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Context and Objectives: Respiratory muscle training (RMT) is considered an effective tool to improve cardiorespiratory limitations in athletes. The goals of this systematic review were to explore the role of RMT and its implementation within sport rehabilitation programs in para-athletes. Evidence Acquisition: Several databases were searched until January 2024. Eligible studies were independently reviewed by 2 reviewers. Quality assessment was made using the PEDro scale and version 2 of the Cochrane Risk-of-Bias Tool for Randomized Trials. Eight studies (a total of 108 participants) were selected for the analysis. Evidence Synthesis: Five studies preferred using resistive loading, while 2 studies used normocapnic hyperpnea, and 1 study used threshold inspiratory muscle training. Respiratory functions (respiratory muscle strength and endurance, spirometry measures) and exercise performance were assessed as the main outcomes. Significant increases in respiratory muscle strength were reported in 5 studies. Two studies observed improvement in respiratory muscle endurance and 3 studies reported increased exercise capacity. Conclusions: This review suggests that although RMT can enhance respiratory muscle strength and endurance, it should not be considered the primary method for boosting the exercise performance of para-athletes. Additional research is necessary to explore the impact of various RMT techniques on different outcomes from the perspective of sport rehabilitation in para-athletes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of assistive mobility carts on companion animals and caretakers' quality of life by investigating factors pertaining to caretaker satisfaction, the ability to perform daily tasks, and complication rates. Materials and methods: A 23-question survey was distributed to caretakers of animals using carts to evaluate the animal and caretakers' quality of life, acceptance, ability to complete functional tasks, and complications. Data from canine, feline, and rabbit responses were analyzed separately. Results: Dogs and cats had improved quality of life in 62 and 57% of responses and 61 and 60% for their caretakers, respectively. There was no improvement in the quality of life of rabbits or their caretakers. Regarding the complication rate, 64% were reported to have at least one complication associated with cart use, 53% of which were wounds. Across all species, there was a reported improvement in ability to perform daily tasks and activities. Conclusions and clinical relevance: Caretakers reported that assistive mobility carts improve both companion animals' and caretakers' quality of life, despite high prevalence of complications, including wounds. Future studies exploring specific disease conditions and long-term outcomes will be useful for guiding clinical recommendations. [ABSTRACT FROM AUTHOR]

Abstract\nIMPLICATIONS FOR REHABILITATIONPurpose: After a stroke, older adults may encounter social stigma due to their disability and age. This can cause emotions of shame, low self-esteem, and social isolation. The use of assistive devices can make the stigmatizing conditions even more difficult. This study attempts to establish a conceptual framework for designing wheelchairs that can help reduce stigma and improve the well-being of older people with lived experience of stroke.Method: The study utilized the research question construct classification to identify three primary research questions. To address these questions, a bibliographic search was performed using Scopus, Web of Science databases, and PubMed. Articles were selected based on their relevance to the development of wheelchairs and their focus on reducing stigma or enhancing well-being for post-stroke older adults.Results: Seventy articles were chosen to be meticulously reviewed and categorized into sub-themes. This categorization led to the creation of a comprehensive synthesis summary to address each question. The results are further synthesized to formulate a potential theoretical proposition for future investigation. The results suggest enhancing wheelchair design focusing on visibility, symbolism, usefulness, aesthetics, and adaptability through user empowerment and cultural interventions that can effectively reduce stigma, thereby improving the well-being, self-competence, and life quality of post-stroke older adults.Conclusion: The findings offer a design framework for wheelchair innovation specifically aimed at reducing the stigmatizing conditions to improve the well-being of post-stroke older adults through an interdisciplinary perspective. This study suggests further research to explore specific design strategies for wheelchair innovation across various contexts and cultures.The attributes of wheelchairs can influence both the social stigma and self-stigma experienced by older people with lived experience of stroke.User empowerment and cultural interventions in the development of wheelchairs can help reduce the stigma experienced by post-stroke older adults.The well-being of post-stroke older adults can be enhanced through wheelchair improvement by improving mobility, positive emotions, belonging, and fulfillment. [ABSTRACT FROM AUTHOR]

Purpose: This study is a randomized controlled trial (RCT) that examines the feasibility, acceptability, and initial efficacy of a home-based, remotely supported and supervised exercise training program that was developed using a three-step community engaged research process for persons with multiple sclerosis (MS) who are wheelchair users. Materials and Methods: The study design is a parallel group RCT (NCT05888727). We aim to enroll 24 wheelchair users with MS who will be randomly assigned using REDCap randomization module into exercise training or attention/contact wellness control conditions. The conditions will be delivered remotely over 16 weeks and supported using online, one-onone behavioral coaching. The feasibility outcomes of interest include recruitment and retention rates, and safety outcomes collected throughout the study period. The acceptability outcomes include participant satisfaction and perceptions measured using formative surveys and interviews following the 16-week period. Efficacy outcomes include metabolic health, MS symptoms, and exercise behavior measured before and after the 16-week period. The data analysis will follow intent-to-treat principles using 2 group by 2 time mixed factor ANOVA with estimation of Cohen's d values as effect sizes. Conclusions: The results will guide future research targeting health outcomes using exercise training among wheelchair users with MS who have largely been absent from health promotion research. IMPLICATION FOR REHABILITATION: The current study aims to test the first home-based exercise training program for wheelchair users with multiple sclerosis Community-engaged research methods across this research agenda aim to build partnerships with the target population This research may yield a scalable approach for rehabilitation research and practice by providing a critically needed home-based exercise training program for wheelchair user with multiple sclerosis [ABSTRACT FROM AUTHOR]

In this single-blind randomized controlled trial, we tested the hypotheses that, in comparison with control participants receiving only self-study materials (SS group), caregivers of manual wheelchair users who additionally receive remote training (RT group) have greater total Wheelchair Skills Test Questionnaire (WST-Q) performance and confidence scores post-training and at follow-up; and that self-study and remote training each individually lead to such gains. We studied 23 dyads of wheelchair users and their caregivers. Caregivers in the SS group received a handbook and videorecording. Those in the RT group also received up to four real-time ("synchronous") sessions remotely. The WST-Q 5.1 was administered pre-training (T1), post-training (T2), and after a 3-month follow-up (T3). The mean total WST-Q scores of both groups rose slightly at each new assessment. For the T2-T1 and T3-T1 gains, there were no statistically significant differences between the groups for either WST-Q performance or WST-Q confidence. For performance, the T2-T1 gain was statistically significant for the RT group and the T3-T2 gain was statistically significant for the SS group. For both groups, the T3-T1 gains in performance were statistically significant with gains of 12.9% and 18.5% relative to baseline for the SS and RT groups. For confidence, only the T3-T1 gain for the SS group was statistically significant with a gain of 4.5% relative to baseline. Although less than the gains previously reported for in-person training, modest but important gains in total WST-Q performance scores can be achieved by self-study, with or without remote training. Registration Number: NCT03856749. IMPLICATIONS FOR REHABILITATION: Self-study can improve the manual wheelchair skills of caregivers. Remote training can improve the manual wheelchair skills of caregivers. Improvements are slightly less than those reported in the literature for in-person training. [ABSTRACT FROM AUTHOR]

Wheelchair provision training is essential to overcome barriers related to the lack of knowledge of health professionals on this topic. Appropriate knowledge of the service provision process may lead to higher quality service and products, and thus be more likely to help people with mobility impairments achieve the fundamental human right of personal mobility. This study aimed to describe a training intervention for two groups of future physiotherapists in Colombia, assess cohort differences in performance on a knowledge test, and explore their post-training perceptions. A quantitative retrospective study with a historical, descriptive-comparative design was conducted. 525 sixth-semester participants completed the International Society of Wheelchair Professionals Wheelchair Service Provision – Basic Test online in Spanish after curriculum modifications were implemented. The test assesses knowledge in seven domains: Assessment; Prescription; Products; Fitting; User training; Follow-up, maintenance, and repairs; and Process. The training intervention was successfully implemented with Physiotherapy students from two institutions, resulting in a 57% increase in test approval rates. Participants demonstrated increased knowledge, satisfaction with the course content, and application of learning to their current work. These results suggest implications for what pedagogical approach to employ, when curricular change may be warranted, and specific considerations for the Colombian context. Furthermore, identifying the minimal knowledge basis for undergraduate programs and facilitating its dissemination can support interprofessional education and enhance professionals' capacity to support wheelchair provision services. IMPLICATIONS FOR REHABILITATION: Developing pedagogical materials and resources should address academic needs while also being adaptable to the healthcare system and cultural and economic resources. Establishing minimal knowledge bases for physiotherapists and facilitating their dissemination to support interprofessional education are crucial steps. Sharing pedagogical experiences that improve health workforce training promotes the quality of wheelchair service provision, benefiting the functional independence and well-being of people with disabilities. The use of international resources such as the ISWP test in the training of the health workforce contributes to the standardization of the training process regardless of the context. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the predictive accuracy of the Pittsburgh Impairment Testing Tool. It was hypothesized that the Pittsburgh Impairment Testing Tool would have a good overall accuracy (≥80%) for predicting both ambulation and transfer ability and that overall accuracy of the Pittsburgh Impairment Testing Tool would be higher than that of other scales. Design: A retrospective chart review was used to classify 409 adults with spina bifida according to seven neurological scales. A Naïve Bayes classifier was used to obtain accuracy estimates for predicting both ambulation and transfer ability as a function of each scale. Results: The Pittsburgh Impairment Testing Tool was the only scale demonstrating >80% overall accuracy for predicting both ambulation and transfer ability. While several scales demonstrated ≥80% overall accuracy in predicting transfer ability, none were useful in predicting inability to transfer. Inability to transfer was difficult for all tools to predict. Conclusions: The Pittsburgh Impairment Testing Tool demonstrated good overall accuracy for predicting both ambulation and transfer ability. Sensory and anatomic levels were less useful than motor level in predicting functional ability. [ABSTRACT FROM AUTHOR]

AbstractThis study aimed to explore the potential of a mobile health (mHealth) application (app) to support the delivery of a fall prevention and management program, Individualized Reduction of FaLLs (iROLL), for people with spinal cord injury (SCI) and multiple sclerosis (MS) who use wheelchairs and scooters (WC/S) full-time by seeking end-users’ input into the functioning and ongoing design of the iROLL-O + mobile app. Two focus group discussions included nine adults with SCI or MS who used a WC/S for at least 75% of mobility, who experienced at least one fall in the past three years and have internet and access to an internet-capable device. One group had prior iROLL experience (n = 4); while the other had none (n = 5). The focus groups examined the app’s usefulness, accessibility, appearance, and ease of use. The participants with prior iROLL experience also discussed how the app would enhance their experience with the program. Thematic analysis revealed five app-related themes: perceived usefulness, perceived usability, accessibility, appearance, and enhancement of the iROLL experience, with participants providing actionable suggestions for improvement. Participants with previous exposure to the iROLL program emphasized the app’s potential to facilitate flexible access to the program and expand its reach to a wider audience. The iROLL-O + app was perceived positively, especially with respect to the enhancement of users’ access and experience with the program. Focus group findings will inform ongoing app development for optimized usability and reduced likelihood of technology abandonment.IMPLICATIONS FOR REHABILITATIONEnd-users’ impressions of the Individual Reduction of faLLs Online application (iROLL-O + app) highlight the potential for integrating mHealth apps in fall prevention and management education efforts, offering a promising and accessible avenue to support the delivery of tailored programs.The study notes that the app facilitates flexible access and wider reach to the program, indicating the importance of incorporating features that enhance accessibility and accommodate the diverse needs of individuals who use wheelchairs and scooters.Actionable suggestions provided by participants underscore the importance of a user-centered design approach in developing rehabilitation-related mobile apps.End-users’ impressions of the Individual Reduction of faLLs Online application (iROLL-O + app) highlight the potential for integrating mHealth apps in fall prevention and management education efforts, offering a promising and accessible avenue to support the delivery of tailored programs.The study notes that the app facilitates flexible access and wider reach to the program, indicating the importance of incorporating features that enhance accessibility and accommodate the diverse needs of individuals who use wheelchairs and scooters.Actionable suggestions provided by participants underscore the importance of a user-centered design approach in developing rehabilitation-related mobile apps. [ABSTRACT FROM AUTHOR]

Background: Falls are prevalent among people living with Multiple Sclerosis (PwMS) and Spinal Cord Injury (PwSCI) who use wheelchairs or scooters (WC/S) full time, however, there is a scarcity of evidence-based fall prevention and management programs. Objective: To describe the systematic translation of an in-person fall prevention and management program (Individualized Reduction Of FaLLs - iROLL) for PwMS to an online platform, extending its scope to include PwSCI, and to evaluate the preliminary useability, usefulness, and safety of the intervention. Methods: iROLL was systematically translated to an online platform (iROLL-O). PwMS and PwSCI who use a WC/S full time, experienced at least one fall within the past 36 months, and could transfer independently or with minimal to moderate assistance, enrolled in iROLL-O. Usability, usefulness, and safety were evaluated through 1:1 semi-structured interviews, gathering feedback on: perceived impact of the intervention on falls and functional mobility, program experiences, adverse events, and recommendations for improvement. Results: Five participants successfully completed the iROLL-O program. No safety concerns were raised by participants. Themes emerging from the semistructured interviews included: (1) barriers and facilitators to program access, (2) motivation for participation, (3) program outcomes, and (4) program content and structure. Participants reported reduced concerns about falling, enhanced functional mobility skills, and highlighted the supportive nature of synchronous group meetings for learning. Conclusion: No adverse events occurred during the implementation of iROLL-O and participants found the program to be useable and useful. Further testing is needed to examine efficacy among a large and diverse population. [ABSTRACT FROM AUTHOR]

Background: Spinal cord injury (SCI) is one of the most catastrophic injuries that might lead to permanent use of a wheelchair and severely affects the quality of life, hence SCI patients report lower satisfaction with life (SWL) than the general population. Therefore, it is important to identify factors that determine SWL among wheelchair users with SCI. Our study aimed to assess the prevalence of low SWL and to identify its determinants among wheelchair users with SCI in Egypt. Methods: A cross-sectional study included 105 wheelchair users with SCI from the Al Hassan Foundation for wheelchair users in Egypt. The main outcome measure was low SWL, while the independent variables included sociodemographic characteristics, injury-related characteristics, anxiety, depression, neuropathic pain, functional independence, and environmental barriers. Results: The prevalence of low SWL among study participants was 57.1%. We found significant associations between SWL and age, area of living, and age at injury. Additionally, SWL correlated negatively with anxiety, depression, neuropathic pain, and environmental barriers, and positively with functional independence. Finally, the binary multiple logistic regression revealed that living in Upper Egypt (p = 0.017, OR = 13.7), depression (p = 0.034, OR = 6.08), older age (p = 0.002, OR = 1.21), and work and school environmental barriers (p = 0.022, OR = 0.46) were the predictors of low SWL. Conclusion: To improve the SWL for wheelchair users with SCI we need to effectively manage neuropathic pain, depression, and anxiety, and promote functional independence. There is an urgent need to reinforce legislation to improve the living conditions for wheelchair users with SCI in Egypt, especially in Upper Egypt. [ABSTRACT FROM AUTHOR]

This study aimed to identify the characteristics and challenges faced by children with disabilities and their families living in rural Thailand, and understand the factors that bring changes in their lives through intervention. In a 2021 online survey on the quality of life of school-aged children with disabilities, approximately half of the respondents indicated that they were not enrolled in school. However, the factors responsible were not identified. Therefore, in 2023, we interviewed three children with disabilities in one of the target areas for the abovementioned survey to explore the correlation between the level of independence in the activities of daily living (ADL) and educational and rehabilitation opportunities. This study did not identify a clear correlation between the two factors. Furthermore, a hypothesis emerged that the changes in their lives are influenced more by environmental factors, especially personal factors such as social group awareness and attitudes, caregivers' understanding and support, and individual relationships within the community. Further research is needed to develop environmental factor assessment tools for problem-solving in accordance with the regional characteristics of rural areas, assess the degree of functional independence of children with disabilities in daily life, and build regional support models. [ABSTRACT FROM AUTHOR]

Satisfaction of 81 patients was evaluated before and after receiving occupational therapy services. There was a statistically significant difference between patients' scores before and after receiving occupational therapy services (p <.05). Over 85% indicated a high satisfaction in relation to quality and health outcomes attributed to occupational therapy services, 44% reported barriers related to limited availability, accessibility, and knowledge of occupational therapy services, and 35% made suggestions for improvements. Patient-therapist communication and easy access to occupational therapy services can enhance occupational therapy knowledge, lead to positive patient experience and quality health outcomes, and higher patient satisfaction. [ABSTRACT FROM AUTHOR]

Purpose: The Wheelchair Skills Training Program (WSTP) is underutilized in pediatrics for training manual wheelchair skills because the voluminous manual lacks pediatric specificity and no materials adapted for pediatric manual wheelchair users (PMWUs) are available. A set of resources (storybook, posters, training workbook) based on the WSTP has previously been developed for training basic indoor wheelchair skills with five to 15-year-old PMWUs. Occupational therapists (OTs) and PMWUs expressed a need for additional resources addressing higher-level skills. Two new sets of resources teaching indoor and community wheelchair skills were developed. Objective: Describe OTs' and PMWUs' satisfaction and perceptions regarding usability, relevance and feasibility in pediatrics with the new resources. Methods: A descriptive qualitative study was conducted. A focus group and interviews were respectively conducted with a convenience sample of OTs and a criterion sample of PMWUs to document perceptions regarding satisfaction, usability, relevance and feasibility. A deductive approach to data analyses was used following the Framework Method. Results: Six OTs expressed satisfaction regarding both sets of resources feeling more confident using the WSTP (relevance) and perceiving potential time efficiencies when planning training interventions (feasibility). They provided suggestions to improve the usability of the second set. Six PMWUs participated in the interviews, two of which provided feedback on both sets. They were satisfied with the resources recommending them to novice and temporary PMWUs aged from three to 11 years. Conclusion: Participants' suggested the resources may contribute to reducing the gap between the evidence supporting the WSTP and its utilization in pediatrics. IMPLICATIONS FOR REHABILITATION: Two sets of knowledge transfer resources based on the Wheelchair Skills Training Program (WSTP) are pediatric-friendly materials that could be used in rehabilitation settings to train wheelchair skills among novice and temporary manual wheelchair users. Both sets of knowledge transfer resources may help bridge the gap between the evidence supporting the WSTP and its utilization in pediatrics by responding to clinicians' needs for playful, easy-to-use and condensed materials to use in their interventions. The perspectives of occupational therapists and pediatric manual wheelchair users are important to improve the wheelchair skills training resources so that they align with both knowledge users' needs and preferences. [ABSTRACT FROM AUTHOR]

Purpose: Where pedestrian crossings meet rail tracks, a flange gap allows the train wheel flanges to pass. This gap can be hazardous for wheelchair users as castor wheels may become trapped. While compressible gap fillers can eliminate the flange gap, fillers are subject to wear, pose a derailment hazard to light rail vehicles and can strip grease from passing wheels. These issues could be mitigated by partially filling the flange gap with a compressible filler. The aim was to investigate the risk of entrapment and ease of extraction of wheelchair castors from flange gaps fully and partially filled with compressible fillers, and assess ride quality. Materials and methods: Entrapment risk and ease of extraction for four wheelchairs were tested at various crossing angles with flange gap fillers. Twelve wheelchair users tested ease of extraction and ride quality for partially and fully filled flange gaps. Results: It was found that risk of entrapment is low if a standards-compliant crossing with open flange gaps is traversed in a straight line. However, castors can become trapped if the user alters direction to avoid an obstacle or if the crossing surface is uneven. Once trapped, castors are extremely difficult to remove without external assistance. Conclusions: Flange gap fillers that reduce the gap to 10 mm or less eliminate entrapment while retaining acceptable ride quality. Filling flange gaps or leaving a residual gap depth of less than 10 mm is the best option to eliminate risk of entrapment and ensure good ride quality for wheelchair users. IMPLICATIONS FOR REHABILITATION: Rail crossings flange gaps pose an entrapment hazard for wheelchair users Partial or complete flange gap fillers may reduce entrapment but require research Rehabilitation professionals need to educate wheelchair users on techniques to cross flange gaps safely Consumers and health professionals can consult rail operators to partially fill flange gaps [ABSTRACT FROM AUTHOR]

AbstractThis Current Issues piece is a primarily creative piece of writing that takes as its starting point the concept of broken narratives. In writing with her own disability, the author, a wheelchair user, offers a series of broken narratives through which she actively seeks to create her own narrative coherence. In so doing, she expresses some of her thoughts and feelings about disability that she struggles to articulate verbally and directly. [ABSTRACT FROM AUTHOR]

Abstract\nIMPLICATIONS FOR REHABILITATIONMany Canadian manual wheelchair users face many challenges in winter months such as slippage on ice- or snow-covered ramps, snow windrows, and casters becoming stuck in deep or hard packed snow. These barriers impact wheelchair users’ ability to participate in the community. This study aimed to evaluate the validity and feasibility of a winter wheelchair obstacle course known as the Standardized Navigation Of Winter Mobility & Accessibility Network (SNOWMAN). The results demonstrated that the SNOWMAN course authentically represented real-world winter conditions, as confirmed by participant responses and qualitative feedback from four manual wheelchair users. The course was comprehensive, covering a range of winter obstacles typically encountered by wheelchair users. Construct validity was established by differentiating performance between manual wheelchairs and a motorized platform with snow tracks, showcasing varying completion times and device satisfaction levels. Feasibility was also assessed, with the administration protocol being mostly adhered to, safety measures implemented, and usability scores meeting acceptable thresholds. The SNOWMAN course showed promise for evaluating wheelchair adaptations and devices for winter conditions, as well as training users in winter mobility skills. Future research directions include comparing different wheeled mobility devices, exploring adaptations for usability in winter, and developing new technology tailored for challenging terrains and winter conditions. The SNOWMAN course could serve as a valuable tool for both research and clinical applications in enhancing winter mobility for wheelchair users.The SNOWMAN course demonstrates strong potential for ecologically valid evaluation and development of wheelchairs and adaptations specific to winter conditions.The SNOWMAN course provides a venue to safely evaluate and train authentic winter mobility skills and strategies.The SNOWMAN course has the potential to positively impact the broader community by enhancing awareness of winter mobility and accessibility issues.The SNOWMAN course demonstrates strong potential for ecologically valid evaluation and development of wheelchairs and adaptations specific to winter conditions.The SNOWMAN course provides a venue to safely evaluate and train authentic winter mobility skills and strategies.The SNOWMAN course has the potential to positively impact the broader community by enhancing awareness of winter mobility and accessibility issues. [ABSTRACT FROM AUTHOR]

AbstractIntroductionMaterial and MethodsResults and discussionConclusion\nIMPLICATION FOR REHABILITATIONMost people with a spinal cord injury are concerned by pressure injuries (PrI). Since dynamic activities may involve distributions of forces over time that are different from static and given the significant impact of PrIs on healthcare costs, it is, important to study these sitting forces. We aim to investigate sitting forces (overall normal, shear forces and Peak Pressure Index (PPI)) assessed in both able-bodied and wheelchair users (WCU) under static and dynamic conditions. Our hypothesis is that wheelchair sitting forces encountered by able-bodied participants are significantly different from those of WCUs.An experimental seat and a pressure mapping system were used to investigate forces in two different populations, 102 able-bodied and 15 WCUs, in static conditions and during synchronised hand-cycling. The analysis includes statistical comparisons of the sitting conditions (static/dynamic) and of the populations (able-bodied/WCUs).Significant differences in normal forces and PPI were observed between able-bodied and WCUs; conversely, differences in shear forces were non-significant. This suggests that contrary to shear forces, no conclusion on normal forces drawn from trials with healthy participants can directly be applied to WCUs. Secondly, the present results indicate significant reduced averaged: normal force, PPI, and shear forces for able-bodied performing a dynamic activity compared to static sitting. WCUs experienced non-significant lower averaged normal force and PPI but significant lower averaged shear forces.While the present results seem to indicate lower forces for able-bodied performing a dynamic activity compared to static sitting, due to reduced averaged forces, this conclusion is less clear-cut for WCUs.The present observational study can help understand the specific characteristics of wheelchair users concerning the biomechanical sitting load in rest and during propulsive activity: the shear forces are reduced during activity compared to static conditions.From the data collected in the present study, it seems that no conclusion on normal sitting forces drawn from trials with healthy participants can directly be applied to wheelchair users.The present observational study can help understand the specific characteristics of wheelchair users concerning the biomechanical sitting load in rest and during propulsive activity: the shear forces are reduced during activity compared to static conditions.From the data collected in the present study, it seems that no conclusion on normal sitting forces drawn from trials with healthy participants can directly be applied to wheelchair users. [ABSTRACT FROM AUTHOR]

Most manual wheelchair users with pediatric-onset spinal cord injury (SCI) will experience shoulder pain or pathology at some point in their life. However, guidelines for preservation of the upper limb in children with SCI are limited. What are the relationships between manual wheelchair handrim kinetics and quantitative ultrasound parameters related to subacromial impingement in individuals with pediatric-onset SCI? Subacromial impingement risk factors including supraspinatus tendon thickness (SST), acromiohumeral distance (AHD), and occupation ratio (OR; SST/AHD) were measured with ultrasound in 11 manual wheelchair users with pediatric-onset SCI. Handrim kinetics were acquired during the stroke cycle, including peak resultant force (F R), peak rate of rise of resultant force (ROR) and fractional effective force (FEF). Variability of handrim kinetics was computed using the coefficient of variation and linear regression was performed to assess correlations between handrim metrics and quantitative ultrasound parameters. Peak resultant force significantly increased 1.4 % and variability of FEF significantly decreased 8.0 % for every 0.1 cm increase in AHD. FEF decreased 3.5 % for every 0.1 cm increase in SST. Variability of peak resultant force significantly increased 3.6 % and variability of peak ROR of resultant force significantly increased 7.3 % for every 0.1 cm increase in SST. FEF variability significantly decreased 11.6 % for every 0.1 cm increase in SST. Peak ROR significantly decreased 1.54 % with every 10 % increase in OR. FEF variability significantly decreased 1.5 % with every 10 % increase in OR. This is the first study to investigate relationships among handrim kinetics and shoulder structure in manual wheelchair users with pediatric-onset SCI. Associations were identified between subacromial impingement risk factors and magnitude and variability of wheelchair handrim kinetics. These results indicate the critical need to further explore the relationships among wheelchair handrim kinetics, shoulder joint dynamics, and shoulder pathology in manual wheelchair users with pediatric-onset SCI. • Wheelchair handrim kinetics are associated with risk of subacromial impingement. • Subacromial impingement risk decreases with increasing variability of handrim force. • Ultrasound can quantify risk factors of shoulder impingement in wheelchair users. • Supraspinatus tendon size correlates with handrim force variability and magnitude. • Subacromial occupation ratio decreases with increasing rate of force application. [ABSTRACT FROM AUTHOR]

Background and Aims: Wheelchairs are a basic necessity for people with disabilities, especially people with physical disabilities. Although conventional wheelchairs have aided the mobility of people with disabilities, they are limited in scope due to physical exhaustion and health problems from sitting in wheelchairs for a long time. This research is important to develop seatback and cushion features for Health Electric Wheelchair Portable IoT-Based wheelchairs, for easy and comfortable mobility for people with disabilities. The development of wheelchairs aims to reduce the negative impact of prolonged immobilization on people with physical disabilities. Methods: Research & Development method. The development stage: 1). The development of pads for Health Electric Wheelchair Portable IoT-Based seatback and cushion needed by wheelchair users; 2). Development of expert-validated Health Electric Wheelchair Portable IoT-Based ergonomics and seatback in accordance with the needs of wheelchair users to improve physical independence; 3). Modify components and equipment for Health Electric Wheelchair Portable IoT-Based cushion and seatback. Results: The result of this development of this wheelchair pays attention to ergonomic design by developing seatback and chair features for Health Electric Wheelchair Portable IoT-Based wheelchairs to provide safety and comfort when using wheel-chairs, especially physical disability. Conclusion: The development of cushion and seatback on wheelchairs can reduce the negative impact of immobilization on people with physical disabilities and is able to provide broad access for users to mobilize on wheelchairs and can adjust to the ergonomics of each user's body. [ABSTRACT FROM AUTHOR]

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

INTRODUCTION: Introduction: To define wheelchair suitability in patients with stroke due to a cerebrovascular event (CVE). METHODS: Materials and Methods: The study included 40 patients with a diagnosis of stroke. Demographic and clinical characteristics of the patients were noted. All wheelchair parts were evaluated by the same rehabilitation physician. In general, a wheelchair was considered inappropriate if at least three parts were inappropriate. The dependence and satisfaction of the patients in wheelchair use were evaluated. RESULTS: Results: The mean age of the patients was 68.07+-7.24 years. Seat height (n=24, 60%), seat depth (n=16, 40%), footrest (n=24, 60%), cushion (n=26, 65%) and belt (n=30, 75%) were the most common inappropriate factors. It was determined that 85% of the patients were using an inappropriate wheelchair, 60% of the wheelchairs were purchased on prescription, 90% of the patients were completely wheelchair dependent, and only 2.5% were using a powered-wheelchair. Wheelchair-related falls were reported by 13 (32.5%) patients. DISCUSSION AND CONCLUSION: Conclusıon: The results of this study showed that 85% of patients with stroke due to CVE were using inappropriate wheelchairs. These patients require the use of a wheelchair designed specifically for the patient.

AbstractPurposeMaterials and methodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONTo evaluate the psychometric properties of a Fall Concerns Scale for people who use Wheelchairs and Scooters (FCS-WC/S).Developed by fall prevention experts, FCS-WC/S underwent refinement through interdisciplinary reviews and focus groups with researchers, clinicians, and individuals who use WC/S full-time. The psychometric evaluation involved adults who used WC/S for ≥1 year and had ≥1 fall in the previous 3 years, recruited between April and September 2022.The FCS-WC/S evaluates fall concerns among people with various health conditions who use WC/S full-time across 33 daily activities. One hundred and twenty-four participants responded to the baseline survey. A subgroup of 63 people repeated the FCS-WC/S a week later. The FCS-WC/S demonstrated excellent internal and good test–retest reliability (α ≥ 0.90, ICC = 0.86–0.9), as well as concurrent validity (Spearman’s rho = 0.72) with the Spinal Cord Injury Falls Concern Scale (SCI-FCS). It effectively differentiated fear of falling levels from an established measure (ORs 4.1, 25.8, 46.7). Factor and parallel analysis revealed three factors, two of which were retained for further analysis.Preliminary findings support FCS-WC/S validity and reliability for assessing fall concerns among individuals with various conditions who use WC/S. Further scale construction analysis is recommended.Measuring concerns about falling among full-time wheelchair and scooter users is crucial due to its potential negative impact on activity curtailment, which in turn may affect community participation and quality of life.Most validated tools, except for the Spinal Cord Injury-Falls Concern Scale, designed for manual wheelchair users with spinal cord injury, are primarily tailored for individuals who ambulate, highlighting the need for assessment tools specifically designed for full-time wheelchair and scooter users.Using the Spinal Cord Injury-Falls Concern Scale as a foundation, the Fall Concerns Scale for people who use Wheelchairs and Scooters was developed to measure fall concerns among full-time wheelchair and scooter users, irrespective of their specific health conditions.The Fall Concerns Scale for people who use Wheelchairs and Scooters has a good potential to offer clinicians a valid and reliable tool to systematically screen fall concerns across various health conditions, with further large-scale studies needed to validate the tool across a wider range of health conditions.Measuring concerns about falling among full-time wheelchair and scooter users is crucial due to its potential negative impact on activity curtailment, which in turn may affect community participation and quality of life.Most validated tools, except for the Spinal Cord Injury-Falls Concern Scale, designed for manual wheelchair users with spinal cord injury, are primarily tailored for individuals who ambulate, highlighting the need for assessment tools specifically designed for full-time wheelchair and scooter users.Using the Spinal Cord Injury-Falls Concern Scale as a foundation, the Fall Concerns Scale for people who use Wheelchairs and Scooters was developed to measure fall concerns among full-time wheelchair and scooter users, irrespective of their specific health conditions.The Fall Concerns Scale for people who use Wheelchairs and Scooters has a good potential to offer clinicians a valid and reliable tool to systematically screen fall concerns across various health conditions, with further large-scale studies needed to validate the tool across a wider range of health conditions. [ABSTRACT FROM AUTHOR]

Seat tilting wheelchair features can increase the comfort and safety of the user. Although many power wheelchairs have tilting mechanisms, they are often designed with a specific wheelchair model in mind. In this study, a design process for seat tilting mechanisms that can be applied to most rear-wheel drive wheelchair models is developed. Equations were developed to describe the geometrical and load constraints that were used to size the electric actuator that powers the system and define its position. Finally, the equations were used to create the seat tilting mechanism of a prototype wheelchair, which was then tested. The equations yielded coherent results which showed that advantageous actuator positions from a load minimization perspective usually require dimensions that cannot be found in commercial actuators. Also, there are positions in which the load increases exponentially, which should be avoided. The tests showed that the system was able to function properly on the prototype wheelchair and that the actuator position affected the time taken for the actuator to execute different parts of the tilting movement. The design process presented here was successful and modelled by general equations that can be applied to most front-wheel drive wheelchairs. It presents a low-cost option for the design of seat tilting systems, which can increase their accessibility. Developing new systems to provide improvements in assistive technologies is fundamental for social reintegration and quality of life improvement. Wheelchairs with a seat stabilization system for moving through inclined terrain can provide greater comfort and safety to the user. Adding low-cost functionalities to wheelchairs is essential to make them more accessible to people, therefore, this paper provides a design method of a new seat stabilization system applied to low-cost wheelchairs. [ABSTRACT FROM AUTHOR]

Manual wheelchairs, which are the basic means of transport for people with disabilities, are usually characterized by an inefficient adaptation to the physical capabilities of their users. For this reason, it is advisable to search for solutions that will allow us to change the parameters of the mechanical power generated by human muscles. For this purpose, mechanical gearing known from other solutions, for example, from bicycles, can be used. The paper describes the design methodology and a number of issues related to the construction of an innovative wheelchair prototype using a chain transmission in its drive system. This solution allows for the implementation of a variable ratio between the wheels and the pushrims. Thus, it effectively allows for matching the demand for driving torque to the movement conditions and the physical capabilities of its user. The use of such a system provides the basis for increasing the efficiency of the manual propulsion process. Initial studies show that changing the gear ratio allows for different speeds of the wheelchair wheel. In the tests conducted, the root mean square of this value varied from 15.2 RPM to 35.5 RPM, which resulted in a change in power from 15.8 W to 40.1 W. Of course, the values of rotational speed and torque show a cyclically changing character, which results from the intermittent nature of generating drive by the wheelchair user. The average peak values of rotational speed were 31.4 ± 1.7 RPM, 44.3 ± 3.4 RPM and 57.9 ± 3.4 RPM, while the torque was 12.1 ± 0.5 Nm, 12.4 ± 0.4 Nm and 14.1 ± 0.6 Nm for Gears 1, 4 and 6, respectively. [ABSTRACT FROM AUTHOR]

Abstract\nIMPLICATIONS FOR REHABILITATIONWheelchair users (WCUs) face additional challenges than non-WCU to multi-tasking (i.e. open doors, cook, use a cell-phone) while navigating their environments. While assistive devices have attempted to provide WCUs with mobility solutions that enable multi-tasking capabilities, current devices have been developed without the input of end-users and have proven to be non-usable. More balanced approaches that integrate the end-users’ voices may improve current assistive technology usability trends. This study sought to empathically understand the lived experience of WCUs, their needs towards a mobility device, and their perceptions towards hands-free mobility. Full-time WCUs and care providers participated in semi-structured interviews examining wheelchair use and perceptions towards current and future mobility devices. Thematic analysis was used to analyze interview data. 9 WCUs (aged 32.1 ± 7.0 years; wheelchair experience 17.9 ± 11.6 years) and five care providers (years caring for WCU 3.75 ± 0.96 years) participated in the study. The most common disability type was spinal cord injury (WCUs: n = 3; care providers: n = 3). Qualitative analysis revealed four key themes: (1) Current wheelchair usage, (2) WCU and care provider perspectives, (3) Future wheelchair, and (4) Hands-free wheelchair. Accordingly, participants desire bespoke, light-weight mobility devices that can through tight spaces, access uneven terrain, and free the hands during navigation. This study provides meaningful insight into the needs of WCUs and care providers that assistive technology innovators can use to develop more usable assistive technologies. Amongst study participants, the concept of a hands-free mobility device appears to be usable and desirable.Integrating end-users’ voices into the development of assistive technology may improve current usability trendsWheelchair users desire access to their hands and the ability to multi-task while navigating their wheelchairsThe development of a hands-free mobility device may profoundly improve the quality of life of wheelchair users.Integrating end-users’ voices into the development of assistive technology may improve current usability trendsWheelchair users desire access to their hands and the ability to multi-task while navigating their wheelchairsThe development of a hands-free mobility device may profoundly improve the quality of life of wheelchair users. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although rehabilitation exercise is known to be beneficial for cardiovascular and mental health, it remains a daunting challenge for patients with spinal cord injury (SCI) who rely on wheelchairs for mobility. OBJECTIVE: This study aimed to examine the effectiveness of a 4-week para table tennis program in enhancing self-efficacy and health outcomes in adults with SCI. METHODS: A total of 39 SCI patients were included and divided into the experimental group (n = 18, a 4-week para table tennis training program) and the control group (n = 21). Frequency domain indices of heart rate variability (HRV) were used to evaluate the function of the autonomic nervous system. RESULTS: Following para table tennis training, there was a significant reduction in the physical stress index (PSI, P < 0.001), accompanied by shifts in autonomic regulation of vagal dominance. Additionally, the para table tennis training led to significant improvements in vessel state, differential pulse wave index, atrial elasticity, eccentric constriction power, remaining blood volume, and self-efficacy (all P < 0.05). CONCLUSION: Para table tennis training results in favorable changes in sympathetic tone, enhanced self-efficacy, improved cardiovascular well-being, and an overall positive transformation in HRV. [ABSTRACT FROM AUTHOR]

The increasing number of wheelchair users and their risk of medical complications such as pressure ulcers (PU) make it important to have a better understanding of their seating characteristics. However, while most studies tackling this issue are based on static measurements, wheelchair users are active in their wheelchairs when performing daily life activities. This suggests the need to assess the mechanical loads at the wheelchair user's body–seat interface during dynamic activities. A scoping review was conducted to explore the existing data (shear load and pressure) and highlight significant parameters, relevant conditions and methodological strategies when studying wheelchair users performing a dynamic task. The literature search was performed by applying the PRISMA methodology. A total of 11 articles met the inclusion criteria. Differences between static and dynamic data were found in the literature for peak pressure values, pressure distribution and the location of peak pressure. None measured tangential load at the seat/body interface, although two studies measured the shift of the ischial region. A significant impact of the type of pathology has been quantified, showing the need to perform experimental studies on diverse populations. The protocol and the pressure parameters studied were very diverse. Further studies carefully choosing interface pressure mapping parameters and investigating a broader range of pathologies are required. Additionally, researchers should focus on finding a way to measure seated tangential load. [ABSTRACT FROM AUTHOR]

Adapted ride-on cars (ROC) are an affordable, power mobility training tool for young children with disabilities. Previous qualitative research has identified environmental factors, such as weather and adequate drive space, as barriers to families' adoption of their ROC. However, we do not currently know the relationship between the built environment and ROC usage. In our current study, we quantified the driving patterns of 14 children (2.5 ± 1.45 years old, 8 male: 6 female) using ROCs outside and inside of their homes over the course of a year using a custom datalogger and geospatial data. To measure environmental accessibility, we used the AccessScore from Project Sidewalk, an open-source accessibility mapping initiative, and the Walk Score, a measure of neighborhood pedestrian-friendliness. The number of play sessions with the ROC ranged from 1 to 76; 4 participants used it less than 10 times and 4 participants used it more than 50 times. Our findings indicate that more play sessions took place indoors, within the participants' homes. However, when the ROC was used outside the home, children engaged in longer play sessions, actively drove for a larger portion of the session, and covered greater distances. Most children tended to drive their ROCs in close proximity to their homes, with an average maximum distance from home of 181 meters. Most notably, we found that children drove more in pedestrian-friendly neighborhoods and when in proximity to accessible paths. The accessibility of the built environment is paramount when providing any form of mobility device to a child. Providing an accessible place for a child to move, play, and explore is critical in helping a child and family adopt the mobility device into their daily life. Ride-on cars provided a novel means for young children with disabilities to explore their home and community environments. Children drove their adapted ride-on cars for longer periods of time outside than inside, and in close proximity to their homes. The identification of an accessible route increased driving frequency and drive session duration. Recommending accessible routes and play locations where families can use their adapted ride-on car may be an important aspect of increasing mobility technology use. Because there were a higher number of play sessions inside, it is important to consider indoor accessibility when designing and implementing mobility technology for young children. [ABSTRACT FROM AUTHOR]

To characterize the relationship among rolling resistance (RR), preferred speed, and propulsion mechanics. N = 11 non-disabled individuals (mean (SD)); Age 24 years (2), BMI 23.8 kg/m2 (4.3) completed a submaximal graded wheelchair exercise test (GXTsubmax, fixed speed, terminated at Rating of Perceived Effort (RPE)=8 (0-10 scale)) and a single-blind, within-subject repeated measures wheelchair propulsion experiment (RME). RR at RPE = 10 (estimated maximum workload, Maxestimated) was estimated from the GXTsubmax RPE-RR relationship. RME consisted of N = 19 1-minute trials (self-selected speed) each followed by 2-minutes rest. The trials included N = 16 unique RR between 25-100% of Maxestimated. Averages of all pushes in N = 16 unique 1-minute trials were computed for average RR (N), speed (m/s), peak force (Fpeak (N)), force rate of rise (Fror (N/s)), push frequency (PF (pushes/min)), and push length (PL (deg)). Repeated measures correlation assessed relationships among outcome variables (α = 0.05). RR was associated with decreased speed (r=–0.81, p < 0.001), increased Fpeak (r = 0.92), Fror (r = 0.26), and PL (r = 0.32) (all p > 0.001), and unrelated to PF (r = 0.02, p = 0.848). Increased speed was associated with increased Fror (r = 0.23, p = 0.003) and PF (r = 0.27, p < 0.001) and decreased Fpeak (r=–0.66, p < 0.001) and PL (r=-0.25, p < 0.001). Increasing RR increases Fpeak despite reducing self-selected speed. RR and speed were strongly and moderately related to Fpeak, respectively, but weakly related to other propulsion mechanics. These results suggest that reducing user-system RR may confer dual benefits of improved mobility and decreased upper extremity loading. Further testing among wheelchair users is required. Clinical trial registration number: NCT04987177 To our knowledge, this is the first study to directly characterize the dose-response relationship between rolling resistance and manual wheelchair propulsion biomechanics. By characterizing the relationship between rolling resistance and propulsion mechanics, more objective and accurate clinical interventions can be assessed/implemented. Our results suggest that reducing the user-wheelchair system rolling resistance should decrease peak forces, which is favorable, as increased peak forces have been linked to upper extremity pain and pathology. Our findings of weak relationships between rolling resistance and push length, push frequency, and force rate of rise, suggest that reductions in rolling resistance may not be the optimal method for "improving" these variables. Propulsion training has been shown to achieve long-term favorable changes in these variables, so an area for future work can be to evaluate if reducing rolling resistance or propulsion training is more effective at "improving" these variables. The strong relationship we observed between rolling resistance and self-selected speed, suggests that user-wheelchair system rolling resistance reductions might encourage increased mobility in the home and community, theoretically improving participation and thus quality of life. [ABSTRACT FROM AUTHOR]

To examine the biomechanical demands of manual wheelchair propulsion, it is crucial to determine the wheelchair user's (WCU) force for propulsion technique parameter calculation. When using a pushrim-activated power-assisted wheelchair (PAPAW) on a wheelchair ergometer, a combined propulsion force from the WCU and PAPAW is exerted. To understand PAPAW's assistance and distinguish the WCU's force application from the force exerted by the PAPAW, both propulsion components must be assessed separately. In this study, a calibration of the PAPAW on an ergometer was developed to achieve this separation. The calibration consists of five steps: (I) Collecting data on force and velocity measured from the ergometer, along with electrical current and velocity from the PAPAW. (II) Synchronizing the velocity signals of the wheelchair ergometer and PAPAW using cross-correlation. (III) Calibrating the PAPAW's electromotors to convert electrical current (mA) to force (N). A product-specific motor constant of 0.30, provided an average ICC of 0.563, indicating a moderate agreement between the raw ergometer data (N) and the motor constant-converted drive-rim (PAPAW) data (from mA to N). (IV) Subtracting the PAPAW's force signal from the ergometer's measured force to isolate forces generated by the WCU. (V) Using markerless motion capture to determine and validate the phase of hand contact with the handrim. This technical note provides an example of PAPAW calibration for researchers and clinicians. It emphasizes the importance of integrating this calibration into the development of PAPAW devices to reveal the complex interaction between PAPAW and WCU during wheelchair propulsion. [ABSTRACT FROM AUTHOR]

powered mobility device (PMD) users in an assisted living facility (ALF). Method: A case study approach using three forms of data (semi-structured interview, observation, and media collection of pictures) was used to formulate a comprehensive description of the two PMD user’s experiences. Data analysis was completed using line-by-line coding and in vivo to generate possible themes. Process coding, descriptive coding, and analytic memos were then employed to better understand the connection of the data and ensure themes generated were appropriate. Results: Following data analysis, five themes emerged from the data: (a) “I swore I’d never be in a wheelchair” – Initial disapproval, (b) “Because I lost my leg” – The need to use a power wheelchair, (c) “I don’t know what I’d do without it” – Independence and usability, (d) “If somebody tells you STOP! You stop” – Adaptations for safety, and (e) “They just put me in it and let me go” – Lack of training. Conclusion: The importance of screening users before implementing a PMD and providing training to all PMD users when provided is indicated. [ABSTRACT FROM AUTHOR]

Introductions: To define wheelchair suitability in patients with stroke due to a cerebrovascular event (CVE). Materials and Methods: The study included 40 patients with a diagnosis of stroke. Demographic and clinical characteristics of the patients were noted. All wheelchair parts were evaluated by the same rehabilitation physician. In general, a wheelchair was considered inappropriate if at least three parts were inappropriate. The dependence and satisfaction of the patients in wheelchair use w ere evaluated. Results:: The mean age of the patients was 68.07±7.24 years. Seat height (n=24, 60%), seat depth (n=16, 40%), footrest (n=24, 60%), cushion (n=26, 65%) and belt (n=30, 75%) were the most common inappropriate factors. It was determined that 85% of the patie nts were using an inappropriate wheelchair, 60% of the wheelchairs were purchased on pres cription, 90% of the patients were completely wheelchair dependent, and only 2.5% were using a powered-wheelchair. Wheelchair-related falls were reported by 13 (32.5%) patients. Conclusion: The results of this study showed that 85% of patients with stroke due to CVE were using inappropriate wheelchairs. These patients require the use of a wheelchair designed specifically for the patient. [ABSTRACT FROM AUTHOR]

This study aimed to clarify the kinematics, particularly of the shoulder and hip joints, during preparation for manual wheelchair-to-bed transfer (i.e. when flipping up the arm and foot supports). This cross-sectional study included 32 able-bodied individuals. The kinematics of the shoulder and hip joints when the arm and foot supports were flipped up of manual wheelchair, were evaluated using a markerless inertial sensor-based motion capture system. We found that flipping the arm support upwards involved a large amount of abduction, internal and external rotation, flexion, and extension at the shoulder joint, whereas flipping the foot support upwards involved a large amount of flexion at the hip joint. The findings suggest that it is necessary to consider the range of motion required to flip up the arm and foot supports of manual wheelchairs, particularly in those with limited shoulder and hip range of motion such as older people, neuromuscular disorders, and orthopedic disorders. [ABSTRACT FROM AUTHOR]

Wheelchairs are the primary means of movement for people with mobility disabilities, regardless of their type of drive. One of the main features of wheelchairs, besides their ability to generate drive, maneuverability, and body support, is their stability of movement. This stability largely depends on the height of the center of gravity in the human-wheelchair system. This parameter is very important from the perspective of wheelchair user safety, especially when overcoming architectural obstacles such as curbs, stairs, or slopes. Currently, many models available on the market have additional protection in the form of support wheels, which prevent the wheelchair from tipping over backwards with the user. However, the use of these support wheels is associated with an increase in the weight and dimensions of the wheelchair, as well as a decrease in ergonomics. Faced with this problem, the authors have set out to present an innovative method for calculating the height of the center of gravity and conducted a series of experimental tests on various wheelchair designs. The research analyzed the displacement of the center of gravity depending on the angle of the inclination of the ground from 0° to 15°. The conclusions obtained regarding stability and the calculation of the center of gravity in relation to maintaining balance can form the basis for designing new wheelchair structures. [ABSTRACT FROM AUTHOR]

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AbstractPurposeMaterials and MethodsResults and Conclusions\nIMPLICATIONS FOR REHABILITATIONWheelchair users experience many barriers to physical activity as affordable and accessible exercise equipment options are limited. Thus, the home-based adapted rower (aROW) and gym-based aROW were developed. The objectives were to determine: 1) wheelchair users’ preferences, perspectives, facilitators, and barriers to using the home-based versus the gym-based aROW, 2) perceived usability of the home and gym aROWs, and 3) recommendations to adapt the aROW further for home and community use.In this two-phase exploratory mixed-methods study, participants completed one month of using a home aROW, followed by one month of using a community gym aROW. After each phase, participants completed a semi-structured interview and the System Usability Scale (SUS) questionnaire. Interview data were analyzed using conventional content analysis and effect size comparing SUS data was calculated.Four categories were identified: what worked well, barriers to using the aROWs, what could be improved and important considerations. There was a large effect size in perceived usability between the aROWs with participants preferring the home aROW. Overall, rowing was enjoyable, and participants achieved positive physical outcomes. As preferences are individual, the home aROW provides wheelchair users with a potential choice between home or gym exercise.Rowing is an enjoyable and effective form of aerobic exercise for wheelchair usersWheelchair users experience social, environment and financial barriers to engaging in exerciseThe home aROW provides a low-cost and accessible option for wheelchair-adapted aerobic exerciseRowing is an enjoyable and effective form of aerobic exercise for wheelchair usersWheelchair users experience social, environment and financial barriers to engaging in exerciseThe home aROW provides a low-cost and accessible option for wheelchair-adapted aerobic exercise [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusion\nIMPLICATION FOR REHABILITATIONTo identify the factors associated with the fear of falling (FOF) and fall-related injuries (FRI) among full-time wheelchair and motorized mobility scooter (WC/S) users with various health conditions.This cross-sectional study included participants (≥18 years old) who used WC/S for at least one year for ≥ 75% of mobility and had a history of ≥ 1 fall in the past three years. Logistic regression models identified factors associated with FOF (yes/no) and FRI (yes/no) during the past year. Data on demographics, prior falls, mental health, environmental accessibility, and WC/S usage were used as independent variables.Among 156 participants, 96% reported at least one fall within the past year, among whom 94.6% reported FOF, and 74% reported FRI within the same period. FOF was associated with fall incidence in the past year (OR = 17.75, p = 0.001). FRI was associated with higher levels of anxiety (OR = 1.15, p = 0.003) and fewer hours of WC/S use per week (OR = 0.98, p = 0.012).This study highlights the high prevalence of FOF and FRI among WC/S users who had falls. The findings emphasized the relation between prior fall experiences and FOF and underscored the significance of addressing anxiety symptoms and WC/S usage in relation to FRI.Among individuals with a variety of health conditions who use wheelchairs and motorized mobility scooters full-time for most of their mobility and have experienced at least one fall incident within the past year, the prevalence of psychosocial and physical consequences of falls (fear of falling and fall-related injuries) is relatively high.Given the significant association between an individual’s previous fall experiences and the likelihood of fear of falling, continuous screening for falls is a crucial step toward fall prevention for people who use wheelchairs and motorized mobility scooters full-time.Recognizing the importance of the unique needs of individuals who use wheelchairs and motorized mobility scooters and tailoring interventions like wheelchair skills and anxiety management education may enhance overall rehabilitation outcomes.Among individuals with a variety of health conditions who use wheelchairs and motorized mobility scooters full-time for most of their mobility and have experienced at least one fall incident within the past year, the prevalence of psychosocial and physical consequences of falls (fear of falling and fall-related injuries) is relatively high.Given the significant association between an individual’s previous fall experiences and the likelihood of fear of falling, continuous screening for falls is a crucial step toward fall prevention for people who use wheelchairs and motorized mobility scooters full-time.Recognizing the importance of the unique needs of individuals who use wheelchairs and motorized mobility scooters and tailoring interventions like wheelchair skills and anxiety management education may enhance overall rehabilitation outcomes. [ABSTRACT FROM AUTHOR]

Seat pressure measurements in wheelchair users have been available for some time; however, repeated measurements from a commercially available pressure mat over 90 min did not differ in the pressure-loaded measurement area or the coordinates of the center of pressure, even in participants who were able to reposition themselves in the wheelchair. The question therefore arises: to what extent are there other parameters that reflect the activity of wheelchair users with the pressure mat? To investigate this, a commercial pressure mat (BodiTrak®) was used to perform the measurements of pressure of 33 adult wheelchair-dependent people with spinal cord injury after 30 and 90 min sitting on the cushion. In addition to the standard output of the pressure mat, graph-based surface analyses (calculation of the area of maximum pressure, calculation of the pressure-loaded measurement area, and pressure–area ratio) was performed retrospectively using Python 3.7. The analysis of the measurements after 30 and 90 min was performed by distinguishing the participants between those who could actively change their position (N = 24) and those who could not (N = 9). The parameters of the pressure mat and the graph-based analyses remained unchanged for active participants. In participants who were unable to actively change their position, the area of maximum pressure and the pressure–area ratio (ratio of maximum pressure area and total pressure-loaded area) increased. Significant differences between minutes 30 and 90 are only found for the pressure–area ratio. Thus, when measuring the seat pressure of wheelchair users, the pressure–area ratio should be taken into account as it reflects the daily relief activities of wheelchair users. [ABSTRACT FROM AUTHOR]

AbstractPurpose of the articleMaterials and MethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONThe aim of this study was to determine user satisfaction with manual wheelchairs in the United Kingdom and to determine areas that could be improved to help drive future design and development.Manual wheelchair users, aged 18-65 years old living in the United Kingdom, were invited, to complete an online cross-sectional questionnaire. The link to the questionnaire was distributed using a range of methods to charities, organisations and wheelchair user groups via invitation by email and social media. Responses were gathered from 122 respondents and analysed using descriptive statistics, cross-tabulation and content analysis.Respondents felt comfort (39.3%), weight (35.4%), manoeuvrability (34.3%) and durability (30.7%) were the most important features of a wheelchair. Seventy percent of respondents that were “not at all satisfied” with their current wheelchair were fitted by the National Health Service (NHS, X2 = 42.39, p < 0.001). Ninety percent of respondents who were “not at all satisfied” with their current wheelchair experienced issues with comfort (X2 = 17.82, p = 0.001). Sixty percent who were “not satisfied at all” with their wheelchair had not chosen their wheelchair (X2 = 25.15, p < 0.001).Wheelchair satisfaction was largely determined by comfort, location of the users’ wheelchair fitting (for example the NHS) and users choosing their own wheelchair. Future wheelchair designs should utilise a user centred and inclusive design approach to cater for a wider range of individual needs and requirements.Manual wheelchair users in the UK are more likely to be satisfied with their wheelchair if they were fitted by a service other than the National Health Service (NHS), chose their own wheelchair and experience no issues with comfort.Wheelchair fittings should account for individual differences and requirements as no model or size can cater for all users. This may help increase wheelchair satisfaction and comfort for the user.Manufacturers should consider more inclusive designs to cater for a wider range of users, for example accommodating female users at different stages throughout their lifetime.Manual wheelchair users in the UK are more likely to be satisfied with their wheelchair if they were fitted by a service other than the National Health Service (NHS), chose their own wheelchair and experience no issues with comfort.Wheelchair fittings should account for individual differences and requirements as no model or size can cater for all users. This may help increase wheelchair satisfaction and comfort for the user.Manufacturers should consider more inclusive designs to cater for a wider range of users, for example accommodating female users at different stages throughout their lifetime. [ABSTRACT FROM AUTHOR]

(1) Background: Upper body pain, particularly in the limbs and shoulders, is a common symptom among patients with spinal cord injury (SCI) and wheelchair users. Despite the focus on resistance muscle training as a suitable intervention for SCI individuals, findings across different populations and conditions have been inconsistent. (2) Methods: We conducted a systematic review to elucidate the correlations among exercise interventions, muscle strength enhancement, and pain reduction. A comprehensive literature search was performed using the keywords "spinal cord injury," "pain," "exercise," "disability," "paraplegia," and "tetraplegia" across the DBpia, EMBASE, PubMed, and Science Direct databases. (3) Results: From 191 identified articles, 13 studies (1 from Korea and 12 from other countries) were selected for analysis. The results indicate that exercise interventions are effective in reducing pain in patients with SCI, with a particular emphasis on alleviating shoulder pain. (4) Conclusion: Exercise is essential for pain reduction in patients with SCI, especially those experiencing shoulder pain. However, there is a notable lack of experimental research focusing primarily on pain. The development of appropriate measurement instruments is crucial for the prevention and relief of pain in this patient population. [ABSTRACT FROM AUTHOR]

A brain‐computer interface for operating an electric wheelchair (wheelchair BCI) has been studied to support independent living for physically disabled patients. The current wheelchair BCI systems are facing the problem that the wheelchair cannot be moved or rotated to an arbitrary place or direction in a single measurement. To solve this problem, we developed a BCI that uses audiovisual stimuli based on mixed‐reality (MR) and virtual sound sources. During the online analysis, six out of seven participants were able to move or rotate the wheelchair to the target location or direction at a rate higher than the chance level. Thus, our results indicate that audiovisual stimulation with MR and virtual sound sources may be useful for intuitive wheelchair operation. © 2024 Institute of Electrical Engineer of Japan and Wiley Periodicals LLC. [ABSTRACT FROM AUTHOR]

Background: Reverse total shoulder arthroplasty (rTSA) has gained popularity in recent years and is indicated for a wide variety of shoulder pathologies. However, use of rTSA in patients with "weight-bearing" shoulders that support wheelchair use or crutches has higher risk. The aim of this study was to assess the results of rTSA in such patients. Methods: Between 2005 and 2014, 24 patients (30 shoulders) with weight-bearing shoulders were treated with rTSA at our unit. Patients had cuff arthropathy (n=21), rheumatoid arthritis (n=3), osteoarthritis (n=1), acute fracture (n=3), or fracture sequela (n=2). Postoperatively, patients were advised not to push themselves up and out of their wheelchair for 6 weeks. This study was performed in 2016, and 21 patients (27 shoulders) were available for a mean follow-up of 5.6 years (range, 2–10 years). The mean age at surgery was 78 years (range, 54–90 years). Results: Constant-Murley score improved from 9.4 preoperatively to 59.8 at the final follow-up (P=0.001). Pain score improved from 2/15 to 13.8/15 (P=0.001). Patient satisfaction (Subjective Shoulder Value) improved from 0.6/10 to 8.7/10 (P=0.001). Significant improvement in mean range of motion from 46° to 130° of elevation, 14° to 35° of external rotation, and 29° to 78° internal rotation was recorded (P=0.001). Final mean Activities of Daily Living External and Internal Rotation was 32.4/36 (range, 16–36). Only three patients showed Sirveaux-Nerot grade-1 (10%) glenoid notching and three grade 2 (10%). Conclusions: rTSA can be used for treatment of patients with weight-bearing shoulders. Such patients reported pain free movement, resumed daily activities, and high satisfaction rates. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Table tennis is a sport that is enjoyed by many, including those with physical and intellectual disabilities. This scoping review summarised the current test protocols for assessing table tennis technical proficiency in individuals with disabilities. Relevant articles were searched through four databases (Scopus, PubMed, SPORTDiscus, and Web of Science) covering three key aspects: disability, table tennis, and technical proficiency. The search resulted in 14 studies included for data extraction, covering physical impairments, intellectual disability, and development coordination disorder. Almost all studies (93%) were conducted on well-trained para-table tennis athletes competing in high-level competitions. There exist protocols to assess service accuracy and stroke accuracy, hand–eye coordination, quality of specific skills and ball control, functional reach, and trunk rotation. The forehand topspin and backhand topspin drives were tested the most. Table tennis robots and video cameras are the common equipment used. Moving forward, future research should develop technical proficiency tests for players across all competency levels. The skill assessment criteria and scoring methods should be standardised and clearly explained. The validity and reliability of tests should be established. Lastly, there is great potential in using artificial intelligence to enhance the assessment of table tennis proficiency in individuals with disabilities. [ABSTRACT FROM AUTHOR]

This study aims to analyze further the effect of service quality on the confidence of wheelchair athletes. The family support is referred to as a moderator variable. This quantitative research type used the Moderated Regression Analysis (MRA) method. Sampling was carried out at a special open tournament for wheelchair athletes. The total number of athletes was 122 (basketball =30, tennis =16, badminton =22, archery =20, fencing =16, table tennis =18), with characteristics as follows: aged 25.36±2.4 years, and had 11.37±1.2 years of coaching rate. The instrument was a questionnaire which had been validated through the focus group discussion (FGD) with experts, namely sports training lecturers and wheelchair trainers. The initial results were typically distributed data based on the Kolmogorov-Smirnov test 0.200. The second regression test analysis without moderation was 0.003, and R2=0.466, meaning there was an effect between service quality and self-confidence. The third moderation analysis was 0.000, and R2=0.583. The family support variable moderated positively and significantly between service quality and self-confidence. In conclusion, the wheelchair athletes' self-confidence is determined in one way, namely developing and improving good service quality. With the support of parents, wheelchair athletes feel supported by emotional, nutritional, instrumental, appreciation, and informative aspects. Thus, good service quality and family support can increase wheelchair athletes' self-confidence, and hopefully it impacts their achievement. [ABSTRACT FROM AUTHOR]

The robotic wheelchair is designed to allow independent movement for patients with severe musculoskeletal and neuromuscular disorders that interfere with normal wheelchair propulsion by hands. Control of the movement of the wheelchair necessities residual motion of the upper extremity which was not applicable for patients with upper extremity disability as in Quadriplegic patients. Several research efforts have been proposed to help quadriplegic patients independently use the robotic wheelchair. However, the proposed solutions had many problems with accuracy, simplicity, and cost. The current work aims to build an accurate, simple, and low-cost control system for robotic wheelchairs using head movement. The proposed system was based on the use of the MEMs inertial measurement unit (IMU) to sense the head movement gestures and transfer the gestures into signals to control the wheelchair movements. A new lightweight algorithm for the detection of head gestures was proposed to improve the system’s accuracy. The proposed system has been applied and tested on volunteers. The results revealed that the accuracy of the proposed method in recognizing head movement was 97% on average. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate the impact of assistive mobility carts on companion animals and caretakers’ quality of life by investigating factors pertaining to caretaker satisfaction, the ability to perform daily tasks, and complication rates.Materials and methodsA 23-question survey was distributed to caretakers of animals using carts to evaluate the animal and caretakers’ quality of life, acceptance, ability to complete functional tasks, and complications. Data from canine, feline, and rabbit responses were analyzed separately.ResultsDogs and cats had improved quality of life in 62 and 57% of responses and 61 and 60% for their caretakers, respectively. There was no improvement in the quality of life of rabbits or their caretakers. Regarding the complication rate, 64% were reported to have at least one complication associated with cart use, 53% of which were wounds. Across all species, there was a reported improvement in ability to perform daily tasks and activities.Conclusions and clinical relevanceCaretakers reported that assistive mobility carts improve both companion animals’ and caretakers’ quality of life, despite high prevalence of complications, including wounds. Future studies exploring specific disease conditions and long-term outcomes will be useful for guiding clinical recommendations.

Objective: To clarify the time-course of longitudinal changes in the independence level of subtasks composing bed–wheelchair transfer among patients with stroke. Design: Single-institution prospective cohort study. Patients: A total of 137 consecutive post-stroke patients using wheelchair on admission to the subacute rehabilitation wards. Methods: The independence degree in each of the 25 transfer-related subtasks was assessed using the Bed–Wheelchair Transfer Tasks Assessment Form on a three-level scale every two weeks, from admission to the endpoint (either discharge or when achieving independent transfer). Patients were classified based on admission and endpoint assessment form scores using two-step cluster analysis. Results: Patients were classified into three clusters. The first cluster included 50 patients who exhibited a greater independence level in all subtasks on admission (52.0–100% of patients performed each subtask independently) and at the endpoint (64.0–100%). The second included 30 patients who showed less independence on admission (0–27.8%) but achieved greater independence levels at the endpoint (44.4–97.2%). The third included 51 patients whose independence level remained low in many subtasks from admission (0–5.8%) until the endpoint (0–29.4%). Conclusion: The independence level and its changing process during transfer were categorized into three time-courses, each requiring different intervention strategies.

BackgroundFalls are prevalent among people living with Multiple Sclerosis (PwMS) and Spinal Cord Injury (PwSCI) who use wheelchairs or scooters (WC/S) full time, however, there is a scarcity of evidence-based fall prevention and management programs.ObjectiveTo describe the systematic translation of an in-person fall prevention and management program (Individualized Reduction Of FaLLs – iROLL) for PwMS to an online platform, extending its scope to include PwSCI, and to evaluate the preliminary useability, usefulness, and safety of the intervention.MethodsiROLL was systematically translated to an online platform (iROLL-O). PwMS and PwSCI who use a WC/S full time, experienced at least one fall within the past 36 months, and could transfer independently or with minimal to moderate assistance, enrolled in iROLL-O. Usability, usefulness, and safety were evaluated through 1:1 semi-structured interviews, gathering feedback on: perceived impact of the intervention on falls and functional mobility, program experiences, adverse events, and recommendations for improvement.ResultsFive participants successfully completed the iROLL-O program. No safety concerns were raised by participants. Themes emerging from the semi-structured interviews included: (1) barriers and facilitators to program access, (2) motivation for participation, (3) program outcomes, and (4) program content and structure. Participants reported reduced concerns about falling, enhanced functional mobility skills, and highlighted the supportive nature of synchronous group meetings for learning.ConclusionNo adverse events occurred during the implementation of iROLL-O and participants found the program to be useable and useful. Further testing is needed to examine efficacy among a large and diverse population.