Manual wheelchairs
Fitzgerald SG. Kelleher A. Durability of manual wheelchairs: a review.
International Journal of Therapy and Rehabilitation. 2005 Dec; 12(12): 551-3
The aim of this article is to explain the differences between the three main categories of manual wheelchairs and describe the durability characteristics of each type. Findings are presented from several research studies that have compared wheelchair durability across these wheelchair classifications.
Results indicate that the most durable type of manual wheelchair (ultralightweight) weigh less than 13.6 kg and are completely adjustable. These wheelchairs are made out of lightweight materials such as titanium and have been shown to last longer, with fewer catastrophic repairs than their heavier counterparts. Recommendations are also provided regarding how to obtain an ultralightweight wheelchair.
Fernandes T. Equipment. Choosing a manual wheelchair: the options. International Journal of Therapy and Rehabilitation. 2007 Feb; 14(2): 89-90, 92-3. (2 ref)
There are a variety of manual wheelchairs available on the market designed to help individuals with mobility difficulties to carry out daily living tasks as independently as possible. Participation in such activities is crucial in enabling users to integrate into society and prevent isolation as a result of a disability. A holistic approach to assessment should take into account all aspects of individual need and will result in the selection of the most appropriate piece of equipment, which in turn may result in an improvement in the quality of life for any individual with an impairment of function. This article will look at the considerations that need to be taken into account when prescribing manual wheelchairs as well as highlighting some of the options available on the market.
DiGiovine CP. Koontz AM. Boninger ML. Advances in manual wheelchair technology.
Topics in Spinal Cord Injury Rehabilitation. 2006 Spring; 11(4): 1-14. (22 ref)
The manual wheelchair has undergone much advancement over the past two decades. The purpose of this article is to provide an overview of the most significant advances in manual wheelchairs. These technological advances are now available in the clinical setting and should be recognized, discussed, and adopted by doctors, clinicians, engineers, funding sources, and, most important, consumers when the most appropriate manual wheelchair is being selected.
Bergstrom AL. Samuelsson K. Evaluation of manual wheelchairs by individuals with spinal cord injuries. Disability and Rehabilitation: Assistive Technology. 2006 Jun; 1(3): 175-82.
Purpose. The aim of this study was to investigate how adults with spinal cord injury assess their satisfaction regarding various aspects and use of their manual wheelchair.
Method. The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) together with seven additional questions was sent to 205 adults with SCI.
Results. One hundred and twenty-four responses were available. The QUEST 2.0 showed a high level of satisfaction with manual wheelchair properties. However, the respondents were less satisfied with the services offered. Ease of use and comfort were identified as most important. Eighty-nine percent of the respondents rated their level of satisfaction as 'quite satisfied' or 'very satisfied' in ease of using a manual wheelchair compared with 68% of the respondents that were 'quite satisfied' or 'very satisfied' with the level of comfort. A greater satisfaction of ease in propulsion indoors compared with sitting comfort in various activities was found.
Conclusions. A discrepancy was shown between users not being as satisfied with comfort in sitting in various activities as opposed to satisfaction with propulsion. This indicates the need for increased knowledge and developments concerning individual solutions, incorporating comfort as well as ease of use of a manual wheelchair.
Best KL, Kirby RL, Smith C, MacLeod DA. Wheelchair skills training for community-based manual wheelchair users: a randomized controlled trial. Arch Phys Med Rehabil. 2005 Dec;86(12):2316-23.
Simpson RC. Smart wheelchairs: A literature review. J Rehabil Res Dev. 2005 Jul-Aug;42(4):423-36.
Richter WM, Axelson PW. Low-impact wheelchair propulsion: achievable and acceptable. J Rehabil Res Dev. 2005 May-Jun;42(3 Suppl 1):21-33.
van der Woude LH, de Groot S, Janssen TW. Manual wheelchairs: Research and innovation in rehabilitation, sports, daily life and health. Med Eng Phys. 2006 Nov;28(9):905-15. Epub 2006 Feb 28. Review.
Martorello L, Swanson E. Effectiveness of an automatic manual wheelchair braking system in the prevention of falls. Assist Technol. 2006 Fall;18(2):166-9.
Ganesh S, Hayter A, Kim J, Sanford J, Sprigle S, Hoenig H. Wheelchair use by veterans newly prescribed a manual wheelchair. Arch Phys Med Rehabil. 2007 Apr;88(4):434-9.
Collins, F. (2001). "How to assess a patient's seating needs: some basic principles." J Wound Care 10(9): 383-386.
Cowan, R. E., M. S. Nash, et al. (2009). "Impact of surface type, wheelchair weight, and axle position on wheelchair propulsion by novice older adults." Arch Phys Med Rehabil 90(7): 1076-1083.
OBJECTIVE: To examine the impact of surface type, wheelchair weight, and rear axle position on older adult propulsion biomechanics. DESIGN: Crossover trial. SETTING: Biomechanics laboratory. PARTICIPANTS: Convenience sample of 53 ambulatory older adults with minimal wheelchair experience (65-87y); men, n=20; women, n=33. INTERVENTION: Participants propelled 4 different wheelchair configurations over 4 surfaces: tile, low carpet, high carpet, and an 8% grade ramp (surface, chair order randomized). Chair configurations included (1) unweighted chair with an anterior axle position, (2) 9.05 kg weighted chair with an anterior axle position, (3) unweighted chair with a posterior axle position (Delta0.08 m), and (4) 9.05 kg weighted chair with a posterior axle position (Delta0.08 m). Weight was added to a titanium folding chair, simulating the weight difference between very light and depot wheelchairs. Instrumented wheels measured propulsion kinetics. MAIN OUTCOME MEASURES: Average self-selected velocity, push frequency, stroke length, peak resultant and tangential force. RESULTS: Velocity decreased as surface rolling resistance or chair weight increased. Peak resultant and tangential forces increased as chair weight increased, as surface resistance increased, and with a posterior axle position. The effect of a posterior axle position was greater on high carpet and the ramp. The effect of weight was constant, but was more easily observed on high carpet and ramp. The effects of axle position and weight were independent of one another. CONCLUSION: Increased surface resistance decreases self-selected velocity and increases peak forces. Increased weight decreases self-selected velocity and increases forces. Anterior axle positions decrease forces, more so on high carpet. The effects of weight and axle position are independent. The greatest reductions in peak forces occur in lighter chairs with anterior axle positions.
Gutierrez, E. M., M. Alm, et al. (2004). "Measuring seating pressure, area, and asymmetry in persons with spinal cord injury." Eur Spine J 13(4): 374-379.
The goal of this study was to measure characteristics of seat loading in manual wheelchair users with complete spinal cord injury (SCI). Pressure distribution on the seating area of 25 adult males with SCI and eight non-injured adult males was measured in a relaxed and an upright posture on a standardized hard surface. Subjects with SCI were also tested in their wheelchairs. Maximum pressure, contact area, area of the highest pressure, and three asymmetry indices were compared. Subjects with SCI have higher pressure distributed over a smaller area, have a much smaller contact area, and distribute the loading more asymmetrically than non-injured subjects. Upright posture only corrects for some loading problems, while the wheelchair corrects for more loading parameters. Routine clinical seat loading evaluation may lead to improved chair and cushion selection for patients with SCI and may even alert clinicians to patients at high risk for complications due to high or unbalanced loads.
MacDonald, B., R. L. Kirby, et al. (2009). "Sitting pressure in the tilted position: manual tilt-in-space wheelchair vs. manual wheelchair with a new rear antitip device." Am J Phys Med Rehabil 88(1): 61-65.
To test the hypothesis that, in comparison with a heavier, larger and more expensive manual tilt-in-space wheelchair, a lightweight manual wheelchair equipped with new rear antitip devices provides comparable mean sitting pressures in the tilted position, each of eight able-bodied participants sat for 8 mins in each wheelchair, upright, and tilted back (38-39 degrees). The mean (+/-SD) sitting pressures (of all active sensors in a force-sensing array) at the eighth minute in the upright and tilted positions with the new rear antitip device wheelchair were 58.6 (+/-14.0) and 45.8 (+/-9.3) mm Hg (a 20.7% reduction) (P = 0.005). For the tilt-in-space wheelchair, the mean values were 55.7 (+/-13.9) and 47.2 (+/-10.8) mm Hg (a 26.3% reduction) (P = 0.008). There were no significant differences between the wheelchairs in the upright (P = 0.843) or tilted (P = 0.624) positions. A lightweight manual wheelchair equipped with a new rear antitip device provides equivalent reductions of sitting pressures in the tilted position to a comparably tilted tilt-in-space wheelchair.
Mason, B. S., L. Porcellato, et al. (2010). "A qualitative examination of wheelchair configuration for optimal mobility performance in wheelchair sports: a pilot study." J Rehabil Med 42(2): 141-149.
OBJECTIVE: To examine wheelchair athletes' perceptions of wheelchair configuration in relation to aspects of mobility performance. METHODS: Nine elite wheelchair athletes from wheelchair basketball, wheelchair rugby and wheelchair tennis were interviewed using a semi-structured format. Interview transcripts were analysed using an Interpretative Phenomenological Analysis, whereby emergent themes with common connections were identified and clustered into 3 superordinate themes: (i) performance indicators; (ii) principal areas of wheelchair configuration; and (iii) supplementary areas of wheelchair configuration. RESULTS: Participants revealed that stability was the most important contributor towards successful performance. Whilst there was some agreement amongst participants on how manipulating most areas of wheelchair configuration influenced performance, opinions were divided as to whether camber had a positive or negative effect on straight line performance. CONCLUSION: Experienced athletes seemed to display a good understanding of how modifying wheelchair configurations can affect sports performance, yet the methods offered for identifying optimal settings were extremely subjective. Therefore, future quantitative research into specific areas of configuration is imperative to identify these optimums and to inform athletes about the decisions they make when configuring a new sports wheelchair.
Samuelsson, K., M. Bjork, et al. (2009). "The effect of shaped wheelchair cushion and lumbar supports on under-seat pressure, comfort, and pelvic rotation." Disabil Rehabil Assist Technol 4(5): 329-336.
AIM: A wheelchair seat and position help clients perform daily activities. The comfort of the wheelchair can encourage clients to participate in daily activities and can help prevent future complications. PURPOSE: This study evaluates how a shaped seat-cushion and two different back supports affect under-seat pressure, comfort, and pelvic rotation. METHOD: Thirty healthy subjects were tested using two differently equipped manual wheelchairs. One wheelchair had a Velcro adjustable back seat and a plane seat-cushion. The other wheelchair had a non-adjustable sling-back seat and a plane cushion. The second wheelchair was also equipped with a shaped cushion and/or a detachable lumbar support. Under-seat pressure, estimated comfort, and pelvic rotation were measured after 10 min in each wheelchair outfit. RESULTS: Peak pressure increased with the shaped cushion compared to the plane cushion. No significant difference in estimated comfort was found. Pelvic posterior-rotation was reduced with the adjustable or detachable back-support irrespective of the shape of the seat cushion. CONCLUSIONS: To support a neutral pelvic position and spinal curvature, a combination of a shaped cushion and a marked lumbar support is most effective.
Sprigle, S., C. Maurer, et al. (2007). "Development of valid and reliable measures of postural stability." J Spinal Cord Med 30(1): 40-49.
BACKGROUND/OBJECTIVE: The development of simple postural stability tests that relate to performance of activities of daily living (ADL) and can be quickly performed in a clinical setting may assist clinicians in determining appropriate wheelchair configurations and postural supports in an efficient manner. The study's purpose was to validate 3 clinical measures of reach-functional reach (FR), reach area (RA), and bilateral reach (BR)-against the performance of ADL tasks. METHODS: Two groups of 20 subjects differing by time since spinal cord injury were tested. Three measures of reach-FR, RA, and BR-were recorded with and without permitting compensatory strategies. Subjects also attempted a series of ADL tasks. Group 2 subjects participated in test-retest reliability of the reach measures and to measure reach while using compensatory strategies. Correlation, ANOVA, and linear regression were used for analysis. RESULTS: Regression analysis showed that injury level was a significant predictor of success in performing ADL tasks (%ADL). Significant but not strong correlations were found between %ADL and all uncompensated reach measures. Within Group 2 subjects, compensated FR (r = 0.663) and RA (r = 0.647) were more related to the %ADL score than the uncompensated FR (r = 0.348) and RA (r = 0.305) measurements. BR had the strongest relationship with %ADL scores (P = 0.031) and was the only significant uncompensated reach measurement within the regression analyses. DISCUSSION AND CONCLUSION: While working with clients on seated stability and functional movement, clinicians should be encouraged to incorporate BR tasks because it has the strongest relationship to ADL performance. Researchers interested in studying postural control and stability during functional tasks should consider using uncompensated reach measures.