Manual wheelchair training approaches and intended training outcomes for adults who are new to wheelchair use: A scoping review.

INTRODUCTION: Wheelchair training is pivotal for safety, independence, and occupational engagement in the community, yet adults coming into wheelchair use often receive insufficient or untailored training. This research aimed to understand the range and type of manual wheelchair training approaches that exist for adults commencing wheelchair use. METHOD: A systematic scoping review involved searching eight electronic databases and grey literature up to September 2023. Papers relating to manual wheelchair training for adults and their caregivers were included for data extraction. Eighty-seven articles were included in this review. The International Classification of Functioning (ICF) was used to organise and analyse data related to intended training outcomes. CONSUMER AND COMMUNITY INVOLVEMENT: Consumer consultation was not included in this review; however, the outcomes suggest that involving consumers in future wheelchair training research is critical to assure community participation outcomes. RESULTS: Data were extracted from 87 papers. Manual wheelchair training was delivered across diverse contexts encompassing varied support structures, trainer backgrounds, and technology and was commonly directed towards wheelchair users with spinal cord injury. Intended training outcomes most frequently mapped to the activity and participation component of the ICF (n = 39), followed by personal factors (n = 27), body structures and functions (n = 18), and environmental factors (n = 3), with limited focus on longer term occupational engagement outcomes. CONCLUSION: Most existing manual wheelchair training focussed on the acquisition of individual wheelchair skill and may not facilitate generalised and long-term occupational participation outcomes. Further exploration into the contexts that support occupational engagement, particularly for older adults with progressive conditions, is required to support service provision. PLAIN LANGUAGE SUMMARY: We looked at what manual wheelchair training approaches exist for adults who need to use a manual wheelchair and what training helps people to do/achieve. We did a scoping review that looked at literature about manual wheelchair training programs for adult wheelchair users. We found 87 research papers and training programs that we included in our review. We recorded and analysed information from all the papers about the wheelchair training programs and outcomes for people who do these programs. We found that manual wheelchair training can be done in structured or ad hoc ways, can have different amounts of training, can be provided face-to-face or online, and can be given by different allied health professionals and other wheelchair users. Most training programs had short-term outcomes like learning manual wheelchair skills, being able to use the wheelchair properly, and feeling confident about using a wheelchair. Some had longer term outcomes about being able to use the manual wheelchair in everyday activities. Most people who did the training programs that we looked at in this review were manual wheelchair users with spinal cord injury. Because not many wheelchair programs have been tried with people who do not have a spinal cord injury, it is hard for occupational therapists to make recommendations about training for other people who use a manual wheelchair. Manual wheelchair training that is done in the community and made to meet the needs of individuals may help people with using their wheelchair for their everyday activities and participate in their community.

The Effectiveness of Warm-Up Using an Assistive Device in Wheelchair Basketball: A Feasibility Study of Able-Bodied Participants.

Introduction A warm-up is often performed to prevent injury and prepare for optimal performance. Nonetheless, research on its impact on performance, particularly in para-sports, remains limited. We hypothesized that the use of an assistive device during warm-up would enable wheelchair basketball players to perform full-body movements efficiently and effectively, contributing to enhanced wheelchair mobility. Therefore, this feasibility study aimed to assess the safety of warm-up exercise with an assistive device and the changes in wheelchair mobility performance before and after warm-up in able-bodied participants. Methods Thirteen able-bodied participants (nine males and four females; mean age: 34.3 ± 6.11 years) were analyzed. Warm-up consisted of a five-minute stand-up exercise using the lumbar-type Hybrid Assistive Limb®. Before and after warm-up, a 3-3-6 m sprint was performed as a wheelchair mobility performance test. The 3-3-6 m sprint is a test in which the athlete repeatedly accelerates, decelerates, and stops while driving at maximum effort for a total of 12 m (0-3 m, 3-6 m, and 6-12 m). The time required for the 3-3-6 m sprint and maximum instantaneous speed, acceleration time, deceleration time, hip joint angle, and average muscle activity of the lower limb and trunk muscles during the acceleration/deceleration phase of each section were compared before and after warm-up exercise. Results Warm-up with an assistive device was safe in healthy participants. The time required for the 3-3-6 m sprint was significantly reduced after the warm-up compared to that before the warm-up (p=0.005). Although not significant, there was a trend toward shorter deceleration times after the warm-up for participants herein. Conclusions In able-bodied participants, warm-up with an assistive device is safe; it may improve wheelchair mobility performance. Further research is required to determine its impact on para-athletes with disabilities.

The care of non-institutionalized ADL-dependent people in the Orcasitas neighborhood of Madrid (Spain) during the Covid-19 pandemic and its relationship with social inequalities, intergenerational dependency and survival.

Background: Mortality among people with dependency to perform basic activities of daily living (ADL) is higher than that of non-dependent people of the same age. Understanding the evolutionary course and factors involved in non-institutionalized ADL dependency, including the influence of the family structure that supports this population, would contribute to improved health planning. Methods: A longitudinal study carried out in the ADL-dependent population of the Orcasitas neighborhood, Madrid (Spain), between June 2020, when the nationwide COVID-19 lockdown ended, and June 2023. A total of 127 patients participated in the study, 78.7% of whom were women and 21.3% were men. Risk analysis was performed via odds ratios (OR) and hazard ratios (HR). Survival analysis was performed using Cox regression. Results: A total of 54.33% of the ADL-dependent persons did not live with their adult children and 45.67% did, being associated living independently with economic capacity and the married marital status but not with the dependency level. In women, being married increased the probability of living independently of their adult children (OR = 12.632; 95% CI = 3.312-48.178). Loss of mobility (OR = 0.398; 95% CI = 0.186-0.853), economic capacity of the dependent (HR = 0.596; 95% CI = 0.459-0.774), and living independently and having better economic capacity (HR = 0.471; 95% CI = 0.234-0.935) were associated with 3-year survival. Those who lived with their adult children had a worse autonomy profile and higher mortality (HR = 1.473; 95% CI = 1.072-2.024). Not being employed, not being married, and not owning a home were significantly associated with being an essential family caregiver. Caregivers were mostly women (OR = 1.794; 95% CI = 1.011-3.182). Conclusion: Among ADL-dependent persons, economic capacity influenced the ability to living independently and affected survival after 3 years. Loss of mobility (wheelchair use) was a predictor of mortality. Social inequalities promote that adult children end up as essential family caregivers. This generates reverse dependency and maintains a vulnerability that is transmitted from generation to generation, perpetuating social and gender inequalities. Dependent parent care in this cohort maintained an archaic pattern in which the eldest daughter cared for her parents. This study made it possible to show that ADL dependence is accompanied by complex interrelationships that must be considered in socio-health planning.

Translation, extension, and evaluation of usability, usefulness, and safety of a fall prevention and management program for people living with spinal cord injury and multiple sclerosis who use wheelchairs or scooters full time.

Background: Falls are prevalent among people living with Multiple Sclerosis (PwMS) and Spinal Cord Injury (PwSCI) who use wheelchairs or scooters (WC/S) full time, however, there is a scarcity of evidence-based fall prevention and management programs. Objective: To describe the systematic translation of an in-person fall prevention and management program (Individualized Reduction Of FaLLs - iROLL) for PwMS to an online platform, extending its scope to include PwSCI, and to evaluate the preliminary useability, usefulness, and safety of the intervention. Methods: iROLL was systematically translated to an online platform (iROLL-O). PwMS and PwSCI who use a WC/S full time, experienced at least one fall within the past 36 months, and could transfer independently or with minimal to moderate assistance, enrolled in iROLL-O. Usability, usefulness, and safety were evaluated through 1:1 semi-structured interviews, gathering feedback on: perceived impact of the intervention on falls and functional mobility, program experiences, adverse events, and recommendations for improvement. Results: Five participants successfully completed the iROLL-O program. No safety concerns were raised by participants. Themes emerging from the semi-structured interviews included: (1) barriers and facilitators to program access, (2) motivation for participation, (3) program outcomes, and (4) program content and structure. Participants reported reduced concerns about falling, enhanced functional mobility skills, and highlighted the supportive nature of synchronous group meetings for learning. Conclusion: No adverse events occurred during the implementation of iROLL-O and participants found the program to be useable and useful. Further testing is needed to examine efficacy among a large and diverse population.

Handrim Reaction Force and Moment Assessment Using a Minimal IMU Configuration and Non-Linear Modeling Approach during Manual Wheelchair Propulsion.

Manual wheelchair propulsion represents a repetitive and constraining task, which leads mainly to the development of joint injury in spinal cord-injured people. One of the main reasons is the load sustained by the shoulder joint during the propulsion cycle. Moreover, the load at the shoulder joint is highly correlated with the force and moment acting at the handrim level. The main objective of this study is related to the estimation of handrim reactions forces and moments during wheelchair propulsion using only a single inertial measurement unit per hand. Two approaches are proposed here: Firstly, a method of identification of a non-linear transfer function based on the Hammerstein-Wiener (HW) modeling approach was used. The latter represents a typical multi-input single output in a system engineering modeling approach. Secondly, a specific variant of recurrent neural network called BiLSTM is proposed to predict the time-series data of force and moments at the handrim level. Eleven subjects participated in this study in a linear propulsion protocol, while the forces and moments were measured by a dynamic platform. The two input signals were the linear acceleration as well the angular velocity of the wrist joint. The horizontal, vertical and sagittal moments were estimated by the two approaches. The mean average error (MAE) shows a value of 6.10 N and 4.30 N for the horizontal force for BiLSTM and HW, respectively. The results for the vertical direction show a MAE of 5.91 N and 7.59 N for BiLSTM and HW, respectively. Finally, the MAE for the sagittal moment varies from 0.96 Nm (BiLSTM) to 1.09 Nm for the HW model. The approaches seem similar with respect to the MAE and can be considered accurate knowing that the order of magnitude of the uncertainties of the dynamic platform was reported to be 2.2 N for the horizontal and vertical forces and 2.24 Nm for the sagittal moments. However, it should be noted that HW necessitates the knowledge of the average force and patterns of each subject, whereas the BiLSTM method do not involve the average patterns, which shows its superiority for time-series data prediction. The results provided in this study show the possibility of measuring dynamic forces acting at the handrim level during wheelchair manual propulsion in ecological environments.

Application of Sensor Technology in Wheelchair Sports for Real-Time Data Collection during Training and Competition and for Assessment of Performance Parameters: A Systematic Review and Future Directions.

This review reports on the use of sensors in wheelchair sports to monitor and analyze performance during match and training time. With rapid advancements in electronics and related technologies, understanding performance metrics in wheelchair sports is essential. We reviewed nine studies using various sensor types, including electric motors, inertial measurement units, miniaturized data loggers with magnetic reed switches, and smartphones with inbuilt accelerometers and gyroscopes, operating at frequencies from 8 Hz to 1200 Hz. These studies measured parameters such as angular and translational velocities, distance, number of starts/pushes, and other performance indicators in sports such as basketball, rugby, tennis, and racing. Despite differences in sport types and methodologies, most studies found sensor-derived data effective for assessment of performance. Future developments and research in this field should focus on multi-sensor systems that could provide real-time match analysis and deeper insights into performance metrics. Overall, sensor technologies show significant potential for improving wheelchair sport performance diagnostics, contributing to better athlete training and future wheelchair design, and enhancing competitive outcomes. This review emphasizes the need for continued innovation and standardization in applying sensor technologies in wheelchair sports.

Nonstandard cardiopulmonary resuscitation and basic life support: A scoping review of techniques applicable to wheelchair users.

AIM: To explore evidence that informs new or non-standard methods for delivery of cardiopulmonary resuscitation (CPR) and basic life support (BLS) that may be used by carers of wheelchair users and assist in the development of an educational intervention. MATERIAL AND METHODS: A scoping review was conducted. Keywords used included cardiac arrest, cardiopulmonary, resuscitation, "basic life support", and special circumstances. In total, 3581 papers were retrieved and 72 full text articles were reviewed with 14 papers meeting the inclusion criteria. RESULTS: Nine intervention studies, three systematic reviews and two expert opinion papers were included and divided into four broad categories pertaining to how they differed from standard CPR guidelines. The four categories were nontraditional compression techniques, CPR not delivered in a flat position, CPR not delivered on a hard surface and CPR not delivered at floor level. CONCLUSION: The scoping review has identified techniques for delivery of CPR and BLS that may be beneficial to wheelchair users. Further research is required to determine applicability and effectiveness.

Determinants of low satisfaction with life among wheelchair users with spinal cord injury in Egypt: a cross-sectional study.

BACKGROUND: Spinal cord injury (SCI) is one of the most catastrophic injuries that might lead to permanent use of a wheelchair and severely affects the quality of life, hence SCI patients report lower satisfaction with life (SWL) than the general population. Therefore, it is important to identify factors that determine SWL among wheelchair users with SCI. Our study aimed to assess the prevalence of low SWL and to identify its determinants among wheelchair users with SCI in Egypt. METHODS: A cross-sectional study included 105 wheelchair users with SCI from the Al Hassan Foundation for wheelchair users in Egypt. The main outcome measure was low SWL, while the independent variables included sociodemographic characteristics, injury-related characteristics, anxiety, depression, neuropathic pain, functional independence, and environmental barriers. RESULTS: The prevalence of low SWL among study participants was 57.1%. We found significant associations between SWL and age, area of living, and age at injury. Additionally, SWL correlated negatively with anxiety, depression, neuropathic pain, and environmental barriers, and positively with functional independence. Finally, the binary multiple logistic regression revealed that living in Upper Egypt (p = 0.017, OR = 13.7), depression (p = 0.034, OR = 6.08), older age (p = 0.002, OR = 1.21), and work and school environmental barriers (p = 0.022, OR = 0.46) were the predictors of low SWL. CONCLUSION: To improve the SWL for wheelchair users with SCI we need to effectively manage neuropathic pain, depression, and anxiety, and promote functional independence. There is an urgent need to reinforce legislation to improve the living conditions for wheelchair users with SCI in Egypt, especially in Upper Egypt.

Near-Infrared Spectroscopy Analysis of Triceps Brachii Muscle Oxygenation During Sprinting in Wheelchair Basketball Players: A Pilot Study.

The purpose of this study was to clarify the characteristics of muscle fatigue by measuring the oxygenation of muscles during wheelchair sprinting in wheelchair basketball players, using near-infrared spectroscopy (NIRS). We believe that this information will be helpful in planning rehabilitation and training programmes.Five male wheelchair basketball players (mean age 30.0 ± 12.0 years, mean height 166.0 ± 12.1 cm, and mean weight 61.0 ± 15.8 kg) participated in this study.These participants performed six 20 m sprint tests after warming up. NIRS measurements were obtained at rest before the start of exercise, during sprinting movements, and during the recovery time after sprinting. Measurements were taken using a wireless NIRS device (PortaMon, Artinis, The Netherlands; sampling rate, 10 Hz) with a single-channel system for tissue oxygenation measurements. The NIRS sensor was applied to the triceps muscle on the participant's dominant arm and fixed with an upper arm supporter. The measurement data were imported into a dedicated computer and the tissue saturation index (TSI) was calculated. Statistical analysis was performed using the Friedman test to compare the TSI before sprinting and at each sprint, and a post hoc Bonferroni test was conducted.Compared to the pre-sprint measurements, TSI significantly decreased during sprints second, fourth, and fifth.In the present study, changes in the oxygen status of the triceps muscle during wheelchair driving varied greatly among individuals, and a tendency was observed towards the oxygen saturation being lowest by the fourth sprint, with the decrease being suppressed from this point on.

Quantifying toddler exploration in different postures with powered mobility.

Access to powered mobility can support play and development for toddlers with disabilities. Using powered mobility in a standing posture has been theorized to support development of muscle coordination, balance, head and trunk stability, and transition to ambulation. The purpose of this study was to quantify and characterize joystick control, bodyweight support, and muscle activity while using the Permobil Explorer Mini in seated and supported standing postures. Nine children with mobility disabilities participated in four visits where they completed two, 15-20 minute play sessions, one in each posture, with a break between. We found that all toddlers engaged with the joystick in both postures, with individual differences in favored directions and control patterns. Participants had similar loading through their feet in both postures, but had slightly higher muscle activity in standing, especially while driving. These results demonstrate that young children with disabilities quickly engage with joystick-based powered mobility in seated and standing postures, with important individual differences that can inform future design of devices and interventions to support play and development.

Wheelchair caster power losses due to rolling resistance on sports surfaces.

The gross mechanical efficiency of the manual wheelchair propulsion movement is particularly low compared to other movements. The energy losses in the manual wheelchair propulsion movement are partly due to energy losses associated with the wheelchair, and especially to the rolling resistance of the wheels. The distribution of mass between the front rear wheels and the caster wheels has a significant impact on the rolling resistance. The study of the caster wheels cannot therefore be neglected due to their involvement in rolling resistance. Thus, this study aimed to evaluate the power dissipated due to rolling resistance by different caster wheels, at different speeds and under different loadings on various terrains. Four caster wheels of different shapes, diameters, and materials were tested on two surfaces representative of indoor sports surfaces at four different speeds and under four loadings. The results showed a minimal dissipated power of 0.4±0.2W for the skate caster, on the parquet, at 0.5 m/s and under a loading of 50 N. The maximal mean power dissipated was 43.3±27.6W still for the skate caster, but on the Taraflex, at 1.5 m/s and under loading of 200 N. The power dissipated on the parquet was lower than the one on the Taraflex. The Spherical and Omniwheel caster wheels dissipated less power than the two other casters. This study showed that caster wheels cannot be neglected in the assessment of gross mechanical efficiency, particularly in light of the power dissipated by athletes during propulsion.

Highlights the importance of choosing the right front casters depending on the conditions of use of the manual wheelchair.First study to evaluate power dissipation due to rolling resistance in front casters during wheelchair propulsion.Shows that a Taraflex type floor is not suitable for wheelchair sports performance and injury prevention purposes and lower musculoskeletal constraints with equivalent performance.

Prescription methodology integrated with equipment designed for customising racing wheelchair.

BACKGROUND: Wheelchair racing is a traditional modality of Paralympic athletics. In general, racing wheelchairs are customized according to the athletes' anthropometric conditions, based on pre-established dimensions according to the manufacturer's manual. Usually, athletes choose the dimensions for their new sports wheelchairs, and when they are delivered for use, they often have problems due to incorrect body adjustments. PURPOSE: To develop a new customization methodology that is made possible through a new multi-adjustable racing wheelchair prescription equipment (RWPE) for athletics. This equipment performs several measurements and adjustments according to the athlete's anthropometric characteristics, evaluating the best-fit athlete to obtain better performance in the personalized wheelchair. MATERIALS AND METHODS: Customizing racing wheelchairs is based on anthropometric measurements of the individual and specific ergonomic adjustments for better performance and safety. The RWPE is a multi-adjustment device composed of modules that use measuring instruments to guarantee maximum precision and accuracy of the assessments. This project's innovation is associated with the multi-regulation equipment itself and a conventional process of manufacturing a racing wheelchair through an online form. The RWPE has a robust and rigid structure for conducting race-track experimental tests. RESULTS AND CONCLUSIONS: The experimental tests allowed the equipment to be validated regarding safety, comfort, and prescription methodology. A high-performance athlete validated the equipment and prescription methodology, and as a result, a new version of a parameterized wheelchair was also developed using the prescription methodology. A comparison between prescription tests showed better athlete performance regarding estimated average power, considering dimensions optimized through RWPE.

Sport provides many benefits to people with disabilities, including physical and emotional benefits during rehabilitation. Therefore, this work provides a better adaptation of the athletes to their racing wheelchair, benefiting these athletes with better conditions to practice the sport and a smoother rehabilitation with less stress.When a racing wheelchair is prescribed for an athlete it needs to be suited to the individual's posture. Incorrectly prescribed racing wheelchairs can cause serious damage to the athlete's health. In this way, this work encourages better collaboration with practitioners of the sport during prescription of their racing wheelchair.In addition to being used for prescription racing wheelchairs, the presented equipment can also be used for training, physical conditioning and rehabilitation of people with disabilities.

High-precision docking of wheelchair/beds through LIDAR and visual information.

To address the low docking accuracy of existing robotic wheelchair/beds, this study proposes an automatic docking framework integrating light detection and ranging (LIDAR), visual positioning, and laser ranging. First, a mobile chassis was designed for an intelligent wheelchair/bed with independent four-wheel steering. In the remote guidance phase, the simultaneous localization and mapping (SLAM) algorithm was employed to construct an environment map, achieving remote guidance and obstacle avoidance through the integration of LIDAR, inertial measurement unit (IMU), and an improved A* algorithm. In the mid-range pose determination and positioning phase, the IMU module and vision system on the wheelchair/bed collected coordinate and path information marked by quick response (QR) code labels to adjust the relative pose between the wheelchair/bed and bed frame. Finally, in the short-range precise docking phase, laser triangulation ranging was utilized to achieve precise automatic docking between the wheelchair/bed and the bed frame. The results of multiple experiments show that the proposed method significantly improves the docking accuracy of the intelligent wheelchair/bed.

How does moderate upper limb activity modify sitting forces for able-bodied persons and wheelchair users?

INTRODUCTION: Most people with a spinal cord injury are concerned by pressure injuries (PrI). Since dynamic activities may involve distributions of forces over time that are different from static and given the significant impact of PrIs on healthcare costs, it is, important to study these sitting forces. We aim to investigate sitting forces (overall normal, shear forces and Peak Pressure Index (PPI)) assessed in both able-bodied and wheelchair users (WCU) under static and dynamic conditions. Our hypothesis is that wheelchair sitting forces encountered by able-bodied participants are significantly different from those of WCUs. MATERIAL AND METHODS: An experimental seat and a pressure mapping system were used to investigate forces in two different populations, 102 able-bodied and 15 WCUs, in static conditions and during synchronised hand-cycling. The analysis includes statistical comparisons of the sitting conditions (static/dynamic) and of the populations (able-bodied/WCUs). RESULTS AND DISCUSSION: Significant differences in normal forces and PPI were observed between able-bodied and WCUs; conversely, differences in shear forces were non-significant. This suggests that contrary to shear forces, no conclusion on normal forces drawn from trials with healthy participants can directly be applied to WCUs. Secondly, the present results indicate significant reduced averaged: normal force, PPI, and shear forces for able-bodied performing a dynamic activity compared to static sitting. WCUs experienced non-significant lower averaged normal force and PPI but significant lower averaged shear forces. CONCLUSION: While the present results seem to indicate lower forces for able-bodied performing a dynamic activity compared to static sitting, due to reduced averaged forces, this conclusion is less clear-cut for WCUs.

The present observational study can help understand the specific characteristics of wheelchair users concerning the biomechanical sitting load in rest and during propulsive activity: the shear forces are reduced during activity compared to static conditions.From the data collected in the present study, it seems that no conclusion on normal sitting forces drawn from trials with healthy participants can directly be applied to wheelchair users.

Initial validation and feasibility of a Standardized Navigation Of Winter Mobility & Accessibility Network (SNOWMAN) course for wheelchairs.

Many Canadian manual wheelchair users face many challenges in winter months such as slippage on ice- or snow-covered ramps, snow windrows, and casters becoming stuck in deep or hard packed snow. These barriers impact wheelchair users' ability to participate in the community. This study aimed to evaluate the validity and feasibility of a winter wheelchair obstacle course known as the Standardized Navigation Of Winter Mobility & Accessibility Network (SNOWMAN). The results demonstrated that the SNOWMAN course authentically represented real-world winter conditions, as confirmed by participant responses and qualitative feedback from four manual wheelchair users. The course was comprehensive, covering a range of winter obstacles typically encountered by wheelchair users. Construct validity was established by differentiating performance between manual wheelchairs and a motorized platform with snow tracks, showcasing varying completion times and device satisfaction levels. Feasibility was also assessed, with the administration protocol being mostly adhered to, safety measures implemented, and usability scores meeting acceptable thresholds. The SNOWMAN course showed promise for evaluating wheelchair adaptations and devices for winter conditions, as well as training users in winter mobility skills. Future research directions include comparing different wheeled mobility devices, exploring adaptations for usability in winter, and developing new technology tailored for challenging terrains and winter conditions. The SNOWMAN course could serve as a valuable tool for both research and clinical applications in enhancing winter mobility for wheelchair users.

The SNOWMAN course demonstrates strong potential for ecologically valid evaluation and development of wheelchairs and adaptations specific to winter conditions.The SNOWMAN course provides a venue to safely evaluate and train authentic winter mobility skills and strategies.The SNOWMAN course has the potential to positively impact the broader community by enhancing awareness of winter mobility and accessibility issues.

Effects of the wheelchair sitting posture on gluteal pressure.

[Purpose] To evaluate the efficacy of the "forward-tilting posture" (the trunk tilted forward against a table) in a wheelchair in relieving gluteal pressure. [Participants and Methods] Thirty-six healthy adults were instructed to sit in a wheelchair assuming the following three postures: (1) both feet placed on the foot support with the trunk upright ("basic sitting posture"), (2) both feet placed on the foot support with the trunk tilted forward against a table ("forward-tilting posture A"), and (3) both feet placed on the floor with the trunk tilted forward against a table ("forward-tilting posture B"). A seat-type sensor pad placed on a wheelchair cushion was used to measure the maximum gluteal pressure and gluteal contact area. [Results] The maximum gluteal pressures in "forward-tilting postures A" and "forward-tilting postures B" were significantly lower than those in the basic sitting posture. The maximum gluteal pressure in "forward-tilting posture B" was significantly lower than that in "forward-tilting posture A". The gluteal contact area in "forward-tilting posture B" was significantly larger than that in "forward-tilting posture A". [Conclusion] The study results indicate that the "forward-tilting posture" in a wheelchair effectively relieves gluteal pressure.

The Prevalence of Low Vitamin D in Elite Para-Athletes: A Systematic Review.

BACKGROUND: Vitamin D insufficiency (25OHD, 50-75 nmolˑl- 1) is a common issue within healthy adults and elite athletes and is associated with decreased musculoskeletal health and performance. However, few studies have identified the prevalence and risk factors associated with vitamin D insufficiency within elite Para-Athletes. METHODS: An electronic search was completed on the 5th January 2023 and updated on the 21st June 2024, searching Web of Science, PubMed, Scopus, Cochrane Library and EASY (originally OpenGrey). To meet the eligibility criteria, retrieved studies were required to include at least one baseline measure of a vitamin D biomarker from elite Para-Athletes performing at national or international levels and therefore all quantitative study designs could be included. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist (8-item) for analytical cross-sectional studies. Data from the eligible studies was extracted and charted, with a supporting narrative synthesis. RESULTS: The search strategy retrieved 3083 articles, of which ten studies met the inclusion criteria. In total there were n = 355 Para-Athletes, 69.6% of which comprised of males in the included studies. Across the ten included studies, n = 546 samples were taken from n = 355 Para-Athletes across different seasons and based upon the 25(OH)D insufficiency and deficiency thresholds set by each individual study 43.2% of the samples were considered insufficient and 28.1% deficient. During the winter months vitamin D insufficiency was at its most prevalent at 74.1%, compared to 57.1% in summer of the 25(OH)D samples measured in Para-Athletes. Wheelchair athletes who competed in indoor sports were also more susceptible to low vitamin D. CONCLUSION: This review has highlighted that vitamin D insufficiency and deficiency is highly prevalent in elite level Para-Athletes, all year, across both summer and winter months. Therefore, this review highlights the need for education, treatment, and preventative measures in elite Para-Athletes throughout the year. REGISTRATION: The following systematic review was prospectively registered through PROSPERO International prospective register of systematic reviews (PROSPERO registration ID number: CRD42022362149).

Validity of a wrist-worn consumer-grade wearable for estimating energy expenditure, sedentary behaviour, and physical activity in manual wheelchair users with spinal cord injury.

PURPOSE: To evaluate the validity of a consumer-grade wearable for estimating energy expenditure, sedentary behaviour, and physical activity in manual wheelchair users with spinal cord injury (SCI). MATERIALS AND METHODS: Fifteen manual wheelchair users with SCI (C5-L1, four female) completed activities of daily living and wheelchair propulsion (2-8 km·h-1). Wrist-worn accelerometry data were collected using consumer-grade (z-Track) and research-grade (ActiGraph GT9X) devices. Energy expenditure was measured via indirect calorimetry. Linear regression was used to evaluate the prediction of criterion metabolic equivalent of task (MET) by each accelerometer's vector magnitude (VM). Area under the receiver operating characteristic curve (ROC-AUC) evaluated the accuracy of VM for discriminating between physical activity intensities and for identifying accelerometer cut-points. RESULTS: Standardised ß-coefficients for the association between z-Track and ActiGraph VM for criterion MET were 0.791 (p < 0.001) and 0.774 (p < 0.001), respectively. The z-Track had excellent accuracy for classifying time in sedentary behaviour (ROC-AUC = 0.95) and moderate-to-vigorous physical activity (ROC-AUC = 0.93); similar values to the ActiGraph (ROC-AUC = 0.96 and 0.88, respectively). Cut-points for the z-Track were ≤37 g·min-1 for sedentary behaviour and ≥222 g·min-1 for moderate-to-vigorous physical activity. CONCLUSIONS: This study supports the validity of a consumer-grade wearable to measure sedentary time and physical activity in manual wheelchair users with SCI.

A consumer-grade wearable device provides valid estimations of sedentary time and physical activity in manual wheelchair users with spinal cord injury.Commercially available consumer-grade wearables may enable accurate self-monitoring in this population and, therefore, have potential for supporting behaviour change.

Skills on wheels: caregiver perspectives on the design and long-term impact of a pediatric wheelchair Skills training program.

Manual wheelchair skills training programs are novel developments, particularly in the United States. As perceived by the caregivers of participants, this study aimed to examine the long-term impact of the Skills on Wheels program on participants' occupational engagement and quality of life at home, at school, and in the community. Secondly, this study investigated the caregivers' perspectives of the program design of Skills on Wheels. This was a qualitative inquiry based upon thematic analyses of semi-structured interviews after participation in a pediatric wheelchair skills training program. The study participants were 9 caregivers whose children participated in this program over the 2021 and 2022 implementation years. Caregivers were given a 10-question semi-structured interview. The five overarching topics included program impact: (i) occupational engagement, (ii) program impact: quality of life factors, (iii) program resources/design, (iv) novelty/importance of program/wheelchair skills training, and (v) desired continued wheelchair skills practice in the future. Results provided tangible feedback to integrate into program design and supported the Skills on Wheels program's positive value as it relates to impact on quality of life and occupational engagement for participants.

Wheelchair skills training programs are important for children with disabilities to fill in service gaps related to community mobility.When developing community programs in general, it is necessary to gain the understanding of the impact on caregivers of children with disabilities.This paper provides insight into how a pediatric wheelchair skills training program is viewed by the caregivers of participating children.Therapists and researchers can see the caregiver impact of programs or training such as that described in this study.