Advocating for transportation equity: A critical examination of paratransit service reductions in St. Louis and its impact on health and community social participation.

Social participation is associated with better health, quality of life, physical activity, and engagement in community living and is thus an emerging health priority. Transportation plays an important role in facilitating social participation. Our team recently reported in the Journal of Disability and Health that Missouri-dwelling adults aging with long-term physical disabilities who use paratransit services as their primary transportation mode are more likely to participate in social roles and activities outside the home compared to those who do not use paratransit. In March of 2023, the paratransit company Metro Call-A-Ride that serves St. Louis announced major scale backs to their coverage zones due in part to staffing shortages. This decision has been met with a formal complaint filed to the U.S. Department of Justice as well as protest from the St. Louis disability community and advocates. Thousands of individuals who relied on Call-A-Ride for their routine community outings-to work, grocery stores, or medical appointments, for example-have been affected by the cuts. In this commentary, we will summarize the media coverage this decision has received, including the perspectives of disability rights advocates and individuals who have been directly affected. We will then present an overview of our original research findings in the context of these recent events and a brief synthesis of existing literature on paratransit services in the U.S. The commentary will end with proposed policy, research, and programming solutions for St. Louis's Metro Call-A-Ride and public transportation at large.

The Relationship of Exercise, Psychosocial Factors, and Social Participation Among Adults Aging With Long-Term Physical Disability: A Cross-Sectional Study.

PURPOSE: This study investigated the relationships among exercise engagement, psychosocial factors, and social participation for adults aging with physical disabilities (AAwPD). DESIGN: A cross-sectional study within a community-based cohort study of participation among AAwPD was conducted. SETTING: A comprehensive survey was administered online or via telephone. PARTICIPANTS: Participants were 474 individuals between the ages of 45-65, primarily living in the Midwestern United States, who reported living with a physical disability for at least 5 years. METHOD: Survey questions created based on prior consolidation of activity domains assessed exercise engagement. Psychosocial health and social participation were measured using the Patient Reported Outcomes Measurement Information System. Chi-square tests, t-tests, and a general linear model were used to examine differences between exercisers and non-exercisers. RESULTS: Participants who exercised reported less pain (P < .001), fatigue (P < .001), and depression (P < .001) and greater self-efficacy for management of chronic conditions (P = .002), satisfaction with participation in social roles and activities (P < .001), and ability to participate in social roles and activities (P < .001) compared with non-exercising participants. CONCLUSIONS: AAwPD who exercised reported fewer secondary conditions and greater social participation. Although causal relationships cannot be drawn, and the frequency, duration, and intensity of exercise were not examined, this study lays important groundwork for future research to determine the health and participation benefits of exercise for AAwPD. Future studies should also focus on the development of exercise interventions to support successful aging with disability.

Feasibility of a community-based structured exercise program for persons with spinal cord injury.

OBJECTIVES: (1) Examine the feasibility of a community-based exercise intervention for persons with spinal cord injury and (2) compare the cardiorespiratory fitness, skeletal muscle strength, and psychosocial well-being of participants in the intervention group versus control group. DESIGN: Community-based pilot randomized controlled trial. Setting: Accessible community-based health and wellness center. Participants: Thirty-two sedentary community-dwelling adults with any level of spinal cord injury. Interventions: Participants were randomized to a 36-session/12-week community-based exercise program (intervention; EG) or to a 36-session/12-week physical activity education group (control; CG). Outcome measures: Primary outcome measures included cardiorespiratory fitness measured by a VO2peak test, a composite score of four upper extremity musculoskeletal strength 1-repetition maximum exercises, and feasibility measured by EG participants' adherence and exercise intensity achieved during the program. EG participants' acceptance of the program was also evaluated using a self-reported satisfaction scale. Self-efficacy, motivation, pain, and goal performance and satisfaction were secondary outcome measures. Adherence and acceptability were also measured. RESULTS: Fifteen participants (n = 15) completed the community-based exercise intervention and seventeen (n = 17) completed the education program. While no statistically significant differences were found, the EG experienced changes of moderate effect size in cardiorespiratory fitness, strength, motivation, and satisfaction with their goals. The EG attended, on average, two sessions per week. The community-based exercise intervention was highly accepted by and satisfying for participants to engage in. CONCLUSIONS: The EG had improvements in the two primary measures, cardiorespiratory fitness and musculoskeletal strength, following the intervention. The community-based exercise intervention was feasible and accepted by participants.

Text messaging intervention for fatigue self-management in people with stroke, spinal cord injury, and multiple sclerosis: A pilot study.

BACKGROUND: Fatigue negatively impacts the function and quality of life of people with disabilities (PwD). Mobile health (mHealth) platforms are recognized as effective and accessible approaches to delivering health interventions and may show higher satisfaction by tailoring the information toward personalized needs for PwD. OBJECTIVE: To evaluate the acceptability, feasibility, and participant engagement with a Short Message Service (SMS) text messaging intervention for fatigue self-management and to explore the pre- and post-score health changes in PwD. METHODS: A total of 27 PwD (multiple sclerosis = 9, spinal cord injury = 9, or stroke = 9) experiencing fatigue in their daily lives participated in a 12-week self-management text messaging intervention. Participants completed a demographic survey and health outcome measures, including patient activation, self-efficacy for managing symptoms, fatigue, sleep, and satisfaction with participation in social roles before and after the intervention. Participants also completed a client satisfaction questionnaire after the intervention. We also tracked the program retention and SMS response rates over the 12-week intervention period. RESULTS: Twenty-five participants completed the entire intervention (93% retention rate), and the overall SMS response rate was 84.67%, indicating high acceptability and adherence to the intervention. The mean satisfaction score was 3.18, indicating high satisfaction with the intervention. Despite finding a negligible effect on patient activation, we found a small intervention effect on self-efficacy for managing symptoms (η2 = 0.04) and moderate effects on fatigue (η2 = 0.06-0.12), sleep (η2 = 0.11), and satisfaction with participation in social roles (η2 = 0.08). CONCLUSIONS: This study provides initial feasibility and health outcome change evidence to support an SMS text messaging intervention to manage fatigue in PwD.

Influence of falls, fall-related injuries, and fear of falling on social participation in people aging with long-term physical disability: a cross-sectional study.

PURPOSE: This study examined prevalence and relationships among falls, injuries, fear of falling, and social participation in people aging with long-term physical disability (PAwLTPD). MATERIALS AND METHODS: A convenience sample of 474 PAwLTPD recruited from community agencies and social media as baseline of a longitudinal cohort study. Inclusion criteria: 45-65 years, self-reported physical disability for ≥5 years, and English-speaking. Self-report surveys of physical/mental health, falls in the past year, fear of falling, and Patient-Reported Outcomes Measurement Information System (PROMIS) ability and satisfaction with participation in social roles and activities measures were collected. RESULTS: Mean age 56.8 years; participants were mostly female (66.7%) and White (61.4%). Nearly 65% reported a fall; 56.6% of falls resulted in injury. Falls and fall-related injuries were associated with worse physical/mental health and presence of >5 health conditions. Seventy-five percent of participants reported fear of falling. Lower ability and satisfaction with participation were found in participants who fell and worried about falls. CONCLUSIONS: PAwLTPD are at increased risk of falls, fall-related injuries, and fear of falling, which affects their ability to engage in social activities. Future research is needed to understand circumstances associated with falls and to develop effective interventions to address falls in PAwLTPD.

Community-dwelling individuals aged 45­65 years who are aging with long-term physical disabilities report increased rates of falls, fall-related injuries, and fear of falling.People aging with long-term physical disabilities who experience falls report decreases in their social participation.Additional work within the rehabilitation field is needed to develop effective, evidence-based interventions to reduce the occurrence of falls among individuals aging with long-term physical disability.

Perspectives of inpatient rehabilitation clinicians on the state of manual wheelchair training: a qualitative analysis.

PURPOSE: The purpose of this study was to identify clinician knowledge regarding manual wheelchair (MWC) training in an inpatient rehabilitation (IPR) setting, identify current MWC education provided to new manual wheelchair users (MWUs), and determine how MWC training resources can be developed or modified to promote use among IPR clinicians. METHODS: Semi-structured interviews were conducted with 20 licenced IPR clinicians who work with MWUs. Using a traditional qualitative research design, researchers completed open, data-driven coding of interview transcripts. Overarching themes were determined through content analysis. RESULTS: Participants included 12 physical therapists, six occupational therapists, one physical therapy assistant, and one occupational therapy assistant. Five themes emerged from the interviews: (1) clinician knowledge, education, and experience (2) current training content (3) training environment, (4) desired programme components (5) barriers to implementation. Participants reported receiving minimal education in school and from their employers on training MWUs. While clinicians expressed the importance of MWU education, they used varying training approaches with little standardization. Participants identified that training protocols for IPR are beneficial if they are quick, straightforward, and flexible. CONCLUSIONS: While MWC training occurs during IPR stays, it appears to be inconsistent across facilities, clinicians, and patients, with varying degrees of adherence to evidence-based practices. This is likely due to limited feasibility and awareness of existing MWC training resources. Clinician input gathered from these interviews provides information for how to best integrate MWC training programmes into the rehabilitative process. Findings may inform the development and assessment of more clinically feasible MWC training protocols. Implications for RehabilitationNew manual wheelchair users must learn numerous wheelchair-related skills in order to participate in everyday life activities.Manual wheelchair education for new users during inpatient rehabilitation is often inconsistent across facilities, clinicians, and patients, with varying degrees of adherence to existing evidence-based practices.Systematic challenges often act as a barrier to the implementation of more comprehensive, structured manual wheelchair training protocols.Manual wheelchair training resources must be concise, flexible, customisable, and easy to follow in order to promote increased implementation among inpatient rehabilitation clinicians.

Detecting clinical practice guideline-recommended wheelchair propulsion patterns with wearable devices following a wheelchair propulsion intervention.

Wheelchair propulsion interventions typically teach manual wheelchair users to perform wheelchair propulsion biomechanics as recommended by the Clinical Practice Guidelines (CPG). Outcome measures for these interventions are primarily laboratory based. Discrepancies remain between manual wheelchair propulsion (MWP) in laboratory-based examinations and propulsion in the real-world. Current developments in machine learning (ML) allow for monitoring of MWP in the real world. In this study, we collected data from participants enrolled in two wheelchair propulsion interventions, then built an ML algorithm to distinguish CPG recommended MWP patterns from non-CPG-recommended patterns. Eight primary manual wheelchair users did not initially follow CPG recommendations but learned and performed CPG propulsion after the interventions. Participants each wore two inertial measurement units as they propelled their wheelchairs on a roller system, indoors overground, and outdoors. ML models were trained to classify propulsion patterns as following the CPG or not following the CPG. Video recordings were used for reference. For indoor detection, we found that a subject-independent model was able to achieve 85% accuracy. For outdoor detection, we found that the subject-independent model achieved 75.4% accuracy. These results provide further evidence that CPG and non-CPG-recommended MWP patterns can be predicted with wearable sensors using an ML algorithm.

A Mobile Phone Text Messaging Intervention to Manage Fatigue for People With Multiple Sclerosis, Spinal Cord Injury, and Stroke: Development and Usability Testing.

BACKGROUND: Fatigue significantly affects daily functioning in persons with disabilities. Fatigue management can be challenging, and the information provided during routine physician visits to manage fatigue can be overwhelming. One way to address fatigue is to increase knowledge, skills, and confidence for self-management (ie, patient activation). Self-management programs have shown promising effects in targeting fatigue in persons with disabilities. However, satisfaction with self-management programs is low for persons with disabilities, and tailoring interventions to personalized needs has been recommended. SMS text messaging is increasingly being used to implement health behavior change interventions in a person's natural environment. Little has been done to link mobile health approaches with patient activation and self-management to address fatigue in persons with disabilities. OBJECTIVE: This study aimed to develop and test a mobile phone-based fatigue self-management SMS text messaging intervention targeting patient activation in 3 groups of persons with disabilities: persons with multiple sclerosis, persons who had a stroke, and persons with a spinal cord injury. METHODS: We used evidence-based resources and input from a consumer advisory board (CAB; composed of 2 participants from each of the 3 disability groups) and a neurologist to develop the intervention. The study was conducted using a 4-step process: development of the initial SMS text messaging library and categorization of the content into 9 content areas, review and modification of the SMS text messages by the neurologist and CAB, integration of the content library into a digital platform, and utility testing by CAB members. RESULTS: A total of 6 CAB participants rated SMS text messages covering 9 domain areas of fatigue self-management with good clarity (mean ratings=3.5-5.0 out of 5) and relevance (mean ratings=3.2-5.0 out of 5). Overall, SMS text messaging content was reported by CAB participants as helpful, clear, and well suited for a mobile health intervention. The CAB reached consensus on the time of day that SMS text messages should be sent (morning) and their frequency (once per day). This feedback led the research team to narrow down the program to deliver 48 SMS text messages, 1 per day, Monday through Thursday only, a total of 4 SMS text messages per week, over a 12-week period. The final set of SMS text messages was programmed into a digital platform with a predefined delivery schedule. The usability of the intervention was high, with 55 (83%) out of 66 responses endorsing the highest rating. CONCLUSIONS: This study demonstrates a step-by-step process for developing a fatigue self-management SMS text messaging intervention for persons with disabilities. For this population, whose access to health services is often limited, this intervention provides an alternative delivery model to increase access to fatigue information and deliver content that aligns with the person's needs.

Mobility Disability and Exercise: Health Outcomes of an Accessible Community-Based Center.

Objective: The purpose of this study was to determine how support and guidance provided by trained professionals during a 12-week, community-based transition exercise program, impact health outcomes and continued engagement in physical activity for persons with a mobility disability (PwMD). Design: A single arm pre-post design was used. Setting: Accessible community-based health and wellness center. Participants: The study included 244 PwMD using a mobility device. Interventions: Participants completed a 12-week transition exercise program provided through an accessible community facility that provided education and support to complete endurance and strength related exercises as well as programming to encourage transition to self-directed engagement in exercise. Main Outcome Measures: Bodyweight, BMI, pain, perceived exertion, speed, and distance during cardiovascular fitness testing, and strength were measured pre and post exercise program. The number of participants that signed up for a monthly membership after the program was also monitored. Results: For the total group, average pain reported over previous 30 days decreased significantly (p < 0.01), current daily pain decreased significantly (p < 0.05), perceived exertion at the end of the 9-min endurance test decreased significantly (p < 0.05), and the four upper extremity strength exercises showed large, significant strength gains (p < 0.01) after the program. There was no significant change in bodyweight, BMI, or speed and distance completed during endurance testing. At the completion of the program, 76% of participants enrolled in a monthly membership at the facility with the intentions to continue to exercise regularly. Conclusions: This study provides evidence that an accessible community-based exercise program, with a transitional component supported by trained professionals, can support the exercise goals of PwMD and improve strength, decrease pain, and may promote regular exercise adoption for PwMD.

An observational study of personal and environmental factors associated with attendance at a community-based adaptive fitness center for adults with physical disabilities.

BACKGROUND: Regular exercise has many benefits for adults with physical disabilities (AwPD). Despite these benefits, significant barriers to participating in exercise exist for AwPD. Community-based adaptive fitness centers promote exercise for AwPD by minimizing barriers. Research has yet to clearly examine the personal and environmental factors associated with enrollment and attendance rates of AwPD in community-based adaptive fitness centers. OBJECTIVE: The purpose of our study was to explore personal and environmental factors associated with AwPD and their attendance at a community-based adaptive fitness center once enrolled. METHODS: Individuals aged 18-85 with a physical disability interested in exercising were referred to a community-based adaptive fitness center. At initial assessment, participants completed demographics, health, barriers to exercise, and exercise self-efficacy (ESE) surveys. Following initial assessment, participant visits to the fitness center were tracked for six months. RESULTS: Of 106 participants, 27 never visited the facility after initial assessment, and the remaining participants with six months of attendance data (n = 67) averaged 14.9 (SD = 14.2) visits. Correlation results showed a negative curvilinear relationship between number of visits and years living with disability (rs = -0.24, p < 0.05), with higher attendance associated with more recent diagnosis. Logistic and stepwise regressions showed that ESE score (ß = 0.107, p = 0.026) was the only significant predictor of attending the fitness center once enrolled. CONCLUSIONS: This study demonstrates the importance of understanding personal and environmental factors and assessing ESE for AwPD who are newly enrolled in a community-based adaptive fitness center.

Retrospective Chart Review Examining Differences and Timelines in Recommended and Delivered Wheelchair Equipment in a Midwestern Dedicated Seating Department.

OBJECTIVE: To compare recommended wheeled mobility equipment with delivered equipment, excluding custom seats and backs, considering demographic factors, such as sex, age, and funding source, as well as the timeline of the procurement process. DESIGN: Retrospective chart review. SETTING: Dedicated wheelchair seating department within a Midwestern rehabilitation hospital and associated complex rehabilitation technology durable medical equipment suppliers. PARTICIPANTS: Wheelchair recommendations (N=546) made between January 1, 2017, and December 31, 2017, to physician-referred wheelchair users of all ages and diagnoses. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Recommended and delivered wheelchair equipment type and length of time between recommendation and delivery. RESULTS: Differences were found between the recommended and delivered equipment in manual wheelchairs, power mobility devices, seat backs, cushions, and power option equipment groups (P≤.001). Delivered manual wheelchairs were 7% more likely to be different than the recommendation for each year decrease in age (P≤.001), although the model lacked sufficient predictive accuracy for clinical application. The average length of time from equipment recommendation to delivery was about 6 months (mean, 176d). Standard and complex power mobility devices were associated with longer timelines (median, 137d and 173d, respectively; P=.001), although only complex power mobility device timelines were significantly associated with public funding sources (P=.02). CONCLUSIONS: Wheelchair bases, positioning accessories, and power options may be delivered differently than originally recommended, and the process for procuring complex power mobility devices with public funding sources should be studied further. Health care professionals should consistently follow up on delivered equipment to ensure that expectations and needs of the wheelchair user are met. Reducing systemic barriers to interdisciplinary communication postrecommendation may improve patient outcomes.

Aging with long-term physical disability: Cohort analysis of survey sample in the U.S.

Background: Chronic health conditions, secondary conditions, and decreasing functional ability related to aging and/or changes in underlying impairment may influence participation for persons aging with long-term physical disability (AwD). Objective: To examine sample integrity and baseline findings through exploration of associations of sociodemographic, health, and disability factors with social participation for persons AwD. Methods: This is a longitudinal cohort study following persons AwD over three years, reporting baseline cohort study data. A convenience sample of 474 persons AwD aged 45-65 reporting physical disability of ≥5 years' duration was recruited through community organizations and social media. The cohort was majority female (66.7%) and single (62.0%), and over one-third (38.6%) was non-White. Pain, fatigue, depression, ability to participate in, and satisfaction with, social roles and activities were measured with the Patient Reported Outcomes Measurement Information System. Results were manually compared against AwD study samples identified through a focused literature review and national census data. Results: Participants aged 55-60 and 61-65 had significantly lower rates of employment and marriage and higher rates of living alone than participants aged 45-54. Participants reported higher rates of fatigue, pain, and depression and lower ability to participate in, and satisfaction with, participation in, social roles and activities than the general population. Ability to participate and satisfaction with participation were highest among Black/African American participants. Conclusions: Participants reported higher rates of common AwD symptoms and lower ability to participate and satisfaction with participation than the general population, consistent with prior studies of AwD samples. This cohort reflects the AwD population and can be considered an AwD sample, comparable to those found in existing literature. The focus of future analyses will be to gain a greater understanding of chronic health conditions, incidence of falls, engagement in everyday life activities, and the impact of the environment.

Community-based exercise goals of persons with spinal cord injury: Interpreted using the International Classification of Functioning, Disability, and Health.

OBJECTIVE: To identify goals for exercising among community-dwelling persons with spinal cord injury (PwSCI). DESIGN: Qualitative descriptive study. SETTING: Community-based exercise facility for persons with a disability. PARTICIPANTS: Fifty-five PwSCI identified their exercise goals prior to participation in a community-based exercise intervention. INTERVENTIONS: None. OUTCOME MEASURES: A modified version of the Canadian Occupational Performance Measure was used to ask about exercise goals. The International Classification of Functioning, Disability, and Health (ICF) was used to code the goals for themes. RESULTS: The participants were predominantly male (76%) and Black (56%) with thoracic-level injury (51%) and a mean age of 39.44 (standard deviation [SD] 13.62). A total of 231 goals (mean 4.2 goals per participant; SD 1.25) were identified. Participants rated their performance and satisfaction with their goals as 4.256 (SD 1.55) and 3.57 (SD 1.67), respectively. Participants most frequently reported goals related to endurance, muscle strengthening, weight loss, activities of daily living, transferring, and home and community mobility. The most commonly reported goals fell into five ICF domains: Functions of Cardiovascular, Hematological, Immunological, and Respiratory Systems; Neuromusculoskeletal and Movement-Related Functions; Structures Related to Movement; Mobility; and Self-Care. CONCLUSION: PwSCI have goals they would like to achieve through participation in exercise. The goals are multifaceted and encompass improving health and fitness as well as improving performance in everyday activities such as transferring and mobility. Identifying themes of goals for PwSCI to achieve through exercise is an important step in developing programs and interventions needed to support PwSCI living in the community.

Exercise testing protocol using a roller system for manual wheelchair users with spinal cord injury.

OBJECTIVE: Determine the validity and reliability of an exercise testing protocol to evaluate cardiorespiratory measures in manual wheelchair users (MWUs) with spinal cord injury (SCI) using a roller-based (RS) wheelchair system. DESIGN: Repeated measures within-subject design. SETTING: Community-based research laboratory. PARTICIPANTS: Ten adults with SCI requiring the use of a manual wheelchair. INTERVENTIONS: Not applicable. OUTCOME MEASURES: Cardiorespiratory measures (peak oxygen consumption [VO2peak], respiratory exchange ratio [RER], pulmonary ventilation [VE], energy expenditure [EE], heart rate [HR], accumulated kilocalories [AcKcal]) and perceived exertion (RPE) were measured during three separate maximal exercise tests using an arm crank ergometer (ACE) and an RS. RESULTS: At maximal exertion, there were no significant differences in variables between groups, with moderate-to-strong correlations (P < 0.05, r = 0.79-0.90) for VO2, HR, RPE, AcKcal, and rate of EE between RS and ACE trials. Significant moderate-to-strong correlations existed between RS trials for VO2, AcKcal, rate of EE, and peak power output (P < 0.01, r = 0.77-0.97). CONCLUSIONS: VO2peak was highly correlated between ACE and RS trials and between the two RS trials, indicating the RS protocol to be reliable and valid for MWUs with SCI. Differences in perceived exertion and efficiency at submaximal workloads and maximal pulmonary ventilation at peak workloads indicated potential advantages to using the RS.

Meaningful components of a community-based exercise program for individuals with disabilities: A qualitative study.

BACKGROUND: Enhanced methods of evaluation are necessary to identify community-based exercise interventions that promote physical activity and improve health and participation for individuals with disabilities. The heterogeneity of the populations served, interventions implemented, and outcome measures used remains a barrier to effectively evaluate programs and generate evidence to inform best practice. OBJECTIVE: To explore goals and benefits of community-based exercise for individuals with disabilities and determine barriers and facilitators to evaluation in a community setting. METHODS: We conducted semi-structured interviews with exercise participants and staff of a community-based exercise program for individuals with disabilities. We then coded responses to interview questions for themes using thematic analysis or deductive content analysis, with codes linked to categories within the International Classification of Functioning, Disability and Health (ICF). RESULTS: Identified goals and benefits spanned the ICF domains of Body Functions and Activities and Participation. Commonly cited goals and benefits included improving strength and endurance, general health, self-efficacy, community participation, and the importance of returning to exercise. Barriers and facilitators to evaluation identified by staff included maintaining a balance between evaluation and services, negative attitudes toward evaluation, access to data, and consistency with scheduling. CONCLUSIONS: These results can be used to enhance evaluation within community-based exercise programs for individuals with disabilities, which may improve both the quality and impact of these programs.

Important wheelchair skills for new manual wheelchair users: health care professional and wheelchair user perspectives.

PURPOSE: The purpose of this project was to identify wheelchair skills currently being taught to new manual wheelchair users, identify areas of importance for manual wheelchair skills' training during initial rehabilitation, identify similarities and differences between the perspectives of health care professionals and manual wheelchair users and use the ICF to organize themes related to rehabilitation and learning how to use a manual wheelchair. METHOD: Focus groups were conducted with health care professionals and experienced manual wheelchair users. ICF codes were used to identify focus group themes. RESULTS: The Activities and Participation codes were more frequently used than Structure, Function and Environment codes. Wheelchair skills identified as important for new manual wheelchair users included propulsion techniques, transfers in an out of the wheelchair, providing maintenance to the wheelchair and navigating barriers such as curbs, ramps and rough terrain. Health care professionals and manual wheelchair users identified the need to incorporate the environment (home and community) into the wheelchair training program. CONCLUSIONS: Identifying essential components for training the proper propulsion mechanics and wheelchair skills in new manual wheelchair users is an important step in preventing future health and participation restrictions. Implications for Rehabilitation Wheelchair skills are being addressed frequently during rehabilitation at the activity-dependent level. Propulsion techniques, transfers in an out of the wheelchair, providing maintenance to the wheelchair and navigating barriers such as curbs, ramps and rough terrain are important skills to address during wheelchair training. Environment factors (in the home and community) are important to incorporate into wheelchair training to maximize safe and multiple-environmental-setting uses of manual wheelchairs. The ICF has application to understanding manual wheelchair rehabilitation for wheelchair users and therapists for improving the understanding of manual wheelchair use.

A motor learning approach to training wheelchair propulsion biomechanics for new manual wheelchair users: A pilot study.

CONTEXT/OBJECTIVE: Developing an evidence-based approach to teaching wheelchair skills and proper propulsion for everyday wheelchair users with a spinal cord injury (SCI) is important to their rehabilitation. The purpose of this project was to pilot test manual wheelchair training based on motor learning and repetition-based approaches for new manual wheelchair users with an SCI. DESIGN: A repeated measures within-subject design was used with participants acting as their own controls. METHODS: Six persons with an SCI requiring the use of a manual wheelchair participated in wheelchair training. The training included nine 90-minute sessions. The primary focus was on wheelchair propulsion biomechanics with a secondary focus on wheelchair skills. OUTCOME MEASURES: During Pretest 1, Pretest 2, and Posttest, wheelchair propulsion biomechanics were measured using the Wheelchair Propulsion Test and a Video Motion Capture system. During Pretest 2 and Posttest, propulsion forces using the WheelMill System and wheelchair skills using the Wheelchair Skills Test were measured. RESULTS: Significant changes in area of the push loop, hand-to-axle relationship, and slope of push forces were found. Changes in propulsion patterns were identified post-training. No significant differences were found in peak and average push forces and wheelchair skills pre- and post-training. CONCLUSIONS: This project identified trends in change related to a repetition-based motor learning approach for propelling a manual wheelchair. The changes found were related to the propulsion patterns used by participants. Despite some challenges associated with implementing interventions for new manual wheelchair users, such as recruitment, the results of this study show that repetition-based training can improve biomechanics and propulsion patterns for new manual wheelchair users.

Reliability and validity of the Microsoft Kinect for assessment of manual wheelchair propulsion.

Concurrent validity and test-retest reliability of the Microsoft Kinect in quantification of manual wheelchair propulsion were examined. Data were collected from five manual wheelchair users on a roller system. Three Kinect sensors were used to assess test-retest reliability with a still pose. Three systems were used to assess concurrent validity of the Kinect to measure propulsion kinematics (joint angles, push loop characteristics): Kinect, Motion Analysis, and Dartfish ProSuite (Dartfish joint angles were limited to shoulder and elbow flexion). Intraclass correlation coefficients revealed good reliability (0.87-0.99) between five of the six joint angles (neck flexion, shoulder flexion, shoulder abduction, elbow flexion, wrist flexion). ICCs suggested good concurrent validity for elbow flexion between the Kinect and Dartfish and between the Kinect and Motion Analysis. Good concurrent validity was revealed for maximum height, hand-axle relationship, and maximum area (0.92-0.95) between the Kinect and Dartfish and maximum height and hand-axle relationship (0.89-0.96) between the Kinect and Motion Analysis. Analysis of variance revealed significant differences (p < 0.05) in maximum length between Dartfish (mean 58.76 cm) and the Kinect (40.16 cm). Results pose promising research and clinical implications for propulsion assessment and overuse injury prevention with the application of current findings to future technology.

Person factors and work environments of workers who use mobility devices.

BACKGROUND: Nearly 25% of people with mobility impairments and limitations who are of working age are employed, yet few studies have examined their perspectives on their jobs or work environments required to complete job tasks. OBJECTIVE: The purpose of this study was to describe the factors that contribute to successful employment for those who use mobility devices. PARTICIPANTS: A convenience sample of 132 workers who use power wheelchairs, manual wheelchairs, canes, crutches or walkers. METHOD: Participants completed an online version of the Mobility Device User Work Survey (MWS). A multivariate analysis and a two-step multiple linear regression analysis were used. RESULTS: Study participants had few secondary health conditions that influenced their work. Employee satisfactoriness to their employers was high. Accessibility of worksites was high. Assistive technologies were inexpensive, and personal assistance was used infrequently and usually was unpaid. Co-worker communications were very positive. Flexible work rules and supportive managers were highly valued. Job satisfaction positively correlated with accessibility, work tasks, co-worker communication and work support. CONCLUSION: The description of work environments of successfully employed mobility device users can provide some useful guidance to employers, vocational rehabilitation (VR) counselors and unemployed mobility device users to balance employee abilities and preferences with the needs of employers.

The development of an instrumented wheelchair propulsion testing and training device.

Researchers have used several types of testing devices and training surfaces to examine wheelchair propulsion. Testing and training wheelchair users on the actual surface of interest, such as tile floors or ramps, is ideal but difficult. Devices such as treadmills, dynamometers, and ergometers allow for researchers and clinicians to observe wheelchair users in a controlled space. However, these devices often do not have the ability to realistically simulate the environment. This methodological article describes the instrumentation, development and function of a wheelchair dynamometer system, the WheelMill System (WMS), a uniquely adjustable roller system for wheelchairs. Three participants wheeled on the WMS, over a tile surface and up two different graded slopes with the SmartWheel to compare speed and forces. The WMS reasonably simulated propulsion over a tile floor, though the participants' speed was slightly faster on tile, and the peak forces for each propulsion stroke varied more on tile than on the WMS. For the slopes, the speed oscillated over a greater range and was slower, and the measured peak forces were higher than the values measured on the WMS. The WMS may have several applications, though additional studies on a greater and more diverse population are needed.