Evaluation of 3 pushrim-activated power-assisted wheelchairs in patients with spinal cord injury.

OBJECTIVE: To assess differences between manual wheelchairs and 3 pushrim-activated power-assisted wheelchairs (PAPAWs): Servomatic A and B and E-motion. DESIGN: Repeated measures. SETTING: Rehabilitation hospital. PARTICIPANTS: Volunteers with spinal cord injuries (N=52). INTERVENTIONS: Ten subjects propelled the wheelchairs on a dynamometer, 46 evaluated each wheelchair on indoor and outdoor courses, and 10 evaluated their ability to transfer themselves and their wheelchairs into and out of their car. MAIN OUTCOME MEASURES: Oxygen consumption per unit time (V˙o2) and heart rate were measured during propulsion on the dynamometer. Wheelchair efficiency on the indoor and outdoor courses was evaluated on the basis of heart rate, completion time, handrim push frequency, and patient satisfaction. RESULTS: On the dynamometer, decreases in V˙o2 and heart rate were similar with the 3 PAPAWs compared with manual wheelchairs. On the outdoor course, heart rate was significantly decreased by PAPAWs compared with manual wheelchairs and patient satisfaction was better with Servomatic devices than with the E-motion device. Indoors, the course completion time was longer with the E-motion wheelchair than with other wheelchairs in the overall population, and handrim push frequency was higher with the E-motion wheelchair than with other wheelchairs in the subgroup with T12 to L1 injuries. Car transfer ability was lower with PAPAWs than with manual wheelchairs. CONCLUSIONS: Differences exist across PAPAWs. Compared with E-motion, the 2 Servomatic PAPAWs were easier to use outdoors, and difficulty transferring into/out of the car was similarly increased with all 3 PAPAWs.

Evaluation of a stair-climbing power wheelchair in 25 people with tetraplegia.

OBJECTIVE: To compare the performance of a power wheelchair with stair-climbing capability (TopChair) and a conventional power wheelchair (Storm3). DESIGN: A single-center, open-label study. SETTING: A physical medicine and rehabilitation hospital. PARTICIPANTS: Patients (N=25) who required power wheelchairs because of severe impairments affecting the upper and lower limbs. INTERVENTIONS: Indoor and outdoor driving trials with both devices. Curb-clearing and stair-climbing with TopChair. MAIN OUTCOME MEASURES: Trial duration and Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) tool; number of failures during driving trials and ability to climb curbs and stairs. RESULTS: All 25 participants successfully completed the outdoor and indoor trials with both wheelchairs. Although differences in times to trial completion were statistically significant, they were less than 10%. QUEST scores were significantly better with the Storm3 than the TopChair for weight (P=.001), dimension (P=.006), and effectiveness (P=.04). Of the 25 participants, 23 cleared a 20-cm curb without help, and 20 climbed up and down 6 steps. Most participants felt these specific capabilities of the TopChair--for example, curb clearing and stair climbing-were easy to use (22/25 for curb, 21/25 for stairs) and helpful (24/25 and 23/25). A few participants felt insecure (4/25 and 6/25, respectively). CONCLUSIONS: The TopChair is a promising mobility device that enables stair and curb climbing and warrants further study.

Optimization of power wheelchair control for patients with severe Duchenne muscular dystrophy.

The extended survival of patients with Duchenne muscular dystrophy (DMD) achieved by the introduction of mechanical ventilation is raising new quality-of-life issues. We evaluated passive range of wrist extension, key pinch strength, and power wheelchair driving in 84 patients. The 47 drivers with restricted driving abilities were older than the 37 unrestricted drivers (27.2+/-5.0 y vs. 22.8+/-3.8 y) and had worse upper limb performance. By multiple logistic regression, only key pinch was significant ( R(2) = 0.224, P = 0.02. Eighteen restricted drivers were reassessed after having swapped a conventional joystick for another control system (mini-joystick, isometric mini-joystick, finger joystick, or pad) and having moved the position of the tested control system so that the patient could use it with different fingers, his chin or his mouth. All of them regained the ability to drive unrestricted. Adults with DMD gradually lose their ability to drive with a conventional joystick but can regain unrestricted driving with alternative control systems.

Comparative evaluation of electric wheelchair manoeuvrability.

OBJECTIVE: The aim of this study was to determine whether manoeuvrability varied between electric wheelchairs. DESIGN: Randomized, prospective, repeated measures design. SUBJECTS: Twelve wheelchair users. METHODS: Three different electric powered indoor/outdoor wheelchairs (Invacare Storm 3, Ottobock B500, and Meyra Champ) intended for use by patients with severe impairments were tested over an indoor and an outdoor circuit. Points were assigned when the users touched the circuit boundaries or failed to pass obstacles. The users completed the Quebec User Evaluation of Satisfaction with Assistive Technology questionnaire (QUEST). RESULTS: Performance was significantly worse with Ottobock B500 compared with the other 2 wheelchairs on the indoor test (Wilcoxon, p < 0.05 for both comparisons) and compared with Invacare Storm on the outdoor test (Wilcoxon, p < 0.05). The mean 6-item QUEST score, effectiveness, and simplicity of use were significantly worse for Ottobock B500 than for the other 2 wheelchairs (Wilcoxon, p < 0.05). CONCLUSION: Differences in manoeuvrability exist between commercially available electric wheelchairs belonging to the same category. Driving tests and QUEST provide complementary and concordant information.

Toll motorway accessibility for wheelchair users: a survey.

OBJECTIVE: To identify difficulties encountered by wheelchair users who travel on toll motorways, with the goal of defining areas for improvement. DESIGN: Survey. After observing a wheelchair user travelling on a toll motorway and using the associated services, we designed a self-questionnaire on perceptions by wheelchair users of toll motorway accessibility. SETTING: Toll motorway and rehabilitation hospital in France. SUBJECTS: We recruited 167 wheelchair users by advertisement and, to assess selection bias, 19 consecutive outpatients who visited our hospital's wheelchair showroom. INTERVENTION: None. RESULTS: Of the 186 included subjects, 91 (49%) were used to driving independently on toll motorways. Among them, only 16% used automatic toll booths and 32% reported difficulties at toll booths. Furthermore, 53% routinely asked for help at filling stations, and only 27% were aware of the availability of a free-of-charge assistance service for disabled people at some filling stations. Among the 186 toll motorway users, only 84 (45%) reported never encountering difficulties in lay-bys; 162 (87%) felt that toilet accessibility was the most important feature of lay-bys and 143 (77%) preferred the locked toilets reserved for disabled people. CONCLUSION: Wheelchair users reported difficulties on toll motorways that could be corrected fairly easily.