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Saia T, Vogel E, Salazar S. "We need a world we can operate in": Exploring the relationship between societal stigma and depression among wheelchair users. Disabil Health J 2024:101624. [PMID: 38631970 DOI: 10.1016/j.dhjo.2024.101624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 03/21/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Stigma looms over the disability community. OBJECTIVE OR HYPOTHESIS The aim of this paper is to gain a deeper understanding of how societal stigma impacts depression among wheelchair users. METHODS Mixed research methods were used on a sample of sixty full-time wheelchair users (M age = 43.78, SD = 15.50) whose disability was either acquired (n = 32) or congenital (n = 28). Data was collected via an anonymous Qualtrics survey. Qualitative and quantitative content analyses were performed. RESULTS Three major themes were identified from the qualitative analysis, including pity, discomfort, and invisibility which demonstrated that our participants felt frequently stigmatized in public. Several participants noted how assumptions were made about their competence, intellect, ability, and the entire disability experience based on the physical representation of their wheelchair. The quantitative results demonstrated a positive correlation between The Major Depression Index and the Able Privilege Scale-Revised, a scale constructed to examine personal power and privilege in relation to society depending on disability type. CONCLUSIONS Wheelchair users feel stigmatized by members of society, which is associated with increased levels of depression and perceived pity, discomfort, and invisibility.
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Affiliation(s)
- Toni Saia
- Department of Administration, Rehabilitation, & Postsecondary Education, San Diego State, USA.
| | - Emily Vogel
- Department of Psychological Sciences, Northern Arizona University, USA.
| | - Sadie Salazar
- Department of Administration, Rehabilitation, & Postsecondary Education, San Diego State, USA.
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2
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Klinich KD, Boyle KJ, Manary MA, Orton NR, Wang Y, Hu J. Optimizing frontal impact occupant protection systems for passengers seated in wheelchairs. Accid Anal Prev 2023; 192:107238. [PMID: 37540978 DOI: 10.1016/j.aap.2023.107238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/27/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE The advent of automated vehicles (AVs) provides an opportunity to design integrated wheelchair seating stations that provide an equivalent level of safety for occupants using wheelchairs as those using vehicle seating. This study designed a frontal occupant protection system for an integrated second-row wheelchair seating station that includes optimized airbags and seatbelt systems. METHODS MADYMO models were used to optimize belt geometry for a midsized male ATD seated in a surrogate wheelchair fixture, with and without inclusion of a Self Conforming Rearseat Air Bag (SCaRAB). Sled tests were performed to confirm the benefits of airbag use and optimized belt geometry. Additional modeling was performed with commercial manual and power wheelchairs, to identify the effects of wheelchair design and forward clear space on occupant kinematics and injury measures. Additional sled tests were performed with manual and power wheelchairs to demonstrate effectiveness of the restraint system with commercial products. RESULTS Simulations and tests both showed improved kinematics using an optimized seatbelt system geometry compared to a commonly used suboptimal D-ring location that places the shoulder belt at a more outboard location. Use of the SCaRAB helped compensate for suboptimal geometry. Results include specific recommendations for belt geometry relative to the wheelchair seating station and airbag parameters suitable for protecting occupants seated in wheelchairs. Restraint systems initially optimized using the surrogate wheelchair also performed well with the two commercial wheelchairs. The clear space required for maneuvering a wheelchair will likely prevent injurious head contact in frontal crashes. CONCLUSIONS This study is the first to design a frontal optimal occupant protection system for an integrated second-row wheelchair seating station, demonstrating that it should be feasible once integrated wheelchair seating stations are included in AVs.
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Affiliation(s)
- Kathleen D Klinich
- University of Michigan Transportation Research Institute, Ann Arbor, MI, USA.
| | - Kyle J Boyle
- University of Michigan Transportation Research Institute, Ann Arbor, MI, USA
| | - Miriam A Manary
- University of Michigan Transportation Research Institute, Ann Arbor, MI, USA
| | - Nichole R Orton
- University of Michigan Transportation Research Institute, Ann Arbor, MI, USA
| | - Yushi Wang
- University of Michigan Transportation Research Institute, Ann Arbor, MI, USA
| | - Jingwen Hu
- University of Michigan Transportation Research Institute, Ann Arbor, MI, USA
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Hansen RK, Laessoe U, Samani A, Mellergaard M, Rasmussen RW, Handberg A, Larsen RG. Impact of upper-body ergometer rowing exercise on aerobic fitness and cardiometabolic disease risk in individuals with spinal cord injury: A 6-month follow-up study. J Spinal Cord Med 2023:1-11. [PMID: 37534922 DOI: 10.1080/10790268.2023.2233820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVE We recently demonstrated that upper-body rowing exercise (UBROW) improved aerobic fitness in individuals with spinal cord injury (SCI), with no effect on traditional cardiometabolic risk factors. Here, we tested the hypothesis that the exercise-induced increase in aerobic fitness was maintained at 6-month (6M) follow-up. DESIGN Six-month follow-up. SETTING University/hospital. PARTICIPANTS Seventeen wheelchair-dependent participants with SCI. INTERVENTIONS 12-week of exercise training (UBROW) or control (CON). OUTCOME MEASURES Aerobic fitness (POpeak and V̇O2peak), body composition, blood pressure, and blood biomarkers of cardiometabolic risk were assessed at 6M follow-up and compared to baseline (BL) and immediately post-intervention (12-week). Minutes of mild, moderate, and heavy intensity leisure time physical activity (LTPA) were assessed by self-report. RESULTS Fourteen participants returned at 6M follow-up (CON, n = 6; UBROW, n = 8). In UBROW, POpeak (median (Q1-Q3)) increased from BL (70 W (37-84)) to 12-week (77 W (58-109), P = 0.01) and 6M follow-up (81 W (51-96), P = 0.01), with no difference between 12-week and 6M follow-up (P = 0.21). Similarly, V̇O2peak increased from BL (15.4 ml/kg/min (10.5-19.4)) to 12-week (16.6 ml/kg/min (12.8-21.3), P = 0.01) with no difference between 12-week and 6M follow-up (16.3 ml/kg/min (12.9-19.7), P = 0.74). No differences were found in CON for either POpeak (P = 0.22) or V̇O2peak (P = 0.27). There were no changes over time in traditional cardiometabolic risk factors or for minutes of different LTPA intensities. CONCLUSION We demonstrate that improvements in aerobic fitness are maintained for at least six months after completion of a 12-week exercise intervention, supporting the use of periodic exercise interventions to boost aerobic fitness level in individuals with SCI.Trial registration: ClinicalTrials.gov identifier: NCT04390087..
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Affiliation(s)
- Rasmus Kopp Hansen
- ExerciseTech, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Research and Development, University College of Northern Jutland, Aalborg, Denmark
| | - Uffe Laessoe
- Department of Research and Development, University College of Northern Jutland, Aalborg, Denmark
| | - Afshin Samani
- ExerciseTech, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Maiken Mellergaard
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Aase Handberg
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ryan Godsk Larsen
- ExerciseTech, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Peters J, Teague A, Halloran K, Sung J, Rice LA, Rice I. The influence of gender on shoulder kinematics and head-hip technique during non-level transfers in full-time wheelchair users. Clin Biomech (Bristol, Avon) 2023; 105:105969. [PMID: 37087880 DOI: 10.1016/j.clinbiomech.2023.105969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Non-level transfers are some of the most demanding tasks for manual wheelchair users. Safely performing these transfer tasks may be needed for maintaining long-term upper limb health. This cross-sectional study aimed to examine the influence of gender on the head-hip technique and lead arm kinematics during multi-height transfers in manual wheelchair users. METHODS Motion analysis was used to obtain lead-arm shoulder kinematics (flexion/extension and abduction/adduction) and trunk flexion during level, uphill, and floor-to-table transfers in full-time manual wheelchair users. FINDINGS Twelve male (N = 12) and fifteen female (N = 15) manual wheelchair users with a mean age of 23 ± 5 years and no signs of shoulder pain participated in the study. Lead-arm shoulder flexion and abduction increased as vertical displacement requirements increased during the various transfer tasks (p < 0.01). Women displaced greater trunk flexion during level transfers at approaching significant levels (p = 0.07). During uphill transfers, women displayed significantly greater trunk flexion than men (p < 0.05). INTERPRETATION Manual wheelchair users use unique kinematic requirements when using the head-hip during level and non-level transfers. Women may be at decreased risk of chronic shoulder pain due to a greater use of the head-hip technique during non-level transfers. Nonetheless, more research that integrates kinetics and strength assessments during non-level transfer biomechanical analyses is needed to better understand technical requirements of non-level transfers in manual wheelchair users.
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Affiliation(s)
- Joseph Peters
- The Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Disability Resources and Educational Services, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Alexander Teague
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Kellie Halloran
- Department of Mechanical Science and Engineering, College of Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ian Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Van Denend T, Peterson EW, Sung J, Rice LA. Process evaluation findings of a fall prevention and management program for wheelchair and scooter users with multiple sclerosis. PEC Innov 2022; 1:100081. [PMID: 37213774 PMCID: PMC10194268 DOI: 10.1016/j.pecinn.2022.100081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 08/16/2022] [Accepted: 09/01/2022] [Indexed: 05/23/2023]
Abstract
Objective To describe process evaluation findings of a clinical trial to evaluate the Individualized Reduction of Falls (iROLL) program, a 6-session, group-based intervention designed to reduce fall incidence among people living with multiple sclerosis (MS) who use a wheelchair or scooter full-time. Methods A mixed-methods process evaluation focusing on implementation and mechanisms of impact (MOI) was conducted. Both iROLL participants and trainers (licensed occupational or physical therapists) provided input. Results Seventeen iROLL participants and nine trainers participated. The overall session attendance rate was 93%. Content and logistics fidelity were 95% and 90%, respectively and average overall participant satisfaction rating was 4.7/5.0. Five MOI themes emerged: group dynamic, comprehensive nature of the program, strong program development, role of a skilled interventionist, and motivated participants. Recruitment challenged program reach. Conclusion iROLL is acceptable to the target audience, can be delivered with high fidelity and has diverse and interacting mechanisms of impact operating. Remote delivery may improve reach. Innovation Effective iROLL delivery requires trainers with strong group management skills who can also individualize material while maintaining program fidelity. Comprehensive training and on-going support of the occupational and physical therapists delivering iROLL bolsters program effectiveness. Program access may improve with online delivery.
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Affiliation(s)
- Toni Van Denend
- Department of Occupational Therapy, University of Illinois Chicago, IL, USA
| | | | - JongHun Sung
- Department of Kinesiology, College of Arts & Sports, Inha University, Incheon, South Korea
| | - Laura A. Rice
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Corresponding author at: 219 Freer Hall, 906 S. Goodwin Ave. Urbana, IL 61801, USA.
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Hu J, Klinich KD, Manary MA, Orton N, Boyle K, Wang Y, Fischer K, Smith A, Adler A. Improving protection system for wheelchair-seated occupants in vehicle side impacts. Traffic Inj Prev 2022; 23:S80-S85. [PMID: 36037001 DOI: 10.1080/15389588.2022.2114795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
Objective: Previous research on occupant protection systems for wheelchair-seated occupants focused on frontal impacts, while similar studies on side impacts are very limited. The objective of this study was to identify the major injury concerns for wheelchair-seated occupants in side impacts and develop restraint systems to mitigate such injury concerns.Methods: Seven sled tests in side impact conditions were first conducted at 30 km/h with a 24 g peak deceleration. An ES2-RE ATD and surrogate wheelchair base (SWCB) were used in all tests, which varied armrest design, width of the SWCB, and wheelchair tiedown conditions. These sled tests set up the baseline performance and provided validation data for computational models. A set of validated MADYMO models were then used to investigate the safety concerns and potential restraint solutions for wheelchair-seated occupants in side impacts. Simulations covered nearside and farside impacts, inboard or outboard D-ring locations, varied wheelchair locations relative to the side door, varied seatbelt anchorage locations, and a few Center Airbag To Contain Humans (CATCH) designs. Finally, another set of sled tests were conducted to demonstrate the effectiveness of varied CATCH designs for protecting wheelchair-seated occupants in farside impacts.Results: Simulations suggested that wheelchair-seated occupants might fall from the wheelchair in farside impacts, while in nearside impacts the seatbelt and curtain airbag can provide reasonable protection to occupants using wheelchairs. The CATCH design, a curtain airbag mounted to the roof centerline with tethers attached outboard of the wheelchair station, was effective at preventing the ATD from falling off the wheelchair. Results from sled tests to iterate CATCH parameters confirmed that the concept was effective at retaining occupants seated in wheelchairs under farside impact loading.Conclusions: This study is the first to investigate wheelchair-seated occupant protection in both nearside and farside impacts. The injury concerns identified in farside impacts and the CATCH design can potentially help improve the protection of wheelchair-seated occupants in side impacts in the future. The CATCH design has potential to improve farside protection for occupants in traditional seating.
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Affiliation(s)
- Jingwen Hu
- Transportation Research Institute, University of Michigan, Ann Arbor, Michigan
| | - Kathleen D Klinich
- Transportation Research Institute, University of Michigan, Ann Arbor, Michigan
| | - Miriam A Manary
- Transportation Research Institute, University of Michigan, Ann Arbor, Michigan
| | - Nichole Orton
- Transportation Research Institute, University of Michigan, Ann Arbor, Michigan
| | - Kyle Boyle
- Transportation Research Institute, University of Michigan, Ann Arbor, Michigan
| | - Yushi Wang
- Transportation Research Institute, University of Michigan, Ann Arbor, Michigan
| | - Kurt Fischer
- Passive Safety Systems, ZF US Inc., Washington, Michigan
| | - Alex Smith
- Passive Safety Systems, ZF US Inc., Washington, Michigan
| | - Angelo Adler
- Passive Safety Systems, ZF US Inc., Washington, Michigan
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Briley SJ, Vegter RJK, Goosey-Tolfrey VL, Mason BS. The longitudinal relationship between shoulder pain and altered wheelchair propulsion biomechanics of manual wheelchair users. J Biomech 2021; 126:110626. [PMID: 34329882 DOI: 10.1016/j.jbiomech.2021.110626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/25/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to investigate the longitudinal association between within-subject changes in shoulder pain and alterations in wheelchair propulsion biomechanics in manual wheelchair users. Eighteen (age 33 ± 11 years) manual wheelchair users propelled their own daily living wheelchair at 1.11 m.s-1 for three minutes on a dual-roller ergometer during two laboratory visits (T1 and T2) between 4 and 6 months apart. Shoulder pain was assessed using the Performance Corrected Wheelchair User's Shoulder Pain Index (PC-WUSPI). Between visits mean PC-WUSPI scores increased by 5.4 points and varied from - 13.5 to + 20.9 points. Of the eighteen participants, nine (50%) experienced increased shoulder pain, seven (39%) no change in pain, and two (11%) decreased pain. Increasing shoulder pain severity correlated with increased contact angle (r = 0.59, P = 0.010), thorax range of motion (r = 0.60, P = 0.009) and kinetic and kinematic variability. Additionally, increasing shoulder pain was associated with reductions in peak torque (r = -0.56, P = 0.016), peak glenohumeral abduction (r = -0.69, P = 0.002), peak scapular downward rotation (r = -0.68, P = 0.002), and range of motion in glenohumeral flexion/extension and scapular angles. Group comparisons revealed that these biomechanical alterations were exhibited by individuals who experienced increased shoulder pain, whereas, propulsion biomechanics of those with no change/decreased pain remained unaltered. These findings indicate that wheelchair users exhibit a protective short-term wheelchair propulsion biomechanical response to increases in shoulder pain which may temporarily help maintain functional independence.
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Hu J, Orton N, Manary MA, Boyle K, Schneider LW. Should airbags be deactivated for wheelchair-seated drivers? Traffic Inj Prev 2020; 21:S37-S42. [PMID: 32529848 DOI: 10.1080/15389588.2020.1778676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Field data have shown significant benefit from driver airbag for occupant protection in frontal crashes. However, vehicle modifiers almost always permanently deactivate airbags for wheelchair-seated drivers. The objective of this study was to conduct sled tests and computational simulations to answer whether driver airbags should be deactivated for drivers seated in wheelchairs. METHODS Five sled tests were conducted under a 48-kph 20-g frontal crash pulse all with driver airbag. Seat-belt fit (good, poor, and unbelted), airbag deployment time (proper and late), and occupant size (midsize male and small female HIII ATDs) were varied in the tests. The 2006 Chrysler Town-and-Country minivan was selected as the nominal vehicle environment, and a surrogate wheelchair with a docking securement system was used for all sled tests. ATD injury measures for the head, neck, chest, and lower extremities were recorded in each test, and were used for validating a set of MADYMO models. Parametric studies with a total of 28 MADYMO simulations were then conducted to investigate the airbag effects on occupant injury risks with varied occupant size, belt fit, and impact angle (0, 15, and 30 deg). RESULTS The sled tests showed potential safety concerns for wheelchair-seated drivers with a poor belt fit or without a belt. Specifically, the unbelted midsize male ATD sustained high femur forces and the small female ATD with poor belt fit sustained high chest deflections. The parametric simulations showed that airbag generally improved the protection for wheelchair-seated drivers. It is especially useful for unbelted wheelchair-seated drivers, and is also helpful for reducing the head and neck injury risks regardless of the belt condition, occupant size, and impact angle. CONCLUSIONS This is the first study using sled tests and computational simulations to investigate the effects of airbag deployment on injury risks of wheelchair-seated drivers. Overall, the results showed little basis for concern that the energy of deploying a driver airbag in today's vehicles will cause serious-to-fatal injuries to drivers seated in wheelchairs. The results of this study therefore support the idea that driver airbags generally offer tangible safety benefits for a wide range of wheelchair-seated drivers in frontal crashes.
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Affiliation(s)
- Jingwen Hu
- University of Michigan Transportation Research Institute, Ann Arbor, Michigan, USA
| | - Nichole Orton
- University of Michigan Transportation Research Institute, Ann Arbor, Michigan, USA
| | - Miriam A Manary
- University of Michigan Transportation Research Institute, Ann Arbor, Michigan, USA
| | - Kyle Boyle
- University of Michigan Transportation Research Institute, Ann Arbor, Michigan, USA
| | - Lawrence W Schneider
- University of Michigan Transportation Research Institute, Ann Arbor, Michigan, USA
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Koyama S, Tanabe S, Saitoh E, Otaka Y, Ohta H, Tatemoto T, Kumazawa N, Katoh A, Sugiyama Y, Kiyono K, Kanada Y. Comparison of two methods of bed-to/from-wheelchair transfer in patients with hemiparetic stroke. Fujita Med J 2020; 6:81-86. [PMID: 35111526 PMCID: PMC8749507 DOI: 10.20407/fmj.2019-016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/06/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The ability to transfer between surfaces is essential for wheelchair users' independence. We hypothesized that transfer of hemiparetic stroke patients would be improved by using surfaces at the same height with no gap or obstacle between them. METHODS A cross-sectional study was conducted to compare the difficulty of two transfer methods as a pilot study. Thirteen hemiparetic stroke patients were transferred from a platform table to a chair (wheelchair or flat chair) and from the chair to the table using the regular and lateral transfer methods. Functional Independence Measure (FIM) transfer score in both transfer methods and Stroke Impairment Assessment Set (SIAS) score were measured. RESULTS The FIM transfer score significantly increased in the lateral transfer condition compared with the regular transfer condition, indicating that the former method reduced the transfer difficulty, regardless of the SIAS scores. CONCLUSIONS The transfer difficulty of patients with hemiparetic stroke decreases when using the lateral transfer method. The lateral transfer method is easy, potentially helping prevent care-related injuries among caregivers.
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Affiliation(s)
- Soichiro Koyama
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health
University, Toyoake, Aichi, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health
University, Toyoake, Aichi, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health
University, Toyoake, Aichi, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health
University, Toyoake, Aichi, Japan
| | - Hirofumi Ohta
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health
University, Toyoake, Aichi, Japan
| | - Tsuyoshi Tatemoto
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health
University, Toyoake, Aichi, Japan
| | - Nobuhiro Kumazawa
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health
University, Toyoake, Aichi, Japan
| | - Ai Katoh
- Department of Rehabilitation, Fujita Health University Hospital,
Toyoake, Aichi, Japan
| | - Yuki Sugiyama
- Department of Rehabilitation, Fujita Health University Hospital,
Toyoake, Aichi, Japan
| | - Kei Kiyono
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health
University, Toyoake, Aichi, Japan
| | - Yoshikiyo Kanada
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health
University, Toyoake, Aichi, Japan
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10
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Gabison S, Mathur S, Nussbaum EL, Popovic MR, Verrier MC. The relationship between pressure offloading and ischial tissue health in individuals with spinal cord injury: An exploratory study. J Spinal Cord Med 2019; 42:186-195. [PMID: 31573438 PMCID: PMC6781203 DOI: 10.1080/10790268.2019.1645404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objectives: To compare thickness and texture measures of tissue overlying the ischial region in able-bodied (AB) individuals vs. individuals with spinal cord injury (SCI) and to determine if there is a relationship between pressure offloading of the ischial tuberosities (IT) and tissue health in individuals with SCI. Design: Exploratory cross-sectional study. Setting: University setting and rehabilitation hospital. Outcome Measures: Thickness and texture measurements from ultrasound images of tissues overlying the IT were obtained from AB individuals (n = 10) and individuals with complete or incomplete traumatic and non-traumatic SCI American Spinal Injury Association Impairment Scale (AIS) classification A-D (n = 15). Pressure offloading was measured in individuals with SCI and correlated with tissue health measurements. Results: The area overlying the IT occupied by the muscle was significantly greater in the SCI when compared with AB cohort. The area occupied by the muscle in individuals with SCI appeared to lose the striated appearance and was more echogenic than nearby skin and subcutaneous tissue (ST). There was no correlation between offloading times and thickness, echogenicity and contrast measurements of skin, ST and muscle in individuals with SCI. Conclusion: Changes in soft tissues overlying the ischial tuberosity occur following SCI corresponding to the loss of striated appearance of muscle and increased thickness of the area occupied by the muscle. Further studies using a larger sample size are recommended to establish if thickness and tissue texture differ between individuals with SCI who sustain pressure injuries vs. those who do not.
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Affiliation(s)
- Sharon Gabison
- SCI Mobility Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada,Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Institute of Medical Science Faculty of Medicine University of Toronto, Toronto, Ontario, Canada,Correspondence to: Sharon Gabison, SCI Mobility Laboratory, Toronto Rehabilitation Institute-University Health Network, 520 Sutherland Drive, Toronto, Ontario M4G 3V9, Canada; Ph: 647-892-4418.
| | - Sunita Mathur
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ethne L. Nussbaum
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,MClSc Program in Field of Wound Healing, Western University, London, Ontario, Canada
| | - Milos R. Popovic
- Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Institute of Medical Science Faculty of Medicine University of Toronto, Toronto, Ontario, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Mary C. Verrier
- SCI Mobility Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada,Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Institute of Medical Science Faculty of Medicine University of Toronto, Toronto, Ontario, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Abstract
Purpose: Transferring to and from the wheelchair is among the most important routine tasks for many wheelchair users. Transfers are also greatly affected by many personal and external factors. The purpose of this study is to investigate personal experiences, needs and concerns of wheelchair users in relation to wheelchair transfers performed in their everyday lives.Methods: A series of focus groups and interviews were carried out with 11 wheelchair users and 4 occupational therapists. Data were analysed using a hybrid deductive and inductive approach of thematic analysis.Results: The seven themes identified emphasize the importance and complexity of wheelchair transfers. Transfers were described as gateways to independence that grant access to life opportunities, and community participation. Nonetheless, transferring skills are difficult to acquire and the concept of correct technique, although really important, is often poorly defined. Wheelchair transfers can be further complicated by the characteristics of the individual, the presence of upper limb pain, fear of falling or the characteristics of the environment. Despite the importance of transfer training to improve safety and reduce the risk of overload injuries, only a few people receive dedicated advice from health professionals. Currently available assistive technologies were perceived as only partially successful in providing support to wheelchair users during the execution of transfers, especially when environmental constraints make the transfer more challenging.Conclusion: Due to their multifactorial nature, creating effective solutions to improve any aspect of wheelchair transfers will require a collaborative effort from users, clinicians, designers and other professionals.Implications for rehabilitationThe ability to transfer independently is extremely important for many wheelchair users and can affect not only their personal and social lives, but also the way they perceive themselves and are perceived by others.The use of a correct transferring technique plays an important role in reducing the effort required to complete a transfer and decreases the risk factors for both falls and upper limb injury development. Unfortunately, few wheelchair users have access to in-person training to develop transferring skills. The remaining people rely on a combination of peer observation, personal research and simple trial and error to figure out the movement strategies that better suit their needs.Currently available assistive technologies are perceived by wheelchair users as only partially successful in providing support during the execution of transfers. Transfer boards and other devices are often described as only useful for basic transfers and for individuals with reduced, but still sufficient, upper limb function.
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Sung J, Trace Y, Peterson EW, Sosnoff JJ, Rice LA. Falls among full-time wheelchair users with spinal cord injury and multiple sclerosis: a comparison of characteristics of fallers and circumstances of falls. Disabil Rehabil 2019; 41:389-395. [PMID: 29069956 DOI: 10.1080/09638288.2017.1393111] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study is to (1) explore and (2) compare circumstances of falls among full-time wheelchair users with spinal cord injury (SCI) and multiple sclerosis (MS). METHODS A mixed method approach was used to explore and compare the circumstances of falls of 41 full-time wheelchair users with SCI (n = 23) and MS (n = 18). In addition to collecting participants' demographic information (age, gender, type of wheelchair used, duration of wheelchair use, and duration of disability), self-reported fall frequency in the past 6 months, self-reported restriction in activity due to fear of falling and the Spinal Cord Injury-Fall Concerns Scale (SCI-FCS) was collected. Qualitative data in the form of participants' responses to an open-ended question yielding information regarding the circumstances of the most recent fall were also collected. To examine differences in survey outcomes and demographic characteristics between participants with SCI and MS, independent t-tests and Pearson's Chi-square tests were used. Qualitative data were analyzed with a thematic analysis. RESULTS Statistical analysis revealed that individuals with MS (mean =3.3) had significantly higher average SCI-FCS than individuals with SCI (mean =2.4). The analysis of the participants' descriptions of the circumstances of their most recent falls resulted in three main categories: action-related fall contributors (e.g., transfer), (2) location of falls (e.g., bathroom), and (3) fall attributions (e.g., surface condition). CONCLUSIONS The results from this study helped to understand fall circumstances among full-time wheelchair users with MS and SCI. Findings from this study can inform the development of evidenced-based interventions to improve the effectiveness of clinically based treatment protocols. Implications for rehabilitation Falls are a common health concern in full-time wheelchair users living with multiple sclerosis and spinal cord injury. The circumstances surrounding falls reported by full-time wheelchair users living with multiple sclerosis and spinal cord injuries were found to be multifactorial. The complex nature of falls must be taken into consideration in the development of fall prevention programs. Findings from this study can inform the development of comprehensive evidence-based, population-specific interventions to manage falls among full-time wheelchair users living with multiple sclerosis and spinal cord injury.
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Affiliation(s)
- JongHun Sung
- a Department of Kinesiology and Community Health , University of Illinois at Urbana , Urbana, IL , USA
| | - Yarden Trace
- a Department of Kinesiology and Community Health , University of Illinois at Urbana , Urbana, IL , USA
| | - Elizabeth W Peterson
- b Department of Occupational Therapy , University of Illinois at Chicago , Chicago , IL , USA
| | - Jacob J Sosnoff
- a Department of Kinesiology and Community Health , University of Illinois at Urbana , Urbana, IL , USA
| | - Laura A Rice
- a Department of Kinesiology and Community Health , University of Illinois at Urbana , Urbana, IL , USA
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Côté-Leclerc F, Boileau Duchesne G, Bolduc P, Gélinas-Lafrenière A, Santerre C, Desrosiers J, Levasseur M. How does playing adapted sports affect quality of life of people with mobility limitations? Results from a mixed-method sequential explanatory study. Health Qual Life Outcomes 2017; 15:22. [PMID: 28122621 PMCID: PMC5264324 DOI: 10.1186/s12955-017-0597-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 01/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Occupations, including physical activity, are a strong determinant of health. However, mobility limitations can restrict opportunities to perform these occupations, which may affect quality of life. Some people will turn to adapted sports to meet their need to be involved in occupations. Little is known, however, about how participation in adapted sports affects the quality of life of people with mobility limitations. This study thus aimed to explore the influence of adapted sports on quality of life in adult wheelchair users. METHODS A mixed-method sequential explanatory design was used, including a quantitative and a qualitative component with a clinical research design. A total of 34 wheelchair users aged 18 to 62, who regularly played adapted sports, completed the Quality of Life Index (/30). Their scores were compared to those obtained by people of similar age without limitations (general population). Ten of the wheelchair users also participated in individual semi-structured interviews exploring their perceptions regarding how sports-related experiences affected their quality of life. RESULTS The participants were 9 women and 25 men with paraplegia, the majority of whom worked and played an individual adapted sport (athletics, tennis or rugby) at the international or national level. People with mobility limitations who participated in adapted sports had a quality of life comparable to the group without limitations (21.9 ± 3.3 vs 22.3 ± 2.9 respectively), except for poorer family-related quality of life (21.0 ± 5.3 vs 24.1 ± 4.9 respectively). Based on the interviews, participants reported that the positive effect of adapted sports on the quality of life of people with mobility limitations operates mainly through the following: personal factors (behavior-related abilities and health), social participation (in general and through interpersonal relationships), and environmental factors (society's perceptions and support from the environment). Some contextual factors, such as resources and the accessibility of organizations and training facilities, are important and contributed indirectly to quality of life. Negative aspects, such as performance-related stress and injury, also have an effect. CONCLUSIONS People with mobility limitations playing adapted sports and people without limitations have a similar quality of life. Participation in adapted sports was identified as having positive effects on self-esteem, self-efficacy, sense of belonging, participation in meaningful activities, society's attitude towards people with mobility limitations, and physical well-being. However, participants stated that this involvement, especially at higher levels, had a negative impact on their social life.
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Affiliation(s)
- Félix Côté-Leclerc
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, QC, Canada
| | - Gabrielle Boileau Duchesne
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, QC, Canada
| | - Patrick Bolduc
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, QC, Canada
| | - Amélie Gélinas-Lafrenière
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, QC, Canada
| | - Corinne Santerre
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, QC, Canada
| | - Johanne Desrosiers
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, QC, Canada.,Research Center on Aging, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Estrie, Sherbrooke, QC, Canada
| | - Mélanie Levasseur
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, QC, Canada. .,Research Center on Aging, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Estrie, Sherbrooke, QC, Canada.
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Garbeloti EJR, Paiva RCA, Restini CBA, Durand MT, Miranda CES, Teixeira VE. Biochemical biomarkers are not dependent on physical exercise in patients with spinal cord injury. BBA Clin 2016; 6:5-11. [PMID: 27331022 PMCID: PMC4900297 DOI: 10.1016/j.bbacli.2016.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 11/05/2022]
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Abstract
BACKGROUND Internationally, wheelchair users are an emerging demographic phenomenon, due to their increased prevalence and rapidly increasing life-span. While having significant healthcare implications, basic robust epidemiological information about wheelchair users is often lacking due, in part, to this population's 'hidden' nature. Increasingly popular in epidemiological research, Respondent Driven Sampling (RDS) provides a mechanism for generating unbiased population-based estimates for hard-to-reach populations, overcoming biases inherent within other sampling methods. This paper reports the first published study to employ RDS amongst wheelchair users. METHODS Between October 2015 and January 2016, a short, successfully piloted, internet-based national survey was initiated. Twenty seeds from diverse organisations were invited to complete the survey then circulate it to peers within their networks following a well-defined protocol. A predetermined reminder protocol was triggered when seeds or their peers failed to respond. All participants were entered into a draw for an iPad. RESULTS Overall, 19 people participated (nine women); 12 initial seeds, followed by seven second-wave participants arising from four seeds . Completion time for the survey ranged between 7 and 36 minutes. Despite repeated reminders, no further people were recruited. DISCUSSION While New Zealand wheelchair user numbers are unknown, an estimated 14% of people have physical impairments that limited mobility. The 19 respondents generated from adopting the RDS methodology here thus represents a negligible fraction of wheelchair users in New Zealand, and an insufficient number to ensure equilibrium required for unbiased analyses. While successful in other hard-to-reach populations, applying RDS methodology to wheelchair users requires further consideration. Formative research exploring areas of network characteristics, acceptability of RDS, appropriate incentive options, and seed selection amongst wheelchair users is needed.
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Affiliation(s)
- John A Bourke
- School of Health Sciences, University of Canterbury, Canterbury, 8140, New Zealand; Burwood Academy of Independent Living, Christchurch, 8140, New Zealand
| | - Philip J Schluter
- School of Health Sciences, University of Canterbury, Canterbury, 8140, New Zealand; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, 4072, Australia
| | - E Jean C Hay-Smith
- Rehabilitation Teaching and Research Unit, University of Otago Wellington, Wellington, 6242, New Zealand
| | - Deborah L Snell
- Burwood Academy of Independent Living, Christchurch, 8140, New Zealand; Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, 8140, New Zealand
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Hiremath SV, Intille SS, Kelleher A, Cooper RA, Ding D. Detection of physical activities using a physical activity monitor system for wheelchair users. Med Eng Phys 2014; 37:68-76. [PMID: 25465284 DOI: 10.1016/j.medengphy.2014.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 09/12/2014] [Accepted: 10/18/2014] [Indexed: 10/24/2022]
Abstract
Availability of physical activity monitors for wheelchair users can potentially assist these individuals to track regular physical activity (PA), which in turn could lead to a healthier and more active lifestyle. Therefore, the aim of this study was to develop and validate algorithms for a physical activity monitoring system (PAMS) to detect wheelchair based activities. The PAMS consists of a gyroscope based wheel rotation monitor (G-WRM) and an accelerometer device (wocket) worn on the upper arm or on the wrist. A total of 45 persons with spinal cord injury took part in the study, which was performed in a structured university-based laboratory environment, a semi-structured environment at the National Veterans Wheelchair Games, and in the participants' home environments. Participants performed at least ten PAs, other than resting, taken from a list of PAs. The classification performance for the best classifiers on the testing dataset for PAMS-Arm (G-WRM and wocket on upper arm) and PAMS-Wrist (G-WRM and wocket on wrist) was 89.26% and 88.47%, respectively. The outcomes of this study indicate that multi-modal information from the PAMS can help detect various types of wheelchair-based activities in structured laboratory, semi-structured organizational, and unstructured home environments.
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Affiliation(s)
- Shivayogi V Hiremath
- Department of Veterans Affairs, Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
| | - Stephen S Intille
- College of Computer and Information Science, Northeastern University, Boston, MA, United States; Department of Health Sciences, Northeastern University, Boston, MA, United States
| | - Annmarie Kelleher
- Department of Veterans Affairs, Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States; Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rory A Cooper
- Department of Veterans Affairs, Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States; Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, United States; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Dan Ding
- Department of Veterans Affairs, Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States; Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, United States; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States.
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Wang Y, Wu D, Zhao M, Li J. Evaluation on an ergonomic design of functional clothing for wheelchair users. Appl Ergon 2014; 45:550-555. [PMID: 23948502 DOI: 10.1016/j.apergo.2013.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 07/15/2013] [Accepted: 07/22/2013] [Indexed: 06/02/2023]
Abstract
Researchers have pointed out that people with physical disabilities find it difficult to obtain suitable clothing. In this study a set of wheelchair user oriented functional clothing was designed. Attention was paid to the wheelchair users' daily living activities related with clothing. An evaluating system combined with sports tournament and rehabilitation medicine was introduced to assess the new designed clothing. Six wheelchair users (3 males and 3 females) were invited to wear the clothing. A set of normal functional clothing was employed as a comparison (Control). The time required to complete three different daily living activities, i.e. dressing and undressing, going to toilet and bathing were recorded. Results showed that with the new clothing wheelchair users' competence of managing toilet was increased by 52.9%. The time needed for toilet was reduced by 45.7%. Their capability of managing dressing and undressing was improved by 24.6%. The study indicated that the newly designed clothing could facilitate wheelchair users' daily living activities related with clothing.
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Affiliation(s)
- Yunyi Wang
- Protective Clothing Research Center, Fashion Institute of Donghua University, Shanghai 200051, China; Key Laboratory of Clothing Design & Technology (Donghua University), Ministry of Education, Shanghai 200051, China
| | - Daiwei Wu
- Protective Clothing Research Center, Fashion Institute of Donghua University, Shanghai 200051, China; Key Laboratory of Clothing Design & Technology (Donghua University), Ministry of Education, Shanghai 200051, China
| | - Mengmeng Zhao
- Protective Clothing Research Center, Fashion Institute of Donghua University, Shanghai 200051, China; Key Laboratory of Clothing Design & Technology (Donghua University), Ministry of Education, Shanghai 200051, China
| | - Jun Li
- Protective Clothing Research Center, Fashion Institute of Donghua University, Shanghai 200051, China; Key Laboratory of Clothing Design & Technology (Donghua University), Ministry of Education, Shanghai 200051, China.
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Levy A, Kopplin K, Gefen A. An air-cell-based cushion for pressure ulcer protection remarkably reduces tissue stresses in the seated buttocks with respect to foams: finite element studies. J Tissue Viability 2013; 23:13-23. [PMID: 24405723 DOI: 10.1016/j.jtv.2013.12.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 12/12/2013] [Accepted: 12/17/2013] [Indexed: 11/25/2022]
Abstract
A sitting-acquired pressure ulcer (PU) is a common injury in wheelchair-bound patients. Preventative measures for the post spinal cord injury (SCI) population include prescription of a supportive thick cushion on the wheelchair, in order to better distribute loads between the buttocks and support surface (which are quantifiable using interface pressure measurements), and potentially, to minimize internal soft tissue loads (which are typically unknown). Information about the biomechanical efficacy of commercially-available structured cushion designs such as air-cell-based (ACB) cushions, gel, and honeycomb-like cushions is sparse. Considering the importance of such evaluations to patient safety and quality of life, we studied the biomechanical performances of an ACB cushion in comparison to standard, flat foam cushions with different stiffness properties. Using a set of finite element (FE) model variants, we determined the mechanical stresses in muscle, fat, and skin tissues under the ischial tuberosities during sitting. Tissue stress analyses were conducted in a reference SCI anatomy, incorporating pathoanatomical and pathophysiological changes associated with chronic SCI, including bone shape adaptation, muscle atrophy, and spasms. We found up to 57% greater immersion and 4 orders-of-magnitude lower muscle, fat, and skin tissue stresses for the ACB cushion. We also found the ACB cushion provides better protection against the aforementioned bone shape adaptation, muscle atrophy, and spasms. Hence, theoretically, the use of a suitable ACB cushion should provide longer safe sitting times for SCI patients with respect to standard foam cushions.
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Affiliation(s)
- Ayelet Levy
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Kara Kopplin
- Efficacy Research, Standards and Public Policy, ROHO, Inc., Belleville, IL, USA
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel.
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