Search Results (96)

Manual wheelchair users (MWUs) are at high risk of developing pressure injuries (PIs) from prolonged static sitting. Clinical practice guidelines suggest periodic pressure redistribution (PR) to mitigate this risk. Prior work has demonstrated that a wheelchair seat pan instrumented with force sensors can track the change in center of pressure (CoP) as MWUs perform PR and use this measurement to infer the direction and degree of a PR. This study’s objective was to quantify the relationship between change in CoP and reduction in seat interface pressure (SIP) under the ischial tuberosities for commonly practiced PR maneuvers. A theoretical model relating SIP and change in CoP for forward leaning PR was developed. Participants performed forward, leftward, and rightward leaning PRs while seated on a pressure mat on the test wheelchair with a load cell-instrumented seat pan. Linear mixed-effects models showed that the relationship of SIP and CoP varies by participant. Across participants, the change in SIP for a given change in CoP was greater with sideways than with forward leans. The type of cushion used did not affect the relationship. These findings can be used as part of her real-time smartphone-based coaching system for PI prevention. Full article

Objectives: To quantify the effects of geared wheelchair wheels on energy expenditure during manual wheelchair propulsion in individuals with spinal cord injury (SCI). Methods: Eleven adult manual wheelchair users with SCI propelled their personal manual wheelchairs, which were equipped with a pair of geared wheels, on a passive wheelchair ergometer in low-gear and standard-gear conditions for six minutes. The energy cost of transport, distance traveled, rate of oxygen consumption (SCI MET), rate of perceived exertion, heart rate, and stroke cycle frequency were measured and compared across the gear conditions. Results: The distance traveled and SCI MET were significantly lower (p = 0.003) and cost of transport was significantly higher under the low-gear condition compared with the standard-gear condition. Gear condition exerted a moderate effect on the level of exertion; however, the decrease in the rate of perceived exertion under the low-gear condition was not statistically significant. Gear condition did not significantly affect heart rate and stroke cycle frequency. Conclusions: Geared manual wheelchair propulsion was significantly more energy-demanding, but less intense (easier) under the low-gear condition than the standard-gear condition. Using geared wheels may be beneficial for manual wheelchair users to independently accomplish strenuous propulsion tasks during typical activities of daily living, such as propulsion on carpeted floor. However, the small sample size and inclusion of only male participants limit the generalizability of these findings, and future studies with larger and more diverse cohorts are warranted. Full article

Introduction: The change in environmental and social context during the COVID-19 pandemic affected daily activities of people with spinal cord injury (SCI), their interactions within the community, and, consequently, their social participation during the first wave of the pandemic. However, there is little information about the changes in social participation as the pandemic evolved in Canada. Objective: Our aim was to explore the change in the social participation of adults with SCI after the first two years of the COVID-19 pandemic in Canada. Methods: A follow-up from a previous study exploring the social participation of adults with SCI living during the first wave was conducted eight months later (second wave). Social participation was measured using the Assessment of Life Habits (LIFE-H 4.0) and Measure of Quality of the Environment (MQE) among 18 adults with SCI. Results: Participants reported increases between both waves of COVID-19 in some life habit categories, including mobility, personal care and health, nutrition, and recreation. New environmental factors were identified as facilitators, including the increased availability of businesses in the community. Conclusion: These findings indicate that people with SCI experienced greater realization and satisfaction with certain life habits. Although most barriers and facilitators showed little or no change between the two waves, the reduction in environmental barriers and the increase in facilitators may have contributed to improved social participation as the pandemic progressed. Full article

Background: Manual wheelchair propulsion is often associated with pain in the upper extremities. Recording spatio-temporal parameters can optimize movement patterns and prevent injuries. This study compares a marker-based camera system with inertial measurement units to validate their use in wheelchair propulsion on a test stand. Methods: Spatio-temporal parameters of 27 manual wheelchair users propelling at three self-selected speeds (slow, normal, fast) were simultaneously recorded using a marker-based camera system and inertial measurement units, and subsequently compared between both systems. Results: A high correlation was observed among all spatio-temporal parameters (ρ > 0.992). The biases for the start time of hand contact with the pushrim (−0.02 ± 0.02 s), hand release from the pushrim (−0.02 ± 0.01 s), and push length (−0.45 ± 21.45 ms) were slightly overestimated, while recovery length (0.54 ± 21.02 ms), cycle speed (2.37 ± 2.67°/s), and push angle (1.75 ± 4.14°) were slightly underestimated. No bias was found for propulsion frequency. Conclusions: The spatio-temporal parameters recorded using inertial measurement units are suitable for the evaluation of manual wheelchair propulsion and can be used in a clinical context. The low acquisition costs and simple installation process may increase the use of inertial measurement units in the future. Full article

Background/Objectives: Spinal cord injuries (SCIs) are among the most debilitating conditions and are a leading cause of disability in young people. This study aimed to analyze the causes of SCIs, assess injury severity using the AIS scale, and evaluate complications during rehabilitation in a hospital setting. Methods: The study involved 176 individuals with SCI, including 142 with a traumatic SCI (TSCI) and 34 with a non-traumatic SCI (NTSCI), rehabilitated at various times post-injury. The data on injury causes, paresis type, complications, wheelchair use, gender, age, and treatment methods were collected. The injury severity was assessed using the AIS. Results: A significant gender difference was found between the TSCI and NTSCI groups (85.2% male vs. 61.8% male). TSCI individuals were also younger. The causes of TSCI were traffic accidents, falls from height, and diving, while the causes for NTSCI included spinal ischemia, tumors, degenerative disc disease, and inflammation. TSCI individuals had more AIS A lesions (52.8% vs. 26.5%) and more cervical injuries (53.5% vs. 14.7%), whereas NTSCI individuals had more AIS C lesions (38.2% vs. 18.3%) and thoracic damage (58.8% vs. 35.2%). TSCI patients were more often treated surgically (95.7% vs. 61.8%) and used wheelchairs (88% vs. 55.9%). No significant differences were found in terms of complications between the groups, though TSCI individuals underwent more chronic rehabilitation. Conclusions: Our research shows that there are significant differences between TSCI and NTSCI both in terms of the level of damage and the severity of damage to neural structures (AIS scales), and thus significant differences in the patients’ functioning in later life for both groups of individuals. Full article

Background: Standing has medical and psychosocial benefits for people with lower limb impairments; however, systemic, logistical, and economic barriers often limit opportunities to stand in daily life. This study explored how users perceive standing and standing-assistive technologies. Methods: This study used a mixed-methods approach: in-person interviews (n = 18) and a nationwide web-based survey (n = 125; 74.4% male, mean age 52.2 ± 13.9 years, diagnoses: spinal cord injury 37.6%, cerebrovascular disease 27.2%, and cerebral palsy 16.8%). Results: Participants described the psychosocial values of standing, such as feeling more confident and being able to interact with others at eye level. The web survey revealed that most participants believed that standing was beneficial for health (76.8%) and task efficiency (76.0%), although only 49.6% showed an interest in standing wheelchairs. The multivariate analysis revealed that ongoing standing training was the strongest predictor of positive perceptions of health benefits, task efficiency, and interest in standing wheelchairs. Younger participants showed a greater interest in standing wheelchairs. The reported barriers include a lack of awareness, high costs, and difficulty in accessing training. Conclusions: These findings suggest the need for a user-centered design and improved support systems to integrate standing into the daily lives of people with mobility impairments. Full article

Wheelchair basketball (WB) grants important benefits for people with disabilities but also presents a relevant risk of injury. Wheelchair straps are restraint devices that can improve safety and performance, but limited research has explored their use in WB. This study aims to analyze the use of different types of straps among professional WB players, according to classification score. A cross-sectional study was conducted through an online survey. Participants were divided into two groups based on classification score: low-point players (LPPs; 1.0–2.5), who have greater physical impairment, and high-point players (HPPs; 3.0–4.5), who have lower physical impairment. A total of 82 WB players participated (43 LPPs; 39 HPPs). The Chi-squared test was used to compare variables between groups. Significant differences emerged: chest (p = 0.036), abdominal (p = 0.036), and foot (p = 0.016) straps were more frequently used by LPPs, while thigh (p = 0.020) and leg (p = 0.050) straps were more common among HPPs. No significant difference was found for pelvic strap. Straps used in WB vary with classification score, reflecting the influence of functional ability. These findings offer insights into individualized wheelchair setup and classification procedures. Further studies are needed to expand knowledge on this topic. Full article

Manual wheelchair users are at high risk of upper limb overuse injuries due to repetitive propulsion mechanics. To address this, we developed a novel detachable push–pull dual-propulsion device that enables both forward and backward propulsion, aiming to reduce shoulder strain and promote balanced muscle engagement. This study presents a protocol to evaluate the device’s biomechanical impact and ergonomic effects, focusing on objective, quantitative analysis using a repeated-measures within-subject design. Thirty participants with spinal cord injury will perform standardized propulsion trials under two conditions: push and pull. Motion capture and surface electromyography (EMG) will assess upper limb kinematics and muscle activation. Each propulsion mode will be repeated over a 10-m track, and maximum voluntary contraction (MVC) data will be collected for EMG normalization. The protocol aims to provide objective evidence on the propulsion efficiency, muscle distribution, and ergonomic safety of the device. Findings will inform future assistive technology development and rehabilitation guidelines for manual wheelchair users. Full article

Wheelchair tennis (WT) is a Paralympic sport designed for athletes with physical impairments. Assessing physical fitness characteristics using appropriate field-based tests and standardized protocols is essential for individualized training, injury prevention, and performance monitoring. However, there is currently limited information on which field-based tests are most suitable and how they should be applied in WT athletes, resulting in inconsistency across studies and practical use. Establishing a standard operating procedure (SOP) enables replicable, cost-effective testing routines that improve data consistency and comparability. We conducted a scoping review to synthesize the existing evidence on field-based physical fitness assessment in WT athletes and to propose a structured SOP for these tests. A comprehensive search was conducted in three electronic databases—NLM PubMed, Web of Science, and Scopus—using predefined keywords and Boolean operators. The inclusion criteria were limited to peer-reviewed, English-language original articles focusing exclusively on field tests in WT athletes. Studies with other populations, reviews, and abstracts were excluded. Eleven studies met the eligibility criteria. This scoping review identified various field tests assessing key fitness components, including cardiorespiratory endurance, muscle strength, agility, and body composition. The most frequently employed tests were the 20 m sprint test, isometric handgrip test, spider test, Illinois Agility Test, and skinfold thickness. These findings highlight the lack of standardized fitness assessments in WT. The proposed SOP offers a practical step toward consistent, replicable, and relevant evaluation in these athletes. Full article

Spinal cord injury (SCI) often necessitates the use of a manual wheelchair, which can overload the shoulders and contribute to upper extremity (UE) pain. Currently, no standardized methods exist to assess UE kinematics during wheelchair propulsion. This study aimed to develop and evaluate a marker-based motion capture model for analyzing UE movement during wheelchair use, with a secondary goal of assessing test–retest reliability. The study was conducted in two phases: (1) development of the motion analysis model and (2) reliability testing. Eleven participants with SCI were included. Reliability was assessed using intraclass correlation coefficients (ICCs) across 15 movement parameters, including total range of motion and minimum and maximum movement values. The model demonstrated good test–retest reliability. For minimum movement, 12 of 15 parameters were significant (ICC = 0.681–0.965). For maximum movement, 13 of 15 were significant (ICC = 0.726–0.981). For total range of motion, 12 of 15 showed significant reliability (ICC = 0.596–0.952). In conclusion, the motion capture model showed promising reliability for assessing UE kinematics during wheelchair maneuvering in individuals with SCI. However, due to the small sample size, further research is needed to validate and refine the model. Full article

Objectives: Wheelchair seat sagging is hypothesized to increase pressure and shear forces, potentially leading to pressure injuries. The objective of this study was to assess the impact of correcting wheelchair seat sagging on ischial pressure, shear force, and posture in a population of healthy adults. Methods: A total of twenty-two participants who met the study requirements were included in the study. Participants were evaluated under two conditions: with seat base correction (With Correction) and without it (No Correction). Correction was achieved using insert panels. Ischial pressure was measured using a pressure-mapping system (CONFORMat), shear force with a specialized sensor (iShear), and posture with accelerometers (TSND151). The primary analysis compared peak pressure index (PPI), shear force, slide, and postural changes between conditions. The subgroup analysis was conducted as an exploratory approach to assess potential variation among participants with elevated shear forces. Results: There was no statistically significant difference in ischial pressure between the No Correction and With Correction conditions (p = 0.37). However, shear force and slide were significantly reduced when seat sagging was corrected (p < 0.05). Accelerometer data showed no significant difference in postural changes between conditions (p ≥ 0.05), although the With Correction condition displayed a slight trend toward greater positional variability over time. Conclusions: These findings indicate that correcting seat sagging can reduce shear force and slide, potentially lowering the risk of pressure injuries. However, because this study targeted healthy adults, further research involving older or at-risk populations is necessary. Addressing seat sagging could be an important component of comprehensive pressure injury prevention strategies. Full article

Background: Pressure injuries (PIs) and shoulder pain (SP) are frequent problems in individuals with spinal cord injury (SCI), affecting both quality of life and healthcare use. Although pressure relief (PR) is recommended to prevent PIs, it is often not performed regularly, and its long-term benefits remain unclear. Furthermore, some PR methods may contribute to SP, resulting in conflicting clinical guidelines. This study aims to objectively measure PR performance and investigate its long-term relationship with PI and SP. Methods: This study is a longitudinal observational study involving 70 manual wheelchair users with complete SCI. Over one year, participants attend five study visits to assess confounding factors such as comorbidities and shoulder range of motion. PR performance (technique, frequency, duration) is continuously monitored for three weeks after each of the first four visits using textile measurement mats, while SP is assessed weekly with a questionnaire. Causal associations with PI and SP will be examined using directed acyclic graphs and multivariable regression modelling. Results: The study is ongoing. Long-term objective data on PR performance will provide insights into its relationship with PI and SP. Conclusions: Findings will inform clinical practice and contribute to improved evidence-based PR guidelines for individuals with SCI. Full article

Background: Manual wheelchairs (MWCs) are critical assistive devices for individuals with spinal cord injury (SCI) and other mobility impairments. However, inconsistencies exist in evaluating usability across different manual wheelchair designs. Usability evaluation methods are essential to ensure optimal design and function. Methods: A systematic review following PRISMA guidelines was conducted. Databases searched included PubMed, ScienceDirect, and DBpia. A comprehensive search was completed up to April 2024. Keywords combined concepts such as “spinal cord injury”, “manual wheelchair”, and “usability evaluation” using Boolean operators (AND, OR) and truncation strategies. Results: From 2134 initial records, 30 studies met the inclusion criteria. Studies included individuals with SCI as the primary population, but also incorporated able-bodied participants when necessary to simulate conditions not feasible for SCI users. Evaluation methods included objective assessments (e.g., kinematics, kinetics, electromyography) and subjective measures (e.g., System Usability Scale, user interviews). Conclusions: This review highlights methodological trends in MWC usability testing and identifies key metrics to guide future research and design improvements. While the primary focus was on individuals with SCI, studies involving healthy participants were included where ethically or practically justified. 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

Introduction: The COVID-19 pandemic challenged people with spinal cord injury (SCI) regarding a variety of mental and physical issues. New challenges may arise as the effects of the pandemic continue. The objective of this descriptive qualitative study was to explore the social participation of Canadians with SCI during the second wave of COVID-19. Methods: Participants with SCI from two Canadian provinces (Quebec and British Columbia) were interviewed. Results: Eighteen participants completed interviews. The facilitators of social participation remain similar since the first wave of COVID-19, such as the use of technology, help received by relatives, and the use of delivery services to obtain groceries and other essentials. Obstacles to mobility due to winter conditions and lack of considerations related to COVID-19 public health measures specific to wheelchair users were also discussed by participants. Conclusions: People with SCI perceived participation restrictions, little changes in life habits, and uncertainty about the future during the second wave of COVID-19. The unique living conditions of people with SCI, ability to adapt life habits, and the lived experiences of people with SCI may have contributed to an overall resilience during the pandemic. Adaptive families, social contacts, and technology made a difference during the pandemic. Full article