Pressure mapping to assess seated pressure distributions and the potential risk for skin ulceration in a population of sledge hockey players and control subjects

Sitting pressure during wheelchair propulsion and handcycling: effects of backrest angle, movement intensity and cushion type

Purpose: The main aim of this study was to compare sitting pressure (peak pressure index (PPI) and peak pressure gradient (PPG)) between a daily wheelchair and fixed-frame handcycle, thereby assessing the effect of handcycle backrest angle, movement intensity and cushion type.

Materials and methods: Twenty able-bodied participants performed static and dynamic (two intensities) tests in a wheelchair and handcycle. A honeycomb wheelchair cushion and standard foam handcycle cushion were used. Handcycle backrest angles were 45° and 60°. The PPI and PPG at the sacro-coccygeal (SC) and ischial tuberosity (IT) regions were determined with a pressure mat.

Results: PPI at the IT-region was higher in the 60° handcycle condition than in the wheelchair (p = 0.04), while PPG at the IT-region did not differ significantly between the wheelchair and handcycle conditions (p > 0.05). PPI and PPG were higher at the 45° handcycle SC-region compared to the wheelchair IT-region (p < 0.03). PPI and PPG at the IT-region were higher with the 60° than with the 45° backrest angle (p < 0.01), while at the SC-region PPI was higher with the 45° backrest angle (p = 0.047). No clear influence of movement intensity was found. PPI and PPG at the IT-region and PPI of the SC-region in the handcycle were significantly lower with the wheelchair cushion than with the handcycle cushion (p < 0.01).

Conclusion: Overall, sitting pressure was higher in the handcycle compared to the daily wheelchair. For handcyclists using an upright position, it is recommended to use a cushion designed to redistribute pressure, thereby reducing internal tissue pressure and shear.

Winter Mobility and Community Participation Among People Who Use Mobility Devices: A Scoping Review

OBJECTIVE

To identify the knowledge, products, and strategies for individuals with mobility-related disabilities used to address challenging winter conditions.

DATA SOURCES

AgeLine, OVID, Scopus, and CIHAHL were searched for studies that met the inclusion criteria, from inception to April 2018. Sources for gray literature, or information outside commercial publishing, included ProQUEST, government websites, and manufacturers, vendors, and consumer organization websites.

SOURCE SELECTION

Population of people with limited or reduced mobility or mobility device users involved in winter-related environmental conditions; aim was to increase activity, participation, or safety.

DATA EXTRACTION

Two reviewers independently applied the inclusion criteria to select eligible sources. Two reviewers independently extracted the data from each source.

DATA SYNTHESIS

Twenty-three published peer-reviewed papers were located. Study populations were predominantly those who used wheelchairs (mixed wheelchair type, n=7; power, n=4; manual, n=2), canes (n=3), or specialized winter footwear (n=2). The primary focus of these papers was determined to be tool or device (n=10), recommendations (n=9), strategy (n=2), or resource (n=2). Civic policy documents were variable in citizen responsibility for snow clearing. Limited winter-related supports were identified on consumer organization websites. Although some winter-specific products exist, very few studies have examined the effectiveness of any of these products.

CONCLUSIONS

Despite the common experience of challenging winter conditions, a paucity of winter-specific research and innovation relevant for individuals who use mobility devices exists. Researchers, consumers, and industry need to partner to develop novel tools, strategies, resources, and evidence-based recommendations.

Influence of wheelchair user interface and personal characteristics on static and dynamic pretibial skin pressures in elite wheelchair racers, a pilot study

Context/objective: To examine personal (athletic classification, age, sex, body mass index, duration of disability, tactile sensation of lower extremities) and wheelchair (kneeling plate angle) factors associated with increased pretibial skin pressures in elite wheelchair racers.

Design: Cross-sectional study.

Setting: University-based laboratory in Champaign, USA.

Participants: A convenience sample of elite wheelchair races with traumatic spinal cord injury and spinal disease were recruited for participation.

Interventions: Interface pressure mapping was used to examine athletes' average and peak pretibial skin pressures in their own racing wheelchairs during static and dynamic (propulsive) conditions on a dynamometer.

Outcome measures: The study examined associations between personal and wheelchair factors and pressure, differences in pressure between static and dynamic conditions, and the influence of athletic classification (T53 vs. T54) on kneeling plate angle preference and skin pressure magnitudes.

Results: Increased kneeling plate angle was moderately associated with dynamic pressures. T53 athletes utilized more vertical kneeling angles and experienced larger average and peak pressures during propulsion. Duration of disability was negatively associated with all measures of pressure. Overall, mean dynamic peak pressure was significantly greater than mean static peak pressure.

Conclusion: This pilot study represents a first step in understanding the influence of user interface on potentially injurious skin pressures in wheelchair racers. Vertical kneeling plate configurations were associated with increased pressures while increased years with disability was associated with lower pretibial pressures. In addition, T53 athletes with less trunk function may be at a greater risk for experiencing larger interface pressures than T54 athletes.

Medical and Musculoskeletal Concerns for the Wheelchair Athlete: A Review of Preventative Strategies

Adaptive sports refers to organized sporting activities that are practiced by individuals with disabilities and are worthwhile to maintain physical and psychological health. As adaptive sports participation continues to rise, health care providers must have an enhanced understanding of injury and illness patterns specific to the adaptive athlete. Early recognition and prevention are important to ensure safe and successful participation in sport. The present review aims to provide a framework for diagnosis and prevention of common conditions specific to the wheelchair athlete. In particular, autonomic dysreflexia, impaired thermoregulation, urinary tract infection, and pressure injuries, as well as shoulder pain, upper-extremity entrapment neuropathies, and osteoporotic fractures will be discussed.

Seated pressures in daily wheelchair and sports equipment: investigating the protective effects of cushioned shorts

Study design

The primary study design was a pretest and posttest study performed in a single session with subjects as their own control. We summarize three integrated and sequential studies.

Objective

The objective of this study was to investigate whether commercially available cushioned shorts would add skin protection when used in adaptive sports equipment (AE).

Setting

Community in Tacoma Washington, USA.

Methods

TekScan Pressure Mapping System for recording average (AP) and peak (PP) seating pressures.Part 1. Pretest/posttest design, subjects as own control. Eight adults with SCI (C5-T6) mapped in daily wheelchair and AE with and without bicycle shorts.Part 2. Sixteen able-bodied subjects were mapped with and without an impact short and full-coverage short in a hand-cycle.Part 3. One individual with T5 SCI was mapped with and without a full-coverage short in personal basketball chair and mountain hand-cycle.

Results

Part 1. Significant differences between the daily wheelchair and AE in the static condition for AP and PP and AP in the dynamic condition. Bicycle shorts showed no significance.Part 2. Impact shorts increased static PP and AP. The full-coverage short decreased static AP.Part 3. The full-coverage short increased AP and PP in the basketball chair. In the mountain hand-cycle, AP decreased but PP increased.

Conclusion

Athletes who are static in their AE may be at greater risk of tissue breakdown than those actively playing. Cushioned shorts had highly variable effects on seated pressure in adaptive equipment. Pressure mapping is recommended prior to using any cushioning in AE by the SCI population.