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Active wheelchair use in daily life: considerations for mobility and seating
Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Wheelchair fit and prescription are central in the rehabilitation process of a spinal cord injured client with an impaired walking ability. The knowledge and consequences of wheelchair use in active wheelchair users is deficient, which might lead to unnecessary problems and disabilities.

Objective: The general aim of the research underlying this thesis was to increase and deepen the knowledge of wheelchair use, considering both mobility and seating aspects.

Methods: The thesis includes five different studies, two of them with a focus on wheelchair mobility, two with a focus on secondary complications common in wheelchair users and one intervention study with a focus on wheelchair seating. Methods used to measure and describe wheelchair use from mobility and seating aspects are well-standardized, valid and reliable methods, custom-made newly developed forms and client estimations.

Results: The power output and mechanical efficiency of wheelchair propulsion was found to be low compared to arm-crank ergometry in a group of experienced wheelchair users. Another study found that it was not possible to affect this mechanical efficiency in a uniform positive way, by a change in rear-wheel position. A significant change in propulsion technique was found which, however, did not correlate to physical effort. Secondary complications such as back pain, spinal defonnities and shoulder pain were common in clients with a spinal cord injury. In the intervention study a change in seating prerequisites had a positive effect on estimated seating comfort, posture and activity.

Conclusion: Wheelchair propulsion and seating mean high physical and musculoskeletal load on the individual with a risk for secondary complications. A prescriber of hand-rim wheelchairs to clients who will spend many years in their wheelchairs has a major responsibility to understand and use available knowledge, to carefully examine the physical prerequisites of each client, and to interrelate these findings to individual needs and wishes. There is a great need for continuous development of new methods and knowledge in this area in order to avoid unnecessary complications due to wheelchair use. There is also a need for new thinking in the construction and design of new wheelchairs.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2002. , 70 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 753
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-28075Local ID: 12839ISBN: 91-7373-196-X (print)OAI: oai:DiVA.org:liu-28075DiVA: diva2:248626
Public defence
2002-11-15, Berzeliussalen, Hälsouniversitet, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-18Bibliographically approved
List of papers
1. Back pain and spinal deformity: common among wheelchair users with spinal cord injuries
Open this publication in new window or tab >>Back pain and spinal deformity: common among wheelchair users with spinal cord injuries
1996 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 3, no 1, 28-32 p.Article in journal (Refereed) Published
Abstract [en]

During the past 15 years, wheelchair development has focused on driving properties. Back pain, however, is a problem among wheelchair users. Thirty-one wheelchair users, mean age 46 years (range 21–79), (3 women and 28 men), with spinal cord injuries were studied with regard to back pain and spinal deformity. Sixteen subjects had tetraplegia and 15 had paraplegia; median time since injury was 11 years (range 2–37). Pain was assessed using pain drawings, visual analogue scale and questionnaire. Spinal deformity was examined using X-ray, weight distribution, 3D magnetic motion tracker, photographs and physical examination. Some degree of back pain was found in 84% of the patients. Most patients could modify their pain by changing their sitting posture or by rest in bed, and had some kind of spinal deformity that might be related to neurological injury and sitting posture. Further wheelchair research considering the ergonomics of both driving and sitting seems important.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81541 (URN)10.3109/11038129609106679 (DOI)
Available from: 2012-09-18 Created: 2012-09-18 Last updated: 2017-12-07Bibliographically approved
2. Power output for wheelchair driving on a treadmill compared with arm crank ergometry
Open this publication in new window or tab >>Power output for wheelchair driving on a treadmill compared with arm crank ergometry
1997 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 31, no 1, 41-44 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The limiting factors with regard to power output available for wheelchair ambulation have not been identified. The aim of the present study was to correlate power output during wheelchair driving with (i) power output and oxygen uptake during arm crank ergometry and (ii) arm muscle strength.

METHODS: Eleven disabled men were examined for maximal power output (POmax) during wheelchair driving on a treadmill and during arm crank ergometry. Oxygen uptake (VO2) was recorded at submaximal and maximal arm crank ergometry in all men and during submaximal wheelchair driving on a treadmill in four men. Power output during wheelchair driving on a treadmill was measured. Static and dynamic elbow muscle strength was measured isokinetically.

RESULTS: POmax was significantly lower (P < 0.001) for wheelchair driving (109 (31) W; mean (SD)) than for arm ergometry (163 (49) W). There was a significant correlation between POmax for arm crank ergometry and wheelchair driving (r = 0.73). There was no correlation between POmax and elbow strength. The mechanical efficiency was constant for the different levels on the arm crank ergometry test. The submaximal testing showed a consistently lower mechanical efficiency for wheelchair driving than for arm crank ergometry.

CONCLUSIONS: It is suggested that the lower level of power output for wheelchair driving is fully explained by the lower mechanical efficiency. Any improvement in power output available for ambulation must be based on wheelchair ergonomics.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81542 (URN)10.1136/bjsm.31.1.41 (DOI)
Available from: 2012-09-18 Created: 2012-09-18 Last updated: 2017-12-07Bibliographically approved
3. Wheelchair seating intervention: Results from a client-centred approach
Open this publication in new window or tab >>Wheelchair seating intervention: Results from a client-centred approach
2001 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 23, no 15, 677-682 p.Article in journal (Refereed) Published
Abstract [en]

Purpose : The aim of this study was to analyse the effects of wheelchair intervention from a client-centred perspective.

Method : Results from 38 consecutive active wheelchair users visiting the wheelchair-seating department at the University Hospital in Linköping, Sweden, were analysed and described. All clients had defined problems related to wheelchair seating. Back pain was estimated before intervention and at follow-up, using a Visual Analogue Scale. The effect of intervention on different aspects of wheelchair functionality, seating and occupational performance was estimated by the clients at follow-up.

Results : Two initial main problem areas were identified among the group; seating discomfort (87% ) and back pain (63% ). Back pain was significantly reduced at follow-up (p<0.001). Problems initially defined by the clients, e.g. seating discomfort, were affected positively, in 79% of all clients, as estimated by the clients at follow-up. No significant correlation was found between the initial cause of intervention or the highest ranked wheelchair functionality aspect and final acceptance of intervention.

Conclusions : The results from this study confirm the possibility of reducing, or even eliminating, common secondary problems such as back pain and discomfort, related to wheelchair seating by individually adjusted measures. Further research and development in this field is both necessary and cost-effective.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27770 (URN)10.1080/09638280110049900 (DOI)12517 (Local ID)12517 (Archive number)12517 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
4. Shoulder pain and its consequences in paraplegic spinal cord-injured, wheelchair users
Open this publication in new window or tab >>Shoulder pain and its consequences in paraplegic spinal cord-injured, wheelchair users
2004 (English)In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 42, no 1, 41-46 p.Article in journal (Refereed) Published
Abstract [en]

Study design: Cross-sectional.

Objectives: To describe the consequences of shoulder pain on activity and participation in spinal cord-injured paraplegic wheelchair users. To describe the prevalence and type of shoulder pain.

Setting: Two spinal cord injury (SCI) centres in Sweden.

Methods: All subjects with paraplegia due to an SCI of more than 1 year living in the counties of Uppsala and Linköping, Sweden were contacted by mail and asked to fill in a questionnaire (89 subjects). Those of the responding 56 subjects with current shoulder pain were asked to participate in further examination and interviews. A physiotherapist examined 13 subjects with shoulder pain in order to describe type and site of impairment. To describe consequences of shoulder pain on activity and participation, the Constant Murley Scale (CMS), the Wheelchair Users Shoulder Pain Index (WUSPI) the Klein & Bell adl-index and the Canadian Occupational Performance Measure (COPM) were used.

Results: Out of all respondents, 21 had shoulder pain (37.5%). Data from 13 of those subjects were used in the description of type and consequences of shoulder pain. Findings of muscular atrophy, pain, impingement and tendinits were described. We found no difference in ADL-performance with, respectively without, shoulder pain (P=0.08) using the Klein & Bell adl-index. No correlation was found between the various descriptions of impairment, activity limitations and participation restriction (P>0.08). All together 52 problems with occupational performance due to shoulder pain were identified using the COPM. Of these, 54% were related to self-care activities.

Conclusion: The consequences of shoulder pain in paraplegic wheelchair users are mostly related to wheelchair activities. Since the wheelchair use itself presumably cause shoulder problems, this will become a vicious circle. More research is needed in order to reduce shoulder problems in wheelchair users.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-23464 (URN)10.1038/sj.sc.3101490 (DOI)2919 (Local ID)2919 (Archive number)2919 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
5. Consequences of a change in rear-wheel position on seating ergonomics and mobility in spinal cord injured wheelchair users
Open this publication in new window or tab >>Consequences of a change in rear-wheel position on seating ergonomics and mobility in spinal cord injured wheelchair users
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The aim of this study was to analyse the consequences of a change in rear-wheel position on mobility and seating ergonomic aspects. Twelve randomly selected paraplegic wheelchair users were tested iu two different activities, treadmill propulsion and computer work, in two different seating positions. The change in wheel position did affect chair ergonomics with respect to weight distribution and seat-inclination. These changes did have an effect on push frequency and stroke angle during treadmill, propulsion. We found no consistent effect on mechanical efficiency, estimated exertion, breathlessness or seating quality in this group. Nor did we find any consistent significant effect on pelvic position or under-seat pressure. There are effects from wheelchair adaptation, but these seem to be individual. With the knowledge of risk factors related to seating posture in mind, future research concerning effects of wheelchair adaptation has to be performed with considerations for individual changes.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81543 (URN)
Available from: 2012-09-18 Created: 2012-09-18 Last updated: 2012-09-18Bibliographically approved

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