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Purpose: To evaluate the effects of a combination of wheelchair mobility skills (WMS) training and exercise training on physical activity (PA), WMS, confidence in wheelchair mobility, and physical fitness., Methods: Y outh using a manual wheelchair ( n  = 60) participated in this practice-based intervention, with a waiting list period (16 weeks), exercise training (8 weeks), WMS training (8 weeks), and follow-up (16 weeks). Repeated measures included: PA (Activ8), WMS (Utrecht Pediatric Wheelchair Mobility Skills Test), confidence in wheelchair mobility (Wheelchair Mobility Confidence Scale), and physical fitness (cardiorespiratory fitness, (an)aerobic performance) and were analysed per outcome parameter using a multilevel model analyses. Differences between the waiting list and training period were determined with an unpaired sample t -test., Results: Multilevel model analysis showed significant positive effects for PA ( p  = 0.01), WMS ( p  < 0.001), confidence in wheelchair mobility ( p  < 0.001), aerobic ( p  < 0.001), and anaerobic performance ( p  < 0.001). Unpaired sample t -tests underscored these effects for PA ( p  < 0.01) and WMS ( p  < 0.001). There were no effects on cardiorespiratory fitness. The order of training (exercise before WMS) had a significant effect on confidence in wheelchair mobility., Conclusions: A combination of exercise and WMS training appears to have significant positive long-term effects on PA, WMS, confidence in wheelchair mobility, and (an)aerobic performance in youth using a manual wheelchair.Implications for rehabilitationExercise training and wheelchair mobility skills (WMS) training can lead to a sustained improvement in physical activity (PA) in youth using a manual wheelchair.These combined trainings can also lead to a sustained increase in WMS, confidence in wheelchair mobility, and (an)aerobic performance.More attention is needed in clinical practice and in research towards improving PA in youth using a manual wheelchair.

Purpose : The objective of this study was to develop a questionnaire to assess confidence in wheelchair mobility in Dutch youth (WheelCon-Mobility Dutch Youth). Methods : (1) A forward-backward translation process was used to translate the original WheelCon-M from English to Dutch. (2) Items related to wheelchair mobility in Dutch youth were selected and adapted based on focus groups with youth, parents and health care professionals to create the WheelCon-Mobility Dutch Youth. (3) The WheelCon-Mobility Dutch Youth and the Utrecht Pediatric Wheelchair Mobility Skills Test 2.0 (UP-WMST 2.0) were administered to 62 participants to evaluate internal consistency and construct validity. Results : Translation and cultural adaptation led to general adaptations in instructions, sentence structure and response scale. At the item level, 24 items were included with ( n = 17) and without ( n = 7) adaptation, 10 items were deleted and 7 new items were included. The WheelCon-Mobility Dutch Youth had an excellent Cronbach's alpha of 0.924 and a significant correlation ( r = 0.44, p < .001) with the UP-WMST 2.0. Conclusions : This study resulted in the adaptation of the WheelCon-M into the WheelCon-Mobility for Dutch youth using a manual wheelchair. Our study suggests there is evidence supporting the internal consistency and construct validity of the WheelCon-Mobility Dutch Youth.Implications for RehabilitationThe WheelCon-Mobility Dutch Youth is a newly developed tool for assessing confidence in wheelchair mobility in Dutch youth using a manual wheelchair.It is important to assess performance and confidence in wheelchair mobility in paediatric rehabilitation.

Background: The assessment of wheelchair mobility skills (WMS) in youths using a manual wheelchair is important. More information is needed regarding the psychometric properties of the newly developed Utrecht Pediatric Wheelchair Mobility Skills Test (UP-WMST)., Objective: The purpose of this study was to evaluate the reliability, content validity, construct validity, and responsiveness of the UP-WMST 2.0 in youths using a manual wheelchair., Design: This was a repeated-measurements, cross-sectional study., Methods: A total of 117 children and adolescents who use a manual wheelchair participated in this study. The UP-WMST 2.0 contains the same 15 WMS items as the original UP-WMST but has an adaptation of the scoring method. Test-retest reliability was estimated in 30 participants. Content validity was assessed through floor and ceiling effect analyses. Construct validity was assessed through hypothesis testing. Preliminary estimates of responsiveness were assessed in 23 participants who participated in a WMS training program., Results: Test-retest reliability analysis showed weighted Cohen kappa coefficients ranging from 0.63 to 0.98 for all but 1 item. The total UP-WMST 2.0 score had an intraclass correlation coefficient of 0.97. No floor or ceiling effects were detected. Independent-sample t test analysis confirmed our hypotheses regarding direction and difference in scores between age and diagnostic groups. Within-group analysis in the responsiveness study showed a positive significant change in UP-WMST 2.0 score (8.3 points)., Limitations: The small sample size used in the responsiveness study was a limitation of this study., Conclusions: This study provided evidence of the test-retest reliability, content, and construct validity of the UP-WMST 2.0. It also provided initial evidence of the responsiveness of the UP-WMST 2.0 for measuring change in WMS in youths using a manual wheelchair., (© 2019 American Physical Therapy Association.)

Background: Wheelchair mobility skills (WMS) training is regarded by children using a manual wheelchair and their parents as an important factor to improve participation and daily physical activity. Currently, there is no outcome measure available for the evaluation of WMS in children. Several wheelchair mobility outcome measures have been developed for adults, but none of these have been validated in children. Therefore the objective of this study is to develop a WMS outcome measure for children using the current knowledge from literature in combination with the clinical expertise of health care professionals, children and their parents., Methods: Mixed methods approach. Phase 1: Item identification of WMS items through a systematic review using the 'COnsensus-based Standards for the selection of health Measurement Instruments' (COSMIN) recommendations. Phase 2: Item selection and validation of relevant WMS items for children, using a focus group and interviews with children using a manual wheelchair, their parents and health care professionals. Phase 3: Feasibility of the newly developed Utrecht Pediatric Wheelchair Mobility Skills Test (UP-WMST) through pilot testing., Results: Phase 1: Data analysis and synthesis of nine WMS related outcome measures showed there is no widely used outcome measure with levels of evidence across all measurement properties. However, four outcome measures showed some levels of evidence on reliability and validity for adults. Twenty-two WMS items with the best clinimetric properties were selected for further analysis in phase 2. Phase 2: Fifteen items were deemed as relevant for children, one item needed adaptation and six items were considered not relevant for assessing WMS in children. Phase 3: Two health care professionals administered the UP-WMST in eight children. The instructions of the UP-WMST were clear, but the scoring method of the height difference items needed adaptation. The outdoor items for rolling over soft surface and the side slope item were excluded in the final version of the UP-WMST due to logistic reasons., Conclusions: The newly developed 15 item UP-WMST is a validated outcome measure which is easy to administer in children using a manual wheelchair. More research regarding reliability, construct validity and responsiveness is warranted before the UP-WMST can be used in practice.

Objectives: To measure and calculate the energy expended by people with stroke during near sedentary behaviors (lying, supported and unsupported sitting, standing, wheelchair propulsion, walking), under controlled laboratory conditions, and to compare these values with the energy expenditure of 1.5 metabolic equivalent task (MET) within the definition of sedentary behavior., Design: Cross-sectional cohort study., Setting: Rehabilitation institutions., Participants: People with stroke (N=27; mean age, 61.0±11.7y), categorized at Functional Ambulation Categories (FAC) 0 to 5., Interventions: Not applicable., Main Outcome Measures: Energy expenditure (measured using indirect calorimetry) expressed in METs. The recorded values were calculated for every participant and averaged for each activity: lying, supported and unsupported sitting, standing, wheelchair propulsion, and walking. Calculations were done for the total group and categorized by the FAC., Results: For the total group the mean METs ± SDs were 1.04±.11 for sitting supported, 1.09±.15 for sitting unsupported, 1.31±.25 for standing, 1.91±.42 for wheelchair propulsion, and 2.52±.55 for walking. People with stroke in all FAC had METs values >1.5 when propelling a wheelchair or walking., Conclusions: Energy expenditure during typical sedentary behaviors (ie, sitting) is narrowly bounded at approximately 1.0 MET. Energy expenditure during sitting and standing was ≤1.5 MET for all FAC, with the exception of FAC 0 (1.6 MET during standing). Independent wheelchair propulsion and walking can be categorized as light activities (≥1.5 MET)., (Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: An adequate wheelchair propulsion capacity is required to perform daily life activities. Exercise training may be effective to gain or improve wheelchair propulsion capacity. This review investigates whether different types of exercise training programs are effective in improving wheelchair propulsion capacity., Data Sources: PubMed and EMBASE databases were searched from their respective inceptions in October 2013., Review Methods: Exercise training studies with at least one outcome measure regarding wheelchair propulsion capacity were included. In this study wheelchair propulsion capacity includes four parameters to reflect functional wheelchair propulsion: cardio-respiratory fitness (aerobic capacity), anaerobic capacity, muscular fitness and mechanical efficiency. Articles were not selected on diagnosis, training type or mode. Studies were divided into four training types: interval, endurance, strength, and mixed training. Methodological quality was rated with the PEDro scale, and the level of evidence was determined., Results: The 21 included studies represented 249 individuals with spinal-cord injury (50%), various diagnoses like spina bifida (4%), cerebral palsy (2%), traumatic injury, (3%) and able-bodied participants (38%). All interval training studies found a significant improvement of 18-64% in wheelchair propulsion capacity. Three out of five endurance training studies reported significant effectiveness. Methodological quality was generally poor and there were only two randomised controlled trials., Conclusion: Exercise training programs seem to be effective in improving wheelchair propulsion capacity. However, there is remarkably little research, particularly for individuals who do not have spinal-cord injury., (© The Author(s) 2014.)

Aim: To investigate the test-retest reproducibility of the Muscle Power Sprint Test (MPST), the 10 × 5-m sprint test, and the arm-cranking Wingate Anaerobic Test (WAnT) in children and adolescents with cerebral palsy (CP). A secondary objective was to assess the construct validity of the MPST., Method: Twenty-three participants with spastic CP (mean age 13 y 3 mo, range 7-18 y, SD 3.6 y; 18 males, five females, two classified as having spastic unilateral CP, 21 as having spastic bilateral CP) using a manual wheelchair for at least part of the day were recruited and tested in different rehabilitation settings in the Netherlands. Participants were classified as in Gross Motor Function Classification System Expanded and Revised (GMFCS-E&R) levels III and IV., Results: Intraclass correlation coefficients (range 0.93-0.99; 95% confidence interval 0.82-1.0) for all variables indicated highly acceptable reproducibility. Limits of agreement analysis revealed satisfactory levels of agreement. The MPST variables demonstrated very strong significant positive correlations for peak power and mean power from both tests (peak power: r=0.91, p<0.001; mean power: r=0.88, p<0.001)., Interpretation: The MPST, the 10 × 5-m sprint test, and the arm-cranking WAnT are reproducible tests for measuring anaerobic performance and agility in adolescents with spastic CP who self-propel a manual wheelchair. The MPST has been shown to be a valid test to measure anaerobic performance in this population., (© 2013 Mac Keith Press.)

Background: For children with cerebral palsy (CP) who are able to walk or run, the 10-m shuttle run test is currently the test of choice to assess cardiorespiratory fitness. This test, however, has not yet been examined in wheelchair-using youth with CP., Objective: The purpose of this study was to investigate the test-retest reproducibility and validity of the 10-m shuttle ride test (SRiT) in youth with CP., Design: Repeated measurements of the SRiT were obtained., Methods: Twenty-three individuals with spastic CP (18 boys, 5 girls; mean age=13.3 years, SD=3.6 years) using a manual wheelchair for at least part of the day participated in this study. During the study, all participants performed one graded arm exercise test (GAET) and 2 identical SRiTs within 2 weeks. Peak oxygen uptake (Vo2peak), peak heart rate (HRpeak), and respiratory exchange ratio (RER) were recorded. Intraclass correlation coefficients (2,1), the smallest detectable difference, and the limits of agreement (LOA) were calculated. The association between the results of the SRiT and GAET was tested using Pearson correlation coefficients., Results: Intraclass correlation coefficients (.99, 95% confidence interval=.98-1.00) for all variables indicated highly acceptable reproducibility. The LOA analysis revealed satisfactory levels of agreement. The SRiT variables demonstrated strong, significant positive correlations for Vo2peak values obtained during the SRiT and the GAET (r=.84, P<.01)., Limitations: Although the GAET is considered the gold standard, the cardiorespiratory demand during the GAET was significantly lower compared with during the SRiT. Future studies should determine whether the GAET can still be accepted as the gold standard for upper-extremity exercise., Conclusions: The SRiT is a reproducible and valid test for measuring cardiorespiratory fitness in youth with spastic CP who self-propel a manual wheelchair.

Aim: The aim of this study was to examine the test-retest reproducibility (reliability and agreement) of the 6-minute push test (6MPT) and the one-stroke push test (1SPT), and construct validity of the 6MPT in children with cerebral palsy (CP) who self-propel a manual wheelchair., Method: Seventy-three children and adolescents with spastic CP (51 males, 22 females; mean age 11 y 9 mo, SD 3 y 7 mo, range 4-18 y; three unilateral, 70 bilateral) using a manual wheelchair for at least part of the day were recruited from and tested in different rehabilitation settings in the Netherlands and Brazil. Participants were classified as Gross Motor Function Classification System (GMFCS) level II (n=7), III (n=36), or IV (n=30)., Results: Intraclass correlation coefficients (ICCs) for distance covered on the 6MPT (mean distance 266.5 m, SD 120.6 m) and the 1SPT (mean distance 4.5 m, SD 2.7 m) showed excellent reliability (ICC=0.97) for both tests. There was a significant correlation between the 6MPT and the 1SPT (r=0.73; p<0.001), and between the 6MPT and heart rate during the 6MPT (r=0.29, p=0.014)., Interpretation: These results indicate that both the 6MPT and the 1SPT test are reproducible functional tests for young people with CP who self-propel a wheelchair. Agreement for the 6MPT seems relatively large for children who perform short distances. Construct validity is supported for the 6MPT in children with CP., (© The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.)