are part of the national database funded through the US Department of Education., Participants: A total of 412 people with SCI who use wheelchairs over 40 hours a week., Intervention: Survey information was obtained from subjects via telephone and in-person interviews and from the national database. Collected information included age, race, education, level of injury, and wheelchair funding source., Main Outcome Measures: Number and type (manual or power) of wheelchairs. Wheelchair customizability as defined by design features (eg, adjustable axle position, programmable controls)., Results: Ninety-seven percent of manual wheelchair users and 54% of power wheelchair users had customizable wheelchairs. No power wheelchair user received a wheelchair without programmable controls. Minorities with low socioeconomic backgrounds (low income, Medicaid/Medicare recipients, less educated) were more likely to have standard manual and standard programmable power wheelchairs. Older subjects were also more likely to have standard programmable power wheelchairs., Conclusions: The standard of care for manual wheelchair users with SCI is a lightweight and customizable wheelchair. The standard of care for power wheelchairs users has programmable controls. Unfortunately, socioeconomically disadvantaged people were less likely to receive customizable wheelchairs.

Objectives: To define differences in pushrim dynamics during manual wheelchair propulsion by users with multiple sclerosis (MS) relative to 2 control groups of subjects with spinal cord injury (SCI) and no disability (ND) and to investigate changes in propulsion biomechanics at different speeds and with fatigue., Design: Case-control., Setting: Biomechanics laboratory., Participants: A convenience sample of 42 people, 8 women and 6 men per group., Interventions: Not applicable., Main Outcome Measures: The propulsion pattern, mean maximum speed, percentage of time in push and recovery phases, push angle, push frequency, mean maximum resultant pushrim force, mean work and push cycle, and hand-to-pushrim coupling and decoupling effects., Results: The MS groups tended to use an arcing propulsion pattern more than did the control groups (Pmax=.003). The MS group pushed at a lower mean maximum velocity (v) when allowed to choose the speed of propulsion (v(MS),.67+/-.20m/s; v(SCI), 1.10+/-0.23m/s; P=.001), when asked to push at 1m/s (v(MS),.91+/-.26m/s; v(SCI), 1.12+/-0.11m/s; v(ND), 1.05+/-0.13m/s; P=.010), and were unable to maintain a self-selected speed during a 5-minute trial (Deltav(MS),.15+/-.02m/s; Deltav(ND),.03+/-.06m/s; P<.001). The MS group spent a higher proportion of time in the push phase of propulsion (Pmax=.001). In general, the MS group had smaller push angles, but push frequencies similar to the controls. Statistically adjusted MS group pushrim forces and work per push measures varied depending on context, but in all trials the MS group displayed a braking effect when grasping and releasing the pushrim. The MS group had declines in most measures when pushing at a self-selected speed for 5 minutes. In all trials, the MS group was more likely to display asymmetry between right and left sides in biomechanic parameters., Conclusions: Manual wheelchair users with MS have difficulty grasping and releasing the pushrim and maintaining speed during a fatigue trial. This likely leads to a slow self-selected speed of propulsion that may not be functional. Clinicians should remember these results when prescribing manual wheelchairs for people with MS.