Evaluation of interface pressure and temperature management in five wheelchair seat cushions and their effects on user satisfaction.

BACKGROUND: Factors such as the manufacturing materials, shape or even the mechanical and thermal response of sitting Pressure Redistribution Support Surfaces (PRSS) can be potential contributors to pressure ulcers. However, few studies have compared a number of characteristics of the most frequently used devices. OBJECTIVE: To compare three potential contributors to pressure ulcers in five commercial PRSS: pressure redistribution, temperature and perceived comfort. METHOD: Study with a cross-over randomized design in healthy volunteer participants. Data was collected in a temperature and relative humidity controlled environment. To assess thermal response, the temperature (Flir-E60) of the region of interest was captured before and after use of each PRSS for further analysis. The region of interest was the gluteal zone. To assess the pressure redistribution a pressure mat (XSensor®) was used between the 5 cushion and each study participant using a standardized method. Finally, a subjective perception questionnaire recorded comfort, adaptability and thermal sensation parameters. Data analysis levels of significance were set at 0.05. RESULTS: A total of 22 participants completed the assessments. There were no statistically significant differences in baseline temperatures between PRSS (>0.05). Pressure redistribution analysis showed significant differences between all PRSS in all variables evaluated except in the maximum and peak pressure index al sacrum. The subjective assessment suggested no major user-perceived differences between PRSS. CONCLUSION: Seat cushions made of open cell polyurethane foam blocks of variable hardness and the horseshoe cushion (also open cell polyurethane foam) seem to provide a more effective pressure relief characteristic than those injected with polyurethane foam and gel in most of the studied pressure variables. However, the cushions provide similar thermal response and perceived comfort.

A Cross-Sectional Study of Nemaline Myopathy.

OBJECTIVE: Nemaline myopathy (NM) is a rare neuromuscular condition with clinical and genetic heterogeneity. To establish disease natural history, we performed a cross-sectional study of NM, complemented by longitudinal assessment and exploration of pilot outcome measures. METHODS: Fifty-seven individuals with NM were recruited at 2 family workshops, including 16 examined at both time points. Participants were evaluated by clinical history and physical examination. Functional outcome measures included the Motor Function Measure (MFM), pulmonary function tests (PFTs), myometry, goniometry, and bulbar assessments. RESULTS: The most common clinical classification was typical congenital (54%), whereas 42% had more severe presentations. Fifty-eight percent of individuals needed mechanical support, with 26% requiring wheelchair, tracheostomy, and feeding tube. The MFM scale was performed in 44 of 57 participants and showed reduced scores in most with little floor/ceiling effect. Of the 27 individuals completing PFTs, abnormal values were observed in 65%. Last, bulbar function was abnormal in all patients examined, as determined with a novel outcome measure. Genotypes included mutations in ACTA1 (18), NEB (20), and TPM2 (2). Seventeen individuals were genetically unresolved. Patients with pathogenic ACTA1 and NEB variants were largely similar in clinical phenotype. Patients without genetic resolution had more severe disease. CONCLUSION: We present a comprehensive cross-sectional study of NM. Our data identify significant disabilities and support a relatively stable disease course. We identify a need for further diagnostic investigation for the genetically unresolved group. MFM, PFTs, and the slurp test were identified as promising outcome measures for future clinical trials.

Determinants of physical activity in young wheelchair-user with spina bifida.

OBJECTIVE: To explore associations between physical activity and peak oxygen uptake (VO2peak), age, sex, and Hoffer classification in young wheelchair-users with spina bifida. DESIGN: Exploratory study. SUBJECTS: Fifty-three dutch children (age 5-19 years) with spina bifida who use a manual wheelchair. METHODS: For the dependent variable physical activity, data from 2 physical activity monitors were analysed: VitaMove data for 34 participants and Actiheart data for 36 participants. Time sedentary, time physically active, and time in moderate to vigorous physical activity were analysed. The Wheelchair Shuttle Test was used to measure VO2peak. Univariate and multivariate regression analyses were performed. Independent variables were VO2peak, age, sex, and Hoffer classification. RESULTS: Time sedentary and time physically active during a school day were influenced by age (ß=0.326/ß=-0.320) and Hoffer classification (ß=0.409/ß=-0.534) and during a weekend day by Hoffer classification (ß=0.617/ß=-0.428). Time in moderate to vigorous physical activity was influenced by Hoffer classification (ß=-0.527) during a school day and by age (ß=-0.600) during a weekend day. CONCLUSION: Older age and the inability to walk negatively influence physical activity. Sex and VO2peak were not associated with physical activity. These results imply that increasing cardiorespiratory fitness alone will not improve physical activity in young wheelchair-users with spina bifida.

Challenges of Developing a Natural Language Processing Method With Electronic Health Records to Identify Persons With Chronic Mobility Disability.

OBJECTIVE: To assess the utility of applying natural language processing (NLP) to electronic health records (EHRs) to identify individuals with chronic mobility disability. DESIGN: We used EHRs from the Research Patient Data Repository, which contains EHRs from a large Massachusetts health care delivery system. This analysis was part of a larger study assessing the effects of disability on diagnosis of colorectal cancer. We applied NLP text extraction software to longitudinal EHRs of colorectal cancer patients to identify persons who use a wheelchair (our indicator of mobility disability for this analysis). We manually reviewed the clinical notes identified by NLP using directed content analysis to identify true cases using wheelchairs, duration or chronicity of use, and documentation quality. SETTING: EHRs from large health care delivery system PARTICIPANTS: Patients (N=14,877) 21-75 years old who were newly diagnosed with colorectal cancer between 2005 and 2017. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Confirmation of patients' chronic wheelchair use in NLP-flagged notes; quality of disability documentation. RESULTS: We identified 14,877 patients with colorectal cancer with 303,182 associated clinical notes. NLP screening identified 1482 (0.5%) notes that contained 1+ wheelchair-associated keyword. These notes were associated with 420 patients (2.8% of colorectal cancer population). Of the 1482 notes, 286 (19.3%, representing 105 patients, 0.7% of the total) contained documentation of reason for wheelchair use and duration. Directed content analysis identified 3 themes concerning disability documentation: (1) wheelchair keywords used in specific EHR contexts; (2) reason for wheelchair not clearly stated; and (3) duration of wheelchair use not consistently documented. CONCLUSIONS: NLP offers an option to screen for patients with chronic mobility disability in much less time than required by manual chart review. Nonetheless, manual chart review must confirm that flagged patients have chronic mobility disability (are not false positives). Notes, however, often have inadequate disability documentation.

Psychophysical Health Factors and Its Correlations in Elderly Wheelchair Users Who Live in Nursing Homes.

Background: The aging is a multi-faceted process comprising both-the physical and mental alterations. Thus, the aim of the study was to evaluate the variables affecting the psychophysical state of the elderly people using wheelchairs and living in nursing homes (NH). Methods: 165 older wheelchair users were included in the study after meeting the inclusion criteria and expressing written consent. The assessment involved cognitive functioning, depression, body balance and flexibility, lung capacity and upper limbs dexterity, strenght and endurance. The results showed negative correlation between depression and balance, upper limb dexterity and endurance and shoulder flexion. A positive correlation between cognitive functioning and balance, upper limb dexterity, strenght and endurance, lung capacity and joint mobility was determined. Also, the study proved positive correlation between daily functioning and functional fitness, muscle strength and endurance, body flexibility, joint mobility. The regression analysis showed that better scores in balance test and joint mobility implied with higher scores in cognitive functioning. The most important determinants of functional fitness were balance, hand grip strenght and joint mobility. Conclusion: The future study should be focused on developing interventions aimed at senior wheelchair users living in NHs to prevent the deterioration of their mental and physical fitness.

Pressure Ulcer Risk Factors in Persons with Mobility-Related Disabilities.

OBJECTIVE: To assess pressure ulcer (PU) risk in persons with mobility impairments using a large data set to identify demographic, laboratory, hemodynamic, and pharmacologic risk factors. METHODS: The cohort of interest was persons with disabilities who have mobility impairments and are diagnostically at risk of PUs. To define this cohort, diagnoses that qualify patients for skin protection wheelchair cushions were used. Data were obtained from the Cerner Health Facts data warehouse. Two cohorts were defined: persons with and without a history of PUs. Analysis included descriptive statistics and multivariate logistic regression modeling. Variables retained in the model were identified using LASSO, gradient boosting, and Bayesian model averaging. MAIN RESULTS: The resulting cohorts included more than 87,000 persons with a history of PUs and more than 1.1 million persons who did not have a PU. The data revealed seven disability groups with the greatest prevalence of PUs: those with Alzheimer disease, cerebral palsy, hemiplegia, multiple sclerosis, paraplegia/quadriplegia, Parkinson disease, and spina bifida. Ulcers in the pelvic region accounted for 82% of PUs. Persons with disabilities who were male or black had a greater prevalence of PUs. Physiologic risk factors included the presence of kidney or renal disease, decreased serum albumin, and increased serum C-reactive protein. CONCLUSIONS: The results indicate that, although persons with disabilities can exhibit a wide functional range, they remain at risk of PUs and should be evaluated for proper preventive measures, including support surfaces and wheelchair cushions.

Acute injuries resulting from accidents involving powered mobility devices (PMDs)-Development and outcomes of PMD-related accidents in Sweden.

Objective: Powered mobility devices (PMDs) are commonly used as aids for older people and people with disabilities, subgroups of vulnarable road users (VRUs) who are rarely noted in traffic safety contexts. However, the problem of accidents involving PMD drivers has been reported in many countries where these vehicles have become increasingly popular. The aim of this study is to extract and analyze national PMD-related accident and injury data reported to the Swedish Traffic Accident Data Acquisition (STRADA) database. The results will provide valuable insight into the risks and obstacles that PMD drivers are exposed to in the traffic environment and may contribute to improving the mobility of this group in the long term. Methods: The current study is based on data from 743 accidents and 998 persons. An analysis was performed on a subset of data (N = 301) in order to investigate the development of accidents over a period of 10 years. Thereafter, each accident in the whole data set was registered as either single (N = 427) or collision (N = 315). Results: The results show that there was a 3-fold increase in the number of PMD-related accidents reported to STRADA during the period 2007-2016. With regard to single accidents, collisions, as well as fatalities, the injury statistics were dominated by males. Single accidents were more common than collisions (N = 427 and N = 316, respectively) and the level of injury sustained in each type of accident is on par. The vast majority of single accidents resulted in the PMD driver impacting the ground (87%), due to either PMD turnover (71%) or the driver falling out of the PMD (16%). The reason for many of the single accidents was a difference in ground level (34%, typically a curb). Cars, trucks, or buses were involved in 67% of collision events; these occured predominantly at junctions or intersections (70%). Abbreviated Injury Scale (AIS) 3+ injuries were dominated by hip and head injuries in both single accidents and collision events. Conclusions: The present study shows that further research on PMD accidents is required, with regard to both single accidents and collision events. To ensure that appropriate decisions are made, future work should follow up on injury trends and further improve the quality of PDM-related accident data. Improved vehicle stability and design, increased usage of safety equipment, proper training programs, effective maintenance services, and development of a supporting infrastructure would contribute to increased safety for PMD drivers.

Shoulder pain assessment in elite wheelchair basketball players / Evaluación de dolor de hombro en jugadores de baloncesto en silla de ruedas de élite / Avaliação da dor no ombro em jogadores de elite de basquete em cadeira de rodas

Objective: The aim of this study was to evaluate shoulder pain in a sample of elite wheelchair basketball players during their preparation for a major competition. Method: Seventeen male wheelchair basketball players, between 16 and 43 years of age, were studied during their athletic preparation for a wheelchair basketball championship. The shoulder pain questionnaire, impingement tests and shoulder range of motion were evaluated during a training camp. Spearman's rank correlation coefficient was used to analyze the relationship between shoulder pain and range of motion indicating the value of the effect size. Results: Shoulder pain was evident in 52.9% of the sample and was significant and negatively correlated with range of motion, while 35.3% related to impingement tests player's reported pain. The correlation was moderate to high. Conclusions: In conclusion, the use of shoulder pain questionnaire, goniometric measurements and clinical test could be a useful approach for monitoring the shoulder injuries of wheelchair basketball players to explore the possible consequences of performing repetitive movements

Objetivo: El objetivo de este estudio fue evaluar el dolor de hombro en jugadores de baloncesto en silla de ruedas de élite durante su preparación para una competencia de alto nivel. Método: Diecisiete jugadores masculinos de baloncesto en silla de ruedas, entre 16 y 43 años, fueron evaluados con el cuestionario para el dolor de hombro en jugadores de baloncesto en silla de ruedas, las pruebas clínicas y el rango de movimiento del hombro durante la preparación para un campeonato. El coeficiente de correlación de Spearman se utilizó para analizar la correlación entre el dolor de hombro y el rango de movimiento, indicando el valor del tamaño del efecto. Resultados: El dolor de hombro fue evidente en el 52.9% de la muestra, siendo significativo. En tanto que, hubo una correlación negativa entre el dolor de hombro y el rango de movimiento, mientras que el 35.3% reportó dolor de acuerdo con las pruebas clínicas. La correlación fue de moderada a alta. Conclusiones: La utilización del cuestionario, las mediciones goniométricas y las pruebas clínicas podrían ser herramientas adecuadas para monitorear la condición del hombro en los jugadores de baloncesto en silla de ruedas, y así explorar las posibles consecuencias de los movimientos repetitivos

Objetivo: O objetivo deste estudo foi avaliar a dor no ombro em uma amostra de jogadores de elite de basquete em cadeira de rodas durante sua preparação para uma competição de alto nível. Método: Dezessete jogadores de basquete em cadeira de rodas do sexo masculino, entre 16 e 43 anos de idade, foram avaliados com o questionário de dor no ombro, testes clínicos de impacto e amplitude articular durante o treinamento para um campeonato. O coeficiente de correlação de Spearman foi utilizado para analisar a relação entre dor no ombro e amplitude de movimento que indica o valor do tamanho do efeito. Resultados: A dor no ombro foi evidente em 52,9% da amostra e foi significativa e negativamente correlacionada com a amplitude de movimento, enquanto 35,3% teve uma correlação de moderada a alta em relação à dor durante os testes de impacto. Conclusões: Em conclusão, o uso de questionário de dor no ombro, medições goniométricas e teste clínico poderia ser uma abordagem útil para monitorar as lesões no ombro de jogadores de basquete em cadeira de rodas para explorar as possíveis consequências da realização de movimentos repetitivos

Anticipation of wheelchair and rollerblade actions in spinal cord injured people, rollerbladers, and physiotherapists.

Embodied Cognition Theories (ECT) postulate that higher-order cognition is heavily influenced by sensorimotor signals. We explored the active role of somatosensory afferents and motor efferents in modulating the perception of actions in people who have suffered a massive body-brain disconnection because of spinal cord injury (SCI), which leads to sensory-motor loss below the lesion. We assessed whether the habitual use of a wheelchair enhances the capacity to anticipate the endings of tool-related actions, with respect to actions that have become impossible. In a Temporal Occlusion task, three groups of participants (paraplegics, rollerbladers and physiotherapists) observed two sets of videos depicting an actor who attempted to climb onto a platform using a wheelchair or rollerblades. Three different outcomes were possible, namely: a) success (the actor went up the step); b) fail (the actor stopped before the step without going up) and c) fall (the actor fell without going up). Each video set comprised 5 different durations increasing in complexity: in the shortest (600ms) only preparatory body movements were shown and in the longest (3000ms) the complete action was shown. The participants were requested to anticipate the outcome (success, fail, fall). The main result showed that the SCI group performed better with the wheelchair videos and poorer with rollerblade videos than both groups, even if the physiotherapists group never used rollerblades. In line with the ECT, this suggests that the action anticipation skills are not only influenced by motor expertise, but also by motor connection.

Falls among full-time wheelchair users with spinal cord injury and multiple sclerosis: a comparison of characteristics of fallers and circumstances of falls.

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.

Data-mining analysis of the provision of mobility devices in the United States with emphasis on complex rehab technology.

The objective of this study was to describe the provision of wheeled-mobility equipment from the perspective of a large equipment supplier in the United States. The records of clients who were prescribed a mobility device over a 6-month period were randomly sampled to product a dataset of 1,689 clients. Analysis was limited to descriptive statistics and measures of relationships. The majority of the clients were adults (72%) and female (58%) with 62% receiving a manual wheelchair. The majority of interventions (58%) included some contribution from the client or client's family. Overall, 86% of all prescribed wheelchairs were classified as complex rehab technology (CRT). About half (52%) of all interventions involved a therapist. Therapist involvement was 2.5 times more likely during CRT interventions compared to standard durable medical equipment (StdDME). The project provides a novel description of mobility-related equipment provision using a large retrospective dataset. The analysis demonstrates the utility of analyzing a large number of client interventions. The capabilities of such analyses have business, clinical, and policy implications. Combining the data available from suppliers with prospective collection of client-specific information, such as outcomes, would be a more powerful means to assess the provision of wheeled-mobility equipment.

Impacts of early powered mobility provision on disability identity: A case study.

BACKGROUND/PURPOSE: Providing powered mobility technology to people with disabilities is a common rehabilitation practice. However, the relationship between powered mobility introduction and identity development, when considered in the context of lived experiences of children with disabilities and their families, is not well understood. Investigating this relationship is timely given the emergence of alternative, community-based early mobility opportunities using adapted mobility toys whose impact may contrast experiences using powered wheelchairs typically provided in rehabilitation settings. METHOD: Using a qualitative, ethnographic case study approach, in-depth interview and field observation data were collected with 2 children and families, 1 who received a traditional powered wheelchair and the other who received an adapted mobility toy. A grounded theory approach guided the data analysis, and emerging themes were discussed until consensus was reached between Heather Feldner and families. RESULTS: Findings revealed four themes: (1) dys/function of mobility technology; (2) daily Life, play, and participation; (3) emerging self/advocacy; and (4) complex family/industry interplay. CONCLUSION: Similarities and differences were present within the situated experiences of each family. Experiences were foregrounded by instances of emerging identity development throughout provision processes that were influenced by caregiver perceptions of disability (positive vs. negative), aesthetics and function (medical vs. adventure), and perceived intent of the devices (an opportunity for freedom vs. prolonging need for undesired mobility equipment). These findings highlight the varied dynamics and spheres of influence this transaction may have on the developing identity of children with disabilities, which may ultimately help inform future models of provision and rehabilitation practices. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Exploring potential prejudice toward older adult mobility device users.

Many older adults require assistive technology to maintain mobility (e.g., canes, walkers, wheelchairs, or scooters), but concerns about experiencing prejudice because of mobility devices can deter use. We explore this potential prejudice in a sample recruited through online crowdsourcing. Overall, prejudice toward older adult mobility device users was not observed. Older adult mobility device users were evaluated more positively than common prejudice target groups. However, heightened prejudice toward older adult mobility device users was observed among those higher in authoritarianism or social dominance orientation. This was explained by perceptions that older adult mobility device users are a greater threat to resources (e.g., health care spending, time, attention) among those higher in these qualities. This pattern was present at all ages assessed but was stronger for those who were younger versus older. Relationships between ideology and heightened threat from older adult mobility device users were not present for those older than 60 years of age. Our results demonstrate that concerns about this prejudice are not completely unwarranted. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Randomized Clinical Trial of Wheeled Mobility for Pressure Injury Prevention and Better Function.

OBJECTIVES: To evaluate the effectiveness of wheelchair assessment and configuration on pressure injury incidence, mobility, and functioning in a wheelchair. DESIGN: Randomized controlled trial with participants individually randomized into intervention and control groups. SETTING: Nursing home. PARTICIPANTS: Nursing home residents aged 60 and older who used wheelchairs and were at risk for pressure injuries (N=258). INTERVENTION: Treatment and evaluation, individually configured wheelchair and skin protection cushion; control and evaluation, facility-provided wheelchair and skin protection cushion. MEASUREMENTS: Pressure injury incidence, Nursing Home Life Space Diameter score, Functioning Every Day in a Wheelchair-Capacity (FEW-C) score, and Wheelchair Skills Test (WST) score. RESULTS: No differences in pressure injuries (p=.77) were found. Pelvic rotation (odds ratio (OR)=0.15, 95% confidence interval (CI)=0.03-0.70, p=.02) and Day 14 WST skill score (OR=0.74, 95% CI=0.60-0.91, p=.004) were significant predictors of pressure injuries. Significant differences were observed between groups in change in FEW-C independence scores between before randomization and endpoint (p=.03) and before randomization and 14 days (p=.04). CONCLUSION: Participants with individually configured wheelchairs improved more in the safe and effective use of their wheelchairs than residents with facility-provided wheelchairs. The outcomes indicated that nursing home residents functioned safely at a higher level in their wheelchairs if their devices were individually configured using a comprehensive wheelchair and seating assessment process. There was no difference in the incidence of pressure injuries between the two groups. TRIAL REGISTRATION: NCT01275313.

Sensitivity to change of the field-based Wheelchair Mobility Performance Test in wheelchair basketball.

OBJECTIVE: The Wheelchair Mobility Performance (WMP) test is a reliable and valid measure to assess mobility performance in wheelchair basketball. The aim of this study was to examine the sensitivity to change of the WMP test by manipulating wheelchair configurations. METHODS: Sixteen wheelchair basketball players performed the WMP test 3 times in their own wheelchair: (i) without adjustments ("control condition"); (ii) with 10 kg additional mass ("weighted condition"); and (iii) with 50% reduced tyre pressure ("tyre condition"). The outcome measure was time (s). If paired t-tests were significant (p <0.05) and differences between conditions were larger than the standard error of measurement, the effect sizes (ES) were used to evaluate the sensitivity to change. ES values ≥0.2 were regarded as sensitive to change. RESULTS: The overall performance times for the manipulations were significantly higher than the control condition, with mean differences of 4.40 s (weight - control, ES = 0.44) and 2.81 s (tyre - control, ES = 0.27). The overall performance time on the WMP test was judged as sensitive to change. For 8 of the 15 separate tasks on the WMP test, the tasks were judged as sensitive to change for at least one of the manipulations. CONCLUSION: The WMP test can detect change in mobility performance when wheelchair configurations are manipulated.

Enzyme replacement therapy reduces the risk for wheelchair dependency in adult Pompe patients.

BACKGROUND: Pompe disease is a rare metabolic myopathy. In adult patients, progressive weakness of limb-girdle and respiratory muscles often leads to wheelchair and respirator dependency. Clinical studies have shown enzyme replacement therapy (ERT) to positively affect motor and respiratory outcomes. Here we investigate whether ERT reduces patients' risk of needing a wheelchair or respirator. METHODS: Data were collected as part of a prospective international survey, the IPA/Erasmus MC Pompe survey, which was conducted annually between 2002 and 2016. We excluded patients who were already using a wheelchair or respirator, those under 18 at survey entry, and those who had missing information. Time-dependent Cox proportional hazard models were used. RESULTS: The inclusion criteria for analyzing the risk of wheelchair use were met by 189 patients (median age 47 years; range 18-75). During follow-up, 126 (67%) started ERT. Over 1120 person-years of follow-up (median 5 years), 46 became wheelchair dependent, 16 of whom used ERT. After adjustment for disease duration, sex and country, ERT reduced the risk for wheelchair use (HR 0.36; 95% CI 0.17-0.75). For analyses of respirator use, 177 patients met the inclusion criteria (median age 46 years; range 18-73). Over 1190 person-years of follow-up (median 6 years), 125 patients (71%) were treated and 48 started respiratory support, 28 of whom received ERT. We found no association between ERT and the risk for respirator use (HR 1.23; 95% CI 0.61-2.47). CONCLUSIONS: Our study found that ERT reduced the risk for wheelchair dependency. We could not demonstrate an effect on respiratory support.

Sensitivity of the SCI-FI/AT in Individuals With Traumatic Spinal Cord Injury.

OBJECTIVE: To examine the ability of the Spinal Cord Injury-Functional Index/Assistive Technology (SCI-FI/AT) measure to detect change in persons with spinal cord injury (SCI). DESIGN: Multisite longitudinal (12-mo follow-up) study. SETTING: Nine SCI Model Systems programs. PARTICIPANTS: Adults (N=165) with SCI enrolled in the SCI Model Systems database. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: SCI-FI/AT computerized adaptive test (CAT) (Basic Mobility, Self-Care, Fine Motor Function, Wheelchair Mobility, and/or Ambulation domains) completed at discharge from rehabilitation and 12 months after SCI. For each domain, effect size estimates and 95% confidence intervals were calculated for subgroups with paraplegia and tetraplegia. RESULTS: The demographic characteristics of the sample were as follows: 46% (n=76) individuals with paraplegia, 76% (n=125) male participants, 57% (n=94) used a manual wheelchair, 38% (n=63) used a power wheelchair, 30% (n=50) were ambulatory. For individuals with paraplegia, the Basic Mobility, Self-Care, and Ambulation domains of the SCI-FI/AT detected a significantly large amount of change; in contrast, the Fine Motor Function and Wheelchair Mobility domains detected only a small amount of change. For those with tetraplegia, the Basic Mobility, Fine Motor Function, and Self-Care domains detected a small amount of change whereas the Ambulation item domain detected a medium amount of change. The Wheelchair Mobility domain for people with tetraplegia was the only SCI-FI/AT domain that did not detect significant change. CONCLUSIONS: SCI-FI/AT CAT item banks detected an increase in function from discharge to 12 months after SCI. The effect size estimates for the SCI-FI/AT CAT vary by domain and level of lesion. Findings support the use of the SCI-FI/AT CAT in the population with SCI and highlight the importance of multidimensional functional measures.

Seasonal Patterns of Community Participation and Mobility of Wheelchair Users Over an Entire Year.

OBJECTIVE: To describe how people who use wheelchairs participate and move at home and in the community over an entire yearlong period, including during times of inclement weather conditions. DESIGN: Longitudinal mixed-methods research study. SETTING: Urban community in Canada. PARTICIPANTS: People who use a wheelchair for home and community mobility (N=11). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Use of a global positioning system (GPS) tracker for movement in community (number of trips per day), use of accelerometer for bouts of wheeling mobility (number of bouts per day, speed, distance, and duration), prompted recall interviews to identify supports and barriers to mobility and participation. RESULTS: More trips per day were taken during the summer (P= .03) and on days with no snow and temperatures above 0°C. Participants reliant on public transportation demonstrated more weather-specific changes in their trip patterns. The number of daily bouts of mobility remained similar across seasons; total daily distance wheeled, duration, and speed were higher on summer days, days with no snow, and days with temperatures above 0°C. A higher proportion of outdoor wheeling bouts occurred in summer (P=.02) and with temperatures above 0°C (P=.03). Inaccessible public environments were the primary barrier to community mobility and participation; access to social supports and private transportation were the primary supports. CONCLUSIONS: Objective support is provided for the influence of various seasonal weather conditions on community mobility and participation for people who use a wheelchair. Longitudinal data collection provided a detailed understanding of the patterns of, and influences on, wheelchair mobility and participation within wheelchair users' own homes and communities.

Gait Training in Acute Spinal Cord Injury Rehabilitation-Utilization and Outcomes Among Nonambulatory Individuals: Findings From the SCIRehab Project.

OBJECTIVES: To investigate the relation of gait training (GT) during inpatient rehabilitation (IPR) to outcomes of people with traumatic spinal cord injury (SCI). DESIGN: Prospective observational study using the SCIRehab database. SETTING: Six IPR facilities. PARTICIPANTS: Patients with new SCI (N=1376) receiving initial rehabilitation. INTERVENTIONS: Patients were divided into groups consisting of those who did and did not receive GT. Patients were further subdivided based on their primary mode of mobility as measured by the FIM. MAIN OUTCOME MEASURES: Pain rating scales, Patient Health Questionnaire Mood Subscale, Satisfaction With Life Scale, and Craig Handicap Assessment and Reporting Technique (CHART). RESULTS: Nearly 58% of all patients received GT, including 33.3% of patients who were primarily using a wheelchair 1 year after discharge from IPR. Those who used a wheelchair and received GT, received significantly less transfer and wheeled mobility training (P<.001). CHART physical independence (P=.002), mobility (P=.024), and occupation (P=.003) scores were significantly worse in patients who used a wheelchair at 1 year and received GT, compared with those who used a wheelchair and did not receive GT in IPR. Older age was also a significant predictor of worse participation as measured by the CHART. CONCLUSIONS: A significant percentage of individuals who are not likely to become functional ambulators are spending portions of their IPR stays performing GT, which is associated with less time allotted for other functional interventions. GT in IPR was also associated with participation deficits at 1 year for those who used a wheelchair, implying the potential consequences of opportunity costs, pain, and psychological difficulties of receiving unsuccessful GT. Clinicians should consider these data when deciding to implement GT during initial IPR.