Wheelchair users' satisfaction after provision using the WHO 8-step guidelines: A pilot study.

BACKGROUND: Wheelchairs are vital for the successful rehabilitation and inclusion of people with mobility disabilities; 10% of the population with disabilities needs a wheelchair, but only 15% have access to an adequate one. Not user-configured wheelchairs may lead to postural deformities and pressure ulcers, thus negatively impact user satisfaction, wheelchair skills, and quality of life. OBJECTIVE: To assess the impact of the 8-step "Guidelines on the provision of manual wheelchairs in less-resourced settings" from the World Health Organization (WHO) on user satisfaction, wheelchair skills, and quality of life of Mexican manual wheelchair users. METHODS: 12 wheelchair users with spinal cord injury that received rehabilitation were recruited. Volunteers were provided a wheelchair and cushion following the WHO 8-step guidelines. Assessment of QUEST, WHOQOL-Bref, and WST-Q was performed at the beginning of the study and 12 months later. RESULTS: Significant improvement was observed in terms of satisfaction (QUEST; P = 0.009) after receiving the wheelchair and the foam cushion (QUEST; P = 0.004). WHOQol-Bref did not denote significant differences. For the dimensions assessed by the WST-Q scores, a significant 10.9% improvement was observed in both, capacity (P = 0.022) and performance (P = 0.009). CONCLUSIONS: The application of the WHO 8-step guidelines for wheelchair provision may contribute to increase user satisfaction regarding the wheelchair and cushion devices as well as the prescription process as determined by the QUEST. According to the WST-Q, functional capacity and mobility may also be improved by following the 8-step guidelines.

Biomechanical characteristics, patient preference and activity level with different prosthetic feet: a randomized double blind trial with laboratory and community testing.

Providing appropriate prosthetic feet to those with limb loss is a complex and subjective process influenced by professional judgment and payer guidelines. This study used a small load cell (Europa™) at the base of the socket to measure the sagittal moments during walking with three objective categories of prosthetic feet in eleven individuals with transtibial limb loss with MFCL K2, K3 and K4 functional levels. Forefoot stiffness and hysteresis characteristics defined the three foot categories: Stiff, Intermediate, and Compliant. Prosthetic feet were randomly assigned and blinded from participants and investigators. After laboratory testing, participants completed one week community wear tests followed by a modified prosthetics evaluation questionnaire to determine if a specific category of prosthetic feet was preferred. The Compliant category of prosthetic feet was preferred by the participants (P=0.025) over the Stiff and Intermediate prosthetic feet, and the Compliant and Intermediate feet had 15% lower maximum sagittal moments during walking in the laboratory (P=0.0011) compared to the Stiff feet. The activity level of the participants did not change significantly with any of the wear tests in the community, suggesting that each foot was evaluated over a similar number of steps, but did not inherently increase activity. This is the first randomized double blind study in which prosthetic users have expressed a preference for a specific biomechanical characteristic of prosthetic feet: those with lower peak sagittal moments were preferred, and specifically preferred on slopes, stairs, uneven terrain, and during turns and maneuvering during real world use.

Temporal and spatial gait parameters analysis in non-pathological Mexican children.

OBJECTIVE: To examine temporal and spatial gait parameters in Mexican healthy pediatric subjects to describe normal values which could serve as reference data to eventually compare pathological patterns of the Mexican infant gait. MATERIALS AND METHODS: Descriptive study that analyzed the gait of 120 children (61 boys and 59 girls) between the ages of 6 and 13 years old. Modifying factors (age, gender, and footwear) were recorded and its impact over temporal and spatial gait parameters was assessed. The data was stratified according to the modifying factors. A GAITRite System was used for recording the gait data. RESULTS: Significant differences were noted for the following factors: age and the use of footwear. As the individual advances in age, a decrease in number of steps, normalized velocity, velocity, cadence, normalized cadence, normalized step and stride length was observed. In contrast, step and stride length increased. Use of footwear increased velocity (normalized and non-normalized), normalized cadence, step and stride length (normalized and non-normalized), and percentage of stance GC phase; cadence and swing GC percentage diminished. Gender stratification showed no significant differences in any temporal and spatial gait parameters. There were also found significant differences with those reported for normal adult and pediatric gait in the literature. CONCLUSION: Age and footwear modified gait pattern in the studied sample, while gender apparently did not exert any influence on it.