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Perceptions of power mobility use and safety within residential facilities.

BACKGROUND: medicare power wheelchairs enhance quality of life by enabling occupation, improving self-esteem and facilitating social interaction. Despite these benefits, the risks associated with power mobility use raise serious concerns in residential facilities. PURPOSE: As there is no gold standard to assess when a client is unsafe, a two-phase study was conducted to develop client-centred guidelines for handicap scooters use. METHOD: In the first phase of the study, presented here, 18 in-depth, qualitative interviews were conducted with a variety of stakeholders, including power mobility users, other residents, staff and family members. RESULTS: A thematic analysis of the interviews revealed four main themes: 1) the meaning of power mobility, 2) learning the rules of the road, 3) red flags: concerns about safety, and 4) solutions. PRACTICE IMPLICATIONS: Given the importance of power mobility, safety measures need to address issues of mobility and safety for power mobility drivers and those around them.

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Keywords: health

Added: September 30, 2008

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The longitudinal relation between physical capacity and wheelchair skill performance during inpatient rehabilitation of people with spinal cord injury

OBJECTIVE: To study the longitudinal relation between physical capacity and wheelchair skill performance in subjects with spinal cord injury (SCI) during rehabilitation. DESIGN: Observational prospective cohort study. Measurements were taken 3 times during subjects’ rehabilitation. SETTING: Eight rehabilitation centers in the Netherlands. PARTICIPANTS: Ninety-seven subjects with SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Parameters of physical capacity were upper-extremity muscle strength (manual muscle test MMT sum score), peak oxygen uptake, and peak power output (POpeak). The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores: ability, performance time, and physical strain. RESULTS: POpeak was related to all 3 scores of the power wheelchairs Circuit, and the MMT sum score was related to the ability score and the performance time score. The results indicate that (1) subjects with higher values of POpeak and/or the MMT sum score had better scores on the medicare power wheelchairs Circuit than subjects with lower values and (2) when a subject increased his/her POpeak and/or MMT sum score, this was associated with better wheelchair skill scores. CONCLUSIONS: There is a significant longitudinal relation between wheelchair skill performance and POpeak and MMT sum score during the rehabilitation of people with SCI. To optimize wheelchair skill performance, attention should be directed toward manual wheelchair exercise training and strength training of the upper body.

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Powered mobility for middle-aged and older adults: systematic review of outcomes and appraisal of published evidence

OBJECTIVE: To identify the outcomes of power mobility devices for middle-aged and older adult users, and to critically appraise the research evidence. DESIGN: Systematic review of primary source studies involving adults aged 50 and over using medicare power wheelchairs, handicap scooters mobility devices (1996-2007). Articles were (i) mapped to the Taxonomy of Assistive Technology Device Outcomes, which describes categories of impact of assistive devices from the vantages of effectiveness, social significance, and subjective well-being; and (ii) appraised using the Grading of Recommendations, Assessment, Development, and Evaluation criteria. RESULTS: This review retained 19 studies and identified 52 different categories of impacts of power mobility devices spanning the three vantages of the taxonomy. The coverage of outcome dimensions was not as extensive for adults age 50 and over as it was for mixed-age groups. Most of the research designs were assigned very low evidence grades. Three studies were low to moderate in quality of evidence, among which one was a randomized trial. CONCLUSIONS: A vast array of potential impacts of powered mobility devices have been described in the last decade. The level of quality of this evidence is improving, but most of these studies were not designed to verify causal relationships, and this is largely responsible for the absence of unequivocal evidence for directly attributing benefits to devices themselves and for quantifying relationships between power mobility device intervention and outcome. To raise the level of evidence about power mobility device interventions in older adults, studies are needed that use prospective designs, better-defined user groups, and well-grounded conceptual frameworks for measuring interventions and outcomes

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Exercise responses and adaptations in rowers and spinal cord injury individuals.

Elite rowers (ROWERS) and those who have had a spinal cord injury (SCI) are different physically in many realms. Both have physical activity histories that affect their lower-extremity extensor muscles in a dramatically different fashion. ROWERS can sustain a 500-W power output during their 5- to 6-min race. After a complete SCI, a 75-W power output might be achieved during a VO(2peak) test. Elite SCI medicare power wheelchairs racers can achieve a higher value that is similar to that of a sedentary able-bodied person. ROWERS can attain a VO(2 max) of more than 7.5 L.min(-1) and can tolerate a blood lactate of 30 mmol.L(-1). After a complete SCI in which muscles become markedly atrophied, a peak VO(2) of 2 L.min(-1) and a blood lactate of 10 mmol.L(-1) might be achieved. ROWERS rely on the 75% slow-twitch fiber composition of their trained thigh muscles to train and race. Such activity modestly increases fiber size and markedly increases mitochondrial content. After a complete SCI, affected muscle fibers markedly atrophy, maintain most of their mitochondrial content, and become fast-twitch. These data suggest remarkable plasticity of physical function to the extreme that a marked increase in energy demanding, rather continuous physical activity can make a muscle more “slow-twitch”; so it will demand less energy when contracted. In contrast, SCI eventually causes muscle to be composed of more fast-twitch fibers. Molecular biologists may explain why fast-twitch fibers, which appear ideal for some athletes because of their high power output, are abundant in muscles that are seldom recruited. Until then, our results indicate that the fiber type composition of muscle in humans is stable unless extreme alterations in physical activity are endured.

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