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Wheeled Mobility and Seating Equipment Following Spinal Cord Injury

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Wheeled Mobility and Seating Equipment Following Spinal Cord Injury Wheeled Mobility and Seating Equipment Following Spinal Cord Injury Laura Titus PhD OT Lindsey Guilbault MScPT Ben Mortenson PhD Stephanie Cornell PT Susan Moir OT Jennifer Birt OT Brooke Benton BSc RDH The following people are greatfully acknowledged for their contribution to the growth of this chapter as past co-authors; Alba Casalino PT, Amanda McIntyre RN, Sandra Connolly OT, Sarah Miles OT, Karen Trenholm PT and, Mary Ann Regan RN. www.scireproject.com Version 7.0 Key Points The evidence suggests that stroke pattern use varies based on individual preference and the environmental demands with some stroke patterns being more effective to achieve specific outcomes. The evidence supports that to avoid accumulating shoulder impingement stresses proper propulsion technique must be considered based on a combination of kinematics (e.g., contact angle, stroke frequency, movement patterns at each joint), stroke pattern, wheelchair fit and set up. Neck, trunk, scapular, clavicle, elbow, wrist and shoulder kinetics and kinematics singly or cumulatively influence the efficacy of manual wheelchair propulsion and therefore all should be considered in propulsion efficiency as well as in propulsion- related injuries, particularly if propulsion speed or surface slope increases. The push and recovery phases of propulsion both need to be considered in relation to manual wheelchair propulsion as the kinetics and kinematics differ, and differ between people with paraplegia and tetraplegia, which therefore have implications for propulsion training in the clinical setting. The following need to be considered in relation to propulsion and back support height; a) effect on propulsion cadence; b) amount of shoulder range of motion used and; c) the length of the push stroke (i.e., length between the start and end position of the hand on the rim). Wheelchair seating characteristics, such as back support height and seat dump angle, affect body positioning and kinematics of propulsion. Therefore, wheelchair and seating set-up both need to be considered when evaluating kinetics and kinematics of wheelchair. Wheeling cross slope can negatively affect the cadence and power that is required for wheelchair propulsion. The strength of specific shoulder and elbow muscles, and the ability to flex the trunk forward all affect the efficiency in performing advanced wheelchair skills particularly those associated with wheelies and caster pop-ups. Given the increased mechanical and muscular demands in these types of advanced skills, the quality of shoulder, elbow and trunk movements should be considered to balance protection of the upper extremity shoulder with being functional in the community. Manual wheelchairs with adjustable axle position appear to improve wheelchair propulsion and reduce the risk of upper extremity injury. This review has been prepared based on the scientific and professional information available in 2018. The SCIRE information (print, CD or web site www.scireproject.com) is provided for informational and educational purposes only. If youThe have use or of suspect lighter you weight have a health wheelchair problem,s you may should improve consult propulsionyour health care effi provider.ciency The in SCIRE those editors, contributorswith SCI and particularly supporting partners at the shall start no oft be propulsion liable for any .damages, claims, liabilities, costs or obligations arising from the use or misuse of this material. Body weight management is important in reducing the forces required to propel a Titus L, Guilbault L, Mortenson B, Cornell S, Birt J, Benton B. (2019). Wheeledwheelchair Mobility andand Seating reducing Equipment the risk Following of upper Spinal extremity Cord Injury. injury.In Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Loh E, McIntyre A, editors. Spinal Cord Injury Rehabilitation Evidence. Version 7.0: p 1-190. www.scireproject.com There is insufficient evidence to determine if wheelchair frame type or wheel type are more effective in reducing spasticity by absorbing vibration forces when wheeling. There is limited evidence to suggest that tires with less than 50% inflation can cause an increase in energy expenditure. Use of flexible handrims may reduce upper extremity strain thereby reducing discomfort and pain symptoms during wheelchair propulsion. The use of power-activated power-assist wheelchairs (PAPAW) provide manual wheelchair users with paraplegia and tetraplegia with a less strenuous means of mobility, improve functional capabilities and reduce the risk of upper extremity injury. Propulsion characteristics of contact angle, stroke frequency and peak force at the handrim, all noted to be important to maintaining upper extremity health during propulsion, can be positively affected through w/c propulsion training. Clinicians should consider incorporating a multimedia approach, such as video and verbal instruction with observational feedback, into wheelchair propulsion training particularly for people who are new to w/c use. Physical conditioning and strengthening of the upper extremity are important to the development of wheelchair propulsion capacity; it should begin at initial rehabilitation. Increased risk of developing or exacerbating shoulder pain is an essential consideration in all wheelchair propulsion training programs at initiation and for ongoing training. Wheelchair use varies between individuals, however daily propulsion distance is small amongst most users. Shoulder strength, the user’s environment, and age all contribute to varaitions and limitations in propulsion distance amongst wheelchair users particularly in the community; these factors should be considered when developing rehabilitation plans related to mobility. Many of the predictive risk factors for wheelchair related falls and resultant injuries are modifiable; therefore, considerations and education related to preventing falls should be included in wheelchair interventions. Maintenance and repair issues arise frequently for people who use wheelchairs therefore are important considerations in the wheelchair service delivery process and the manufacturing process. This review has been prepared based on the scientific and professional information available in 2018. The SCIRE informationOptimizing (print, the CD orpotential web site www.scireproject for satisfaction.com) with is pro wheelchairvided for informational use requires and educational consideration purposes only.of If you have or suspect you have a health problem, you should consult your health care provider. The SCIRE editors, contributorsthe fit and and funcsupportingtion partnersof the wheelchairshall not be liable during for any the damages, service claims, delivery liabilities, proces costs sor particularlyobligations arising fromfor the quality use or misuseof life of-based this material. activities such as leisure pursuits; satisfaction with the service delivery process requires timeliness throughout the wheelchair provision Titusprocess. L, Guilbault L, Mortenson B, Cornell S, Birt J, Benton B. (2019). Wheeled Mobility and Seating Equipment Following Spinal Cord Injury. In Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Loh E, McIntyre A, editors. Spinal Cord Injury Rehabilitation Evidence. Version 7.0: p 1-190. www.scireproject.com There is good evidence that wheelchair skill training can improve skills in the short term and that video feedback produces similar results as conventional skill training. There is strong evidence that manual wheelchair skills training causes an immediate improvement in wheelchair skills, but is mixed evidence regarding how well skills learned are retained. When learning to perform wheelies improvements in postural stability are noted when the rolling resistance is increased. The focus of wheelchair skills training during shortening rehabilitation stays should consider the person’s home and community environments and activities is needed as it is suggested that not all skills are essential to functioning in daily life. Considerations for how individuals use power wheelchairs should include more than distance and speed travelled, as most people spend little time travelling any distance compared to the amount of time they spend in their power wheelchair. For the SCI population power wheelchair provision needs to include at a minimum customizable programmable control. Consideration should be given to the potential provision of both power and manual wheelchairs to meet basic living needs for the SCI population. Patterns of use for power positioning devices are variable but typically in small ranges of amplitude, with the primary reasons for use being discomfort and rest. Individual attention to spinal/pelvic posture and positioning for SCI clients is essential for appropriate wheelchair prescription and set-up. Use of lateral trunk supports in specialized seating improve spinal alignment, reduce lumbar angles and reduce muscular effort for postural control. The set up and type of seating and wheelchair frame are critical to supporting the person’s postural stability thereby effecting functional ability to reach and engage in pressure management strategies. No one cushion is suitable for all individuals with SCI. Cushion selection should be based on a combination of pressure mapping results, clinical knowledge of prescriber, individual characteristics, tissue loading response and preference. This review has been prepared based on the scientific and professional information
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