Search Results (43)

Background: Individuals with neuromuscular diseases (NMDs) have low physical activity levels and an increased risk of cardiovascular and pulmonary diseases. Respiratory gas kinetics obtained during cardiopulmonary exercise testing (CPET) may provide valuable insights into disease mechanisms and cardiorespiratory fitness in individuals with NMD. Recovery from exercise is an important marker of exercise performance and overall physical health, and impaired recovery is strongly associated with poor health outcomes. This study evaluates recovery metrics in individuals with NMD after performing maximal exertion during CPET. Methods: A total of 34 individuals with NMD and 15 healthy volunteers were recruited for the study. CPET was performed using a wearable metabolic system and a wheelchair-accessible total body trainer to peak exertion. Recovery metrics assessed were (i) the time to reach 50% O₂ recovery compared with peak exercise and (ii) the ratios of ventilation and respiratory gases between peak exercise and the highest values observed during recovery (overshoot). Results: The NMD group had a significantly longer time to reach 50% O₂ recovery (T1/2 VO₂: 105 ± 43.4 vs. 76 ± 36.4 s, p = 0.02), lower respiratory overshoot (17.1 ± 13.0% vs. 28.8 ± 9.03%), and lower ventilation/VO₂ (31.9 ± 28.3 vs. 52.2 ± 23.5) compared to the control group. Conclusions: This study observes significantly impaired recovery metrics following peak exercise in individuals with NMD compared to controls. These insights may improve the understanding of exercise recovery and mechanics, thus improving prognostication and optimizing exercise prescriptions for individuals with NMD. Full article

Background: Spasticity, a hallmark of quadriplegic cerebral palsy (CP), severely impacts mobility and quality of life. While exercise is known to enhance fitness and motor function in individuals with CP, its specific efficacy in reducing upper extremity spasticity remains insufficiently studied. This research investigated the effects of weight-resistance exercise (RE), hand cycle bike exercise (BE), and aquatic exercise (AE) on upper extremity spasticity in an adult with quadriplegic CP. Method: The participant was a 35-year-old individual with quadriplegic spastic CP, presenting severe spasticity in the right upper extremity and lower limbs, and milder left arm involvement. Dependent on a power wheelchair, they were cognitively intact, college-educated, and had participated in a community exercise program for five years. Over nine weeks, the participant completed 18 sessions—6 per modality of RE, BE, and AE—with each session held twice weekly for 50 min. Spasticity was assessed using the Modified Ashworth Scale (MAS) before and after sessions, with comprehensive pre- and post-intervention evaluations. Result: Total MAS scores decreased significantly from 2.76 to 2.33 (p < 0.05). AE yielded the largest reduction (2.81 to 2.10), followed by BE (2.75 to 2.36) and RE (2.72 to 2.54). ANOVA confirmed AE’s superior efficacy (F(2,15) = 27.20, p < 0.001, ηp² = 0.78), with a 0.33 reduction overall. Conclusions: AE was most effective, likely due to buoyancy, followed by BE, with RE showing the least impact. These findings highlight aquatic interventions as promising for spasticity management in CP, necessitating further longitudinal, multi-participant research. Full article

Background: Prolonged manual wheelchair usage often leads to musculoskeletal disorders in the upper body of individuals with spinal cord injury (SCI) due to repetitive, unidirectional movements. To mitigate these issues, targeted exercise of the back muscles—particularly those involving pulling movements of the arms and shoulders—is recommended. Therefore, this study aimed to develop a detachable, two-way propulsion system for manual wheelchairs, enabling propulsion through both pushing forward and pulling backward on the wheelchair pushrims. Methods: The propulsion system was engineered using a planetary gear train to facilitate dual-direction propulsion. Specifically, the planetary gear reverses the rotational direction, allowing the wheelchair to advance forward even when users pull the pushrims backward. Thus, the wheelchair can move forward through either pushing forward or pulling backward actions. Results: A prototype of the proposed system was fabricated using 3D printing technology and its functionality was verified. The prototype successfully demonstrated the two-way propulsion capability and the operation of the attachment mechanism. Additionally, the pilot test confirmed that an individual with SCI was able to propel a manual wheelchair equipped with the two-way propulsion system using both propulsion methods and switch between the methods independently while maintaining stability and safety throughout the test. Conclusion: The developed detachable two-way propulsion system shows significant promise as both a mobility aid and an exercise device, potentially reducing musculoskeletal complications among individuals with SCI who regularly utilize manual wheelchairs. Full article

This study presents the design, development, and evaluation of a multifunctional stepladder that integrates four functionalities: a stepladder, Pilates chair, wheelchair, and walking aid. Unlike existing research that focuses on single-function assistive devices, this study uniquely integrates a stepladder, wheelchair, walking aid, and Pilates chair into one multifunctional device, offering a compact, space-saving solution that addresses multiple daily needs in a single design. Building upon previous research, which conceptualized a multifunctional stepladder by synthesizing ideas, features, and functions from patent literature, existing products, and scientific articles, this study focuses on the design and testing phases to refine and validate the concept. Using sustainable materials like mild steel and aluminium, the design was optimized through structural simulations, ensuring durability under loads of up to 100 kg. Usability tests revealed that the invention significantly reduced task completion times, saved five times the space compared to single-function products, and provided enhanced versatility. Cost analysis highlighted its affordability, with a retail price of MYR 1392—approximately 35% lower than the combined cost of its single-function counterparts. Participant feedback noted strengths such as eco-friendliness, practicality, and ergonomic design, alongside areas for improvement, including portability, armrests, and storage. Future work includes enhanced portability for stair navigation, outdoor usability tests, and integration of smart technologies. This multifunctional stepladder significantly contributes to caregivers by reducing the physical burden of managing multiple assistive devices, enhancing efficiency in daily caregiving tasks, and providing a safer, more convenient tool that supports both mobility and exercise for elderly users. This multifunctional stepladder also offers a sustainable, cost-effective, and user-centric solution, addressing usability gaps while supporting global sustainability and accessibility initiatives. Full article

Traditional VO_2max testing methods are often impractical for manual wheelchair users, as they rely on lower-body exercise protocols, require specialized equipment, and trained personnel. The 6-Minute Push Test (6MPT) is a widely used cardiovascular assessment that may provide a feasible alternative for estimating aerobic capacity in this population. This study aimed to develop a predictive model for VO_2max using physiological variables recorded during the 6MPT. Twenty-eight participants (14 novice and 14 expert manual wheelchair users) completed the test while wearing a VO₂ mask and heart rate monitor. Spearman correlation analysis showed that distance covered during the 6MPT significantly correlated with VO_2max (r = 0.685, p < 0.001). A stepwise linear regression identified two predictive models: one using distance alone (R² = 0.416, p < 0.001) and another incorporating both distance and maximum heart rate (R² = 0.561, p < 0.001). These models offer practical estimations of VO_2max, eliminating separate protocols. Our findings suggest that the 6MPT can serve as a simple, cost-effective alternative to laboratory-based VO₂ testing, facilitating routine cardiovascular fitness assessments for manual wheelchair users in clinical and community settings. Future research should focus on validating these models in a larger, more diverse cohort to enhance their generalizability. Full article

Background/Objectives: Physical activity is recommended for people with physical disabilities and is beneficial not only for physical health but also for mental health. This study aimed to evaluate the quality of life (QoL), pulmonary health, and cardiovascular health among a group of older men with physical disabilities who participated in an exercise program. Methods: This study included 23 participants in the exercise group (EG) as an experimental group and 23 in the culture group (CG) as a control group. All participants were ≥65 years, with one or more physical disabilities, and used wheelchairs or crutches for mobility. The participants were each provided with the exercise program for 8 weeks. Assessments included a QoL, pulmonary function test, brachial–ankle pulse wave velocity (baPWV), and factors of metabolic syndrome. The exercise program consisted of aerobics, strength training using dumbbells and tubes, and mat exercises for three days a week for 8 weeks. The culture program included singing, drawing, and writing. Results: The interaction effects by time and group showed that EG had a superior change compared to CG in QoL (physical function, pain, fatigue, social), forced vital capacity, baPWV, triglycerides, and high-density lipoprotein cholesterol (p < 0.05). Conclusions: Participation in the exercise program positively influenced mental, pulmonary, and cardiovascular health in older men with physical disabilities. Our research results will provide useful information for rehabilitation and social security research to improve the health of elderly people with physical disabilities. Full article

Background: cardiorespiratory fitness is one of the most important components of physical fitness. In this paper, we set out to identify cardiopulmonary tests evaluated for measurement properties in wheelchair users and determine which are reliable and valid for this population. Methods: Articles were collected from PubMed, Scopus, SPORTDiscus, and Web of Science. The initial search was conducted in October 2022 and updated in July 2023 for recent publications. From 1257 screened studies, 42 met the criteria: (a) participants were wheelchair users, (b) tests measured cardiorespiratory fitness, (c) test reliability or validity was reported, (d) articles were original, and (e) full text was in English. Two independent researchers extracted participant details (number, gender, age, disability) and test information, with a third researcher resolving disagreements. Statistical analyses of test reliability and validity were documented. Results: Methodological quality was assessed using the COSMIN checklist. Evidence levels for reliability and validity were established. Moderate evidence was found for reliability in one field test, and for validity in two lab and two field tests. Conclusions: While most tests show good reliability and validity, sample sizes are small, limiting conclusions. Further research is needed to strengthen the evidence and identify the most suitable tests for wheelchair users. Researchers are encouraged to replicate validation studies to support future testing. Full article

The increased risk of cardiovascular disease in people with spinal cord injuries motivates work to identify exercise options that improve health outcomes without causing risk of musculoskeletal injury. Handcycling is an exercise mode that may be beneficial for wheelchair users, but further work is needed to establish appropriate guidelines and requires assessment of the external loads. The goal of this research was to predict the six-degree-of-freedom external loads during handcycling from data similar to those which can be measured from inertial measurement units (segment accelerations and velocities) using machine learning. Five neural network models and two ensemble models were compared against a statistical model. A temporal convolutional network (TCN) yielded the best predictions. Predictions of forces and moments in-plane with the crank were the most accurate (r = 0.95–0.97). The TCN model could predict external loads during activities of different intensities, making it viable for different exercise protocols. The ability to predict the loads associated with forward propulsion using wearable-type data enables the development of informed exercise guidelines. Full article

(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. Full article

User-friendly rehabilitation medical devices can enhance health and the quality of life through the convergence of information communication and medical technology. Muscle contraction enables bodily movement, and the assessment of muscle strength is crucial. Muscle contraction includes isometric, isotonic, and isokinetic types. Many individuals with physical disabilities rely on wheelchairs due to lower-limb paralysis. There is a substantial correlation between the level of upper-limb functional recovery and the quality of daily life. This study aimed to design and evaluate a device that utilizes various muscle contractions to enhance the effectiveness of upper-limb rehabilitation exercises. The results from the isometric performance assessment showed percentage error rates of >30% for 5–30 kg. Correction equations were employed, and the isometric performance assessment resulted in error rates below 2.1% for 5–30 kg. Isokinetic performance assessment using video analysis evaluated a consistent wire speed from 10 cm/s to 70 cm/s with an average error rate of 0.91% across all speeds. This study demonstrates the ability to accurately measure various muscle contractions and showcases the potential for real-time feedback. This highlights how such a device could be helpful for target groups, including older adults and individuals with disabilities, during upper-limb rehabilitation exercises. Full article

Illness cognitions (IC) influence how a patient adapts to a chronic disease. The aim was (1) to determine if training for a handcycling mountain time trial (HandbikeBattle) improves IC and (2) to identify factors associated with IC change scores. Persons with a chronic disability (N = 220; including N = 151 with spinal cord disorder) trained 5 months and participated in the time trial. The IC Questionnaire measured helplessness, acceptance, perceived benefits and was assessed before training (T1), after training (T2), and four months after the event (T3). Age, sex, body mass index (BMI), time since injury (TSI), disability characteristics, self-efficacy, mental health (MH) and musculoskeletal pain were obtained at T1. Multilevel regression analyses showed that helplessness decreased (from 11.96 to 11.28, p < 0.01) and perceived benefits increased (from 16.91 to 17.58, p < 0.01) from T1 to T2. For helplessness this decrease persisted during follow-up (11.16 at T3). Changes in helplessness were associated with self-efficacy (p = 0.02), MH (p = 0.02) and lesion completeness (p = 0.02), and were independent of disability type (p = 0.66), lesion level (p = 0.30) and demographics such as sex (p = 0.29) and age (p = 0.67). Training with peers may improve helplessness and perceived benefits in individuals with a chronic disability. Especially individuals with MH problems might benefit from training for an athletic challenge with peers to improve illness cognitions, and ultimately, quality of life. Full article

Exercise increases the serum level of interleukin-6 (IL-6), which in turn stimulates the production of various inflammatory cytokine antagonists, such as interleukin-1 receptor antagonist (IL-1ra). Individuals with cervical spinal cord injury (CSCI) are at high risk of inflammatory conditions. This study compared the effects of wheelchair half marathon on the immune system of male athletes with CSCI and those with thoracic/lumber spinal cord injury (SCI). Neutrophil count, IL-1ra, IL-6, and various endocrine parameters were measured before, immediately and 1 h after the race in five CSCI and six SCI who completed the wheelchair marathon race. The percentage of neutrophils was significantly higher in CSCI immediately and 1 h after the race, compared with the baseline, and significantly higher in SCI at 1 h after the race. IL-6 was significantly higher immediately and 1 h after the race in SCI, whereas no such changes were noted in IL-6 in CSCI. IL-1ra was significantly higher at 1 h after the race in both SCI and CSCI. The race was associated with an increase in IL-1ra in both CSCI and SCI. These findings suggest wheelchair half marathon race increases IL-1ra even under stable IL-6 status in male CSCI individuals, and that such post-race increase in IL-1ra is probably mediated through circulatory neutrophils. Full article

Background: Minutes after an injury to the spinal cord, structural and functional reorganization of the connected brain areas may be initiated. Exercise enhances this neuroplasticity in the further course of the condition, which might modulate the connectivity patterns in brain regions responsible for movement execution and imagination. However, connectivity patterns have not been analyzed as a correlate for activity effects on neuroplasticity after spinal cord injury (SCI). We hypothesize that wheelchair sport has a modulating effect on the cortical connectivity in patients with SCI, such that distinguished activity patterns can be observed between sportive and non-sportive individuals with SCI and healthy participants. Methods: Sportive (n = 16) and non-sportive (n = 7) patients with SCI as well as sportive (n = 16) and non-sportive (n = 14) healthy participants were instructed to either observe, imagine, or conduct an observed movement while high-density EEG (HD-EEG) was recorded. Functional connectivity was computed from the recorded signals, and the coefficients were compared between groups and conditions using a non-parametric repeated measures analysis. Results: We found that depending on being sportive or not, patients with SCI and controls would react differently to the conditions, but the effects depended on the location in the brain as well as the analyzed frequency range (p < 0.05). Further analysis indicates that non-sportive patients showed higher connectivity received by the right posterior parietal cortex and a lower connectivity received by the left M1 compared to sportive patients. These effects were mainly observed during movement imagination, not during movement. Sportive and non-sportive participants in the healthy control group showed smaller differences than the patients. Conclusions: The results suggest a modulative effect of sports on connectivity patterns during movement imagination and to some extent during movement. This effect was predominantly found in patients with SCI, and to a lesser extent in healthy participants with opposing connectivity patterns. We suggest that this might be due to increased cortical excitability and the elevated brain derived neurotrophic factor (BDNF) level in patients with SCI that is enhanced by exercise. Full article

Wheelchair basketball (WB) is an increasingly popular sport that guarantees numerous health benefits for people with disabilities who regularly practice it, such as an improved quality of life and psychophysical well-being. However, WB is a contact and high-stress sport, which exposes players to frequent overloads and injuries, mainly affecting the upper limbs. Therefore, shoulder pain (SP) is the most common musculoskeletal disorder among WB players, forcing them to suspend or abandon this sport activity. This narrative review aims to summarize all the known literature on this topic and to be a starting point for further research. Firstly, it explores the biomechanical causes that lead to SP and the underlying diseases, among which the most recurrent are rotator cuff tendinopathies. Furthermore, this overview deepens the most effective and specific rehabilitation programs for SP in WB players and it emphasizes the need for further studies to trial new rehabilitative protocols using novel technologies to make them faster and more personalized. In this regard, the general recommendation still remains to perform a combination of exercises such as strengthening, endurance and stretching exercises of various durations and intensities. To conclude, the most important prevention strategies are described, underlining the need for constant sport-specific training led by qualified personnel and suggesting some insights on possible new research aimed at improving wheelchair ergonomics, stressing the importance of a multidisciplinary team fully dedicated to the individual athlete. Full article

Treatment of esophageal cancer is based on tumor-node-metastasis (TNM) classification, and surgical treatment is chosen based on the patient’s ability to tolerate surgery. Surgical endurance partly depends on activity status, with performance status (PS) generally used as an indicator. This report describes a 72-year-old man with lower esophageal cancer and an 8-year history of severe left hemiplegia. He had sequelae of cerebral infarction and a TNM classification of T3, N1, and M0, and was judged ineligible for surgery because his PS was grade three; he underwent preoperative rehabilitation with hospitalization for 3 weeks. He had been able to walk with a cane in the past, but once he was diagnosed with esophageal cancer, he began using a wheelchair and was dependent on assistance from his family in his daily life. Rehabilitation consisted of strength training, aerobic exercise, gait training, and activities of daily living (ADL) training for 5 h a day, according to the patient’s condition. After 3 weeks of rehabilitation, his ADL ability and PS improved sufficiently for surgical indication. No complications occurred postoperatively, and he was discharged when his ADL ability was higher than that before preoperative rehabilitation. This case provides valuable information for the rehabilitation of patients with inactive esophageal cancer. Full article