Wheelchair outcome measurement instruments for children: a scoping review protocol.

Purpose: The proposed scoping review aims to explore and map wheelchair outcome measurement instruments for children in the literature.Method: The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology. The review question and eligibility criteria were developed using the PCC (population, concept, context) mnemonic as follows: (P) children manual or motorised wheelchair users (aged ≤ 18 years), (C) wheelchair outcome measurement instruments, (C) primary sources of literature. The search will be conducted in nine relevant electronic databases. including grey literature from Academic Google. Study screening, selection, and data extraction will be performed independently by two authors. A third reviewer will resolve discrepancies between the authors. General characteristics, population, feasibility, interpretability data will be extracted in accordance with the COSMIN methodology (Consensus-based Standards for the selection of health Measurement Instruments). This will encompass data pertaining to the measurement properties of the domains of reliability, validity and responsiveness. A descriptive analysis will be carried out, and the results will be classified into categories and presented in tables accompanied by a descriptive summary.Results: The results can inform future research directions, clinical practice and the development of wheelchair outcome measurement instruments. Furthermore, it will help professionals in rehabilitation and wheelchair services to find the wheelchair outcome measurement instruments according to the target population and cultural context.

IMPLICATIONS FOR REHABILITATIONThis review has the potential to enhance understanding of wheelchair outcome measurement instruments, thereby enabling rehabilitation professionals to assess the impact and progress of wheelchair use within the target population.The findings related to measurement properties may guide future research in the field of wheelchair outcome measurement instruments.Additionally it will assist clinical professionals in identifying appropriate wheelchair outcome measurement instruments based on the target population and cultural context.

Satisfação dos usuários de cadeiras de rodas da Região Metropolitana da Baixada Santista / Satisfaction of wheelchair users in the Baixada Santista Metropolitan Region

Resumo O objetivo deste artigo é identificar a satisfação dos usuários em relação às cadeiras de rodas e à prestação de serviços públicos e privados de saúde da Região Metropolitana da Baixada Santista. Estudo transversal com abordagem quantitativa. Os participantes responderam a um questionário sociodemográfico e à versão brasileira do Quebec Assistive Technology User Satisfaction Assessment. Os dados foram analisados utilizando a estatística descritiva e comparativa por meio do teste t de Student. Os tamanhos de efeito d de Cohen foram calculados. Os participantes (n = 42) estavam "mais ou menos satisfeitos" com as cadeiras de rodas e "pouco satisfeitos" com a prestação de serviços. Os usuários de cadeiras de rodas monobloco apresentaram satisfação significativamente maior com suas cadeiras em comparação com usuários de cadeiras de rodas acima de 90kg (p = 0,010, d = 1,04). Os usuários de serviços privados apresentaram satisfação significativamente maior com a prestação de serviço em comparação aos usuários de serviços públicos (p = 0,021, d = 0,75). Os usuários de cadeiras de rodas da Região Metropolitana da Baixada Santista estão mais satisfeitos com as cadeiras de rodas monobloco e menos satisfeitos com os serviços públicos.

Abstract This article seeks to identify user satisfaction in relation to wheelchairs and the provision of public and private health services in the Baixada Santista Metropolitan Region. It involved a cross-sectional study with a quantitative approach. Participants answered a sociodemographic questionnaire and the Brazilian version of the Quebec Assistive Technology User Satisfaction Assessment. Data were analyzed using descriptive and comparative statistics by means of Student's t test. Cohen's d effect sizes were also calculated. Participants (n = 42) were "more or less satisfied" with the wheelchairs and "quite satisfied" with the services provided. Rigid frame wheelchair users were significantly more satisfied with their wheelchairs compared to users of wheelchairs weighing over 198 lbs. (p = 0.010, d = 1.04). Users of private services showed significantly greater satisfaction with the provision of the service compared to public services users (p = 0.021, d = 0.75). Wheelchair users in the Baixada Santista Metropolitan Region are more satisfied with the rigid frame wheelchair and less satisfied with public services.

e-Seating - Aplicativo para apoiar o processo de avaliação e prescrição de cadeira de rodas e dispositivos de adequação postural: avaliação da experiência do usuário / e-Seating - Application to support evaluation and prescription process of wheelchairs and postural support devices: user experience evaluation

Objetivo: Avaliar a usabilidade do aplicativo e-Seating no estado de MVP, levando em consideração a experiência dos prescritores na prática clínica. Métodos: Foi utilizada a Design-Based Research (DBR) e a metodologia ágil Scrum com abordagem de desenvolvimento iterativo para aperfeiçoamento do e-Seating, considerando as avaliações dos usuários por um questionário de Experiência do Usuário - UEQ (sigla para User Experience Questionnaire) baseado em Schrepp, Hinderks e Thomaschewski. Foram realizados 3 testes com 17 profissionais prescritores de cadeira de rodas, sendo divididos para teste 1 com 6 profissionais, teste 2 com 5 e teste 3 com 6 profissionais. Os dados foram analisados por teste estatístico (teste t) e ferramenta de análise do UEQ. Resultados: Com a avaliação de experiência do usuário e aperfeiçoamento constante do e-Seating com base nas avaliações, conclui-se que o e-Seating teve maior aceitabilidade pelos prescritores que trabalham em locais privados e com profissionais autônomos do que com profissionais que atuam no setor público. Conclusão: O uso do App pode apoiar os profissionais de reabilitação no processo de prescrição de cadeira de rodas, ajudando a sistematizar e integrar as informações em toda jornada do paciente.

Objective: To evaluate the usability of the e-Seating application in the MVP state, taking into account the experience of prescribers in clinical practice. Methods: Design-Based Research (DBR) and agile Scrum methodology with an iterative development approach were used to improve e-Seating, considering user evaluations through a User Experience Questionnaire - UEQ based on Schrepp, Hinderks and Thomaschewski. Three tests were performed with 17 wheelchair prescribers, being divided into test 1 with 6 professionals, test 2 with 5 and test 3 with 6 professionals. Data were analyzed by statistical test (t test) and UEQ analysis tool. Results: With the evaluation of user experience and constant improvement of e-Seating based on the evaluations, it was concluded that e-Seating was more acceptable by prescribers who work in private places and with self-employed professionals than with professionals who work in the Public sector. Conclusion: The use of the App can support rehabilitation professionals in the wheelchair prescription process, helping to systematize and integrate information throughout the patient's journey.

Effects of the WHO 8-step wheelchair-service-delivery process on wheelchair users in El Salvador: a cohort study.

PURPOSE: To test the hypotheses that, after the delivery of manual wheelchairs following the WHO 8-step service-delivery process, wheelchair-related health and quality of life, wheelchair skills, wheelchair use, and poverty probability would improve; and that the number of wheelchair repairs required, adverse events, caregiver burden, and the level of assistance provided would decrease. METHODS: This was a longitudinal, prospective within-subject study including 247 manual wheelchair users, and 119 caregivers, in El Salvador who received a wheelchair following the WHO 8-step process as well as maintenance reminders. Outcome measurements were performed via structured questionnaires and dataloggers at the initial assessment, at wheelchair delivery, and at 3- and 6-month follow-up. RESULTS: Significant improvements in wheelchair-related health indicators (all with p < 0.004) and quality of life (p = 0.001), and a significant reduction in national and "extreme" poverty probability (p = 0.004 and p = 0.012) were observed by six months. Wheelchair use significantly decreased (p = 0.011 and p = 0.035) and wheelchair skills increased (p = 0.009). Caregiver burden did not change (p = 0.226) but the number of activities of daily living (ADLs) that required no assistance significantly increased (p = 0.001) by three months and those who required complete assistance decreased (p = 0.001). No changes were observed in wheelchair repairs (p = 0.967) and breakdowns over time with new wheelchairs. CONCLUSIONS: Wheelchair service delivery using the WHO 8-step process on manual wheelchair users in El Salvador has positive effects on health and quality of life, wheelchair skills, caregiver assistance levels, and poverty. Further research is needed to determine the relative contributions of the intervention components.Implications for RehabilitationProviding manual wheelchairs using the 8-step process of the WHO has benefits on health and quality of life, wheelchair skills, caregiver assistance levels, and poverty.The WHO 8-steps service delivery process for manual wheelchairs can be used in less-resourced settings.

Relationship between functional classification, upper extremity muscle strength, and agility in wheelchair rugby athletes / La relación entre la clasificación funcional, la fuerza muscular de las extremidades superiores y la agilidad de los deportistas de rugby en silla de ruedas / A relação entre classificação funcional, força muscular de membros superiores e agilidade de atletas do rúgbi em cadeira de rodas

ABSTRACT This study aimed to compare the strength and agility of wheelchair rugby (WR) athletes with different functional classifications (FC) and describe the relationship between agility and upper extremity isometric muscle strength (IMS). A total of 10 WR athletes were analyzed, divided into two groups: Group 1 (G1): FC 0.5 and 1.0; and Group 2(G2): FC 1.5 to 2.5. IMS was evaluated by a dynamometer, and agility by a zig-zag test. Spearman's correlation was used to describe the relationship between IMS and performance on the agility test. In contrast, the t-test was used to compare strength and agility between different FCs (p≤0.05). Shoulder extensor IMS was higher in G2 athletes (p=0.001; d=3.10), which were also more agile than G1 athletes (G1=23.66s>G2=17.55s; p=0.015; d=2.00). Both groups showed a correlation between bilateral shoulder extensor strength and agility (r=−0.721; p=0.019). Athletes with high FC scores are more agile than athletes with low scores and, therefore, have greater movement speed when performing WR tasks. Greater shoulder extensor muscle strength is associated with greater agility in WR athletes.

RESUMEN El objetivo de este estudio fue comparar la fuerza y la agilidad de los deportistas de rugby en silla de ruedas (RSR) desde diferentes clasificaciones funcionales (CF), así como describir la relación entre la agilidad y la fuerza muscular isométrica (FMI) de las extremidades superiores. Se evaluaron a diez deportistas RSR en dos grupos: Grupo 1 (G1): CF 0,5 y 1,0; y Grupo 2 (G2): CF 1,5 a 2,5. En la evaluación de la FMI se utilizó la dinamometría; y en la evaluación de la agilidad, la prueba de zigzag. La correlación de Spearman se utilizó para describir la relación entre la FMI y el rendimiento en la prueba de agilidad, mientras que la prueba t se utilizó para comparar la fuerza y la agilidad entre las diferentes CF (p≤0,05). La FMI de los extensores del hombro fue mayor en el G2 (p=0,001; d=3,10), y este también fue más ágil que el G1 (G1=23,66s>G2=17,55s; p=0,015; d=2,00). Hubo una correlación entre la fuerza muscular bilateral de los extensores del hombro y la agilidad en ambos grupos (r=−0,721; p=0,019). Los deportistas con altas puntuaciones de CF fueron los más ágiles en comparación con aquellos con bajas puntuaciones, por lo tanto, se constata que tienen una mayor velocidad de desplazamiento en la realización de tareas de RSR. Una mayor fuerza muscular de los extensores de hombro se asocia con una mayor agilidad en los deportistas RSR.

RESUMO O objetivo do estudo foi comparar a força e a agilidade de atletas do rúgbi em cadeira de rodas (RCR) por meio de diferentes classificações funcionais (CFs), bem como descrever a relação da agilidade com a força muscular isométrica (FMI) de membros superiores. Foram analisados 10 atletas de RCR, divididos em dois grupos: Grupo 1 (G1): CF 0,5 e 1,0; e Grupo 2 (G2): CF 1,5 a 2,5. A FMI foi avaliada pela dinamometria, e a agilidade pelo teste em ziguezague. A correlação de Spearman foi utilizada para descrever a relação entre a FMI e o desempenho no teste de agilidade, enquanto o teste t foi usado para comparar a força e a agilidade entre as diferentes CFs (p≤0,05). A FMI dos extensores do ombro foi maior no G2 (p=0,001; d=3,10), que também se mostrou mais ágil que o G1 (G1=23,66s>G2=17,55s; p=0,015; d=2,00). Verificou-se a correlação entre força muscular bilateral de extensores de ombro e agilidade em ambos os grupos (r=−0,721; p=0,019). Atletas com pontuação alta na CF são mais ágeis comparados a atletas com pontuações baixas e, portanto, apresentam maior velocidade de deslocamento ao executar as tarefas do RCR. Maior força muscular dos extensores de ombro é associada à maior agilidade em atletas do RCR.

Conceptual mapping proposed to comprehend the effect of wheelchair mobility on social participation and quality of life: a systematic review.

PURPOSE: To identify and synthesise the available evidence on the effect of mobility on social participation and quality of life (QoL) of wheelchairs (WC) on adults who use WC as their primary means of mobility. MATERIALS AND METHODS: Systematic review undertaken in accordance with the Centre for Reviews and Dissemination Guidelines and registered in the PROSPERO International Prospective Register of Systematic reviews. Nine electronic databases (MEDLINE via PubMed, EMBASE, Cochrane Library, LILACS, CINAHL, PEDro, SCOPUS, Web of Science, and BVS ECOS) were searched with the following PICO eligibility criteria: (P) Population was individuals with mobility limitations that live in their community, aged 18 or older; (I) Intervention was mobility devices, such as manual and powered wheelchairs; (C) Comparators, not applied; (O) Outcome was factors that can be influenced by wheelchair use, such as: social participation, health-related quality of life and QOL. Critical appraisal of methodological quality of studies were undertaken. RESULTS: A total of 18 studies were included. The proportion of studies evaluating the effects of mobility on participation was higher than to mobility on QoL. WC quality, device benefit (ease of repairs and maintenance), confidence using a WC and WC skills were key factors determining participation. The provision of WC according to the eight steps service proposed by the Word Health Organisation contributed to higher levels of physical health, WC satisfaction, hours using the WC and QoL enhancement. CONCLUSION: Attention should be given to enhance WC service provision (with continuous service support) as well as professional continuing education.IMPLICATIONS FOR REHABILITATIONWheelchair technology is a key element in rehabilitation. Significant effort should be made to provide and maintain the wheelchair as a facilitator to participation. A great attention should be done to enhance wheelchair services as well as professional continuous education.Wheelchair skills are associated with participation and may be targeted in clinical intervention.

Comparison between the isokinetics parameters of shoulder joint and independence functional level in manual wheelchair users / Comparação entre parâmetros isocinéticos da articulação do ombro com nível de independência funcional em usuários de cadeira de rodas manual

Shoulder pain is a common complaint in the wheelchair user's population. This condition brings loss of independence and quality of life. Objective: The aim of this paper is to correlate shoulder joint isokinetic parameters and independence level of manual wheelchair users with or without pain. We hypothesize that users more independent are exposed to overuse injury of shoulder joints. Method: This is an explorative cross-sectional study with a quantitative approach. Community patients attended at a Rehabilitation Center. Manual wheelchair users. Twenty-four patients participated, we used the Functional Independence Measurement (FIM) to investigate the independent level of wheeled patients and isokinetic parameters of internal/external rotators and flexion/extension muscles of shoulder joint was collected using Biodex System 4 Pro. Statistical analyses were made by Fisher Test, Spiro-Wilk Test, Pearson Correlation test, Spearman test and the Coefficient of correlation's value was squared to estimate the percentage of variation in dependent variable, explained by independent variable. Results: Total FIM variation was between 79 and 117 and median ipsilateral strength ratio of rotator muscles were 0.94 on 75°/s and 0.95 on 150°/s for the right limb and respectively 0.96 and 0.93 for the left limb. Conclusion: Wheelchair users present internal/external rotators shoulder muscles imbalance and the covariations samples of time of injury and peak torque ratio external/internal shoulder rotators have a significant predictive value on total MIF. These results suggest that there is correlation between the studied patients and shoulder impairment.

Dor no ombro é uma queixa comum na população de usuários de cadeira de rodas. Esta condição acarreta perda de independência e de qualidade de vida. Objetivo: Correlacionar parâmetros isocinéticos da articulação do ombro com níveis de independência de usuários de cadeira de rodas manual com e sem dores. Nossa hipótese é que usuários mais independentes estão mais expostos à lesões em ombros por sobrecarga. Método: Trata-se de um estudo exploratório transversal com abordagem quantitativa. Foram avaliados pacientes oriundos da comunidade, usuários de cadeira de rodas manual atendidos em um centro de reabilitação. Participaram do estudo vinte e quatro indivíduos e foram utilizados os instrumentos: Medida de Independência Funcional (MIF); parâmetros isocinéticos de rotadores interno/externo e flexor/extensor da articulação de ombro coletados usando Biodex System 4 Pro. Análises estatísticas foram feitas através dos Testes de Fisher, Spiro-Wilk, Correlação de Pearson, Spearman e os coeficientes da correlação foram utilizados para estimar a variação de variáveis dependentes, explicadas por variáveis independentes. Resultados: A variação do MIF total foi entre 79 e 110 e a relação entre a média da força ipsilateral dos músculos rotadores foi 0,94 em 75°/s e 0,95 em 150°/s para o lado direito e respectivamente 0,96 e 0,93 para o membro esquerdo. Usuários de cadeira de rodas apresentam desequilíbrio entre rotadores e as covariáveis de tempo de lesão e relação de pico de torque dos rotadores de ombro apresentam valor preditivo significativo no MIF total. Conclusão: Estes resultados sugerem uma correlação entre os pacientes estudados e comprometimento da articulação do ombro.

Rotator Cuff Lesion in Wheelchair Users with Spinal Cord Injury: Does Time of Injury and Medullary Level Interfere? A Retrospective Evaluation.

Objective To describe magnetic resonance imaging (MRI) characteristics of shoulders from patients with spinal cord injury (SCI) and to correlate these findings with age, duration of SCI and neurological level. Method The study sample included patients with thoracic SCI over 18 years of age, who were active wheelchair users and had undergone an MRI of the shoulder from January 2004 to December 2015. Results We studied 41 shoulders (37 patients), including 27 men (65.9%) and 14 women (34.1%). At the time of MRI, the mean age was 41.9 years and the mean duration of SCI was 9.4 years. The analysis of the relationship between the duration of trauma and severity of the rotator cuff lesion (RCL), as well as between age and the severity of the shoulder injury showed a statistically significant difference ( p < 0.001), with a positive association in both cases. No statistically significant difference ( p = 0.095) was observed between the neurological level of the SCI and RCL. Conclusion In this study, a progressive increase in the severity of the shoulder lesions can be noted with advancing age and a longer duration of SCI. However, level of the SCI does not seem to interfere with RCL. Level of Evidence Level IV, case series.

Rotator Cuff Lesion in Wheelchair Users with Spinal Cord Injury: Does Time of Injury and Medullary Level Interfere? A Retrospective Evaluation / Lesão do manguito rotador em cadeirantes com lesão medular: O tempo de lesão e o nível medular interferem? Uma avaliação retrospectiva

Abstract Objective To describe magnetic resonance imaging (MRI) characteristics of shoulders from patients with spinal cord injury (SCI) and to correlate these findings with age, duration of SCI and neurological level. Method The study sample included patients with thoracic SCI over 18 years of age, who were active wheelchair users and had undergone an MRI of the shoulder from January 2004 to December 2015. Results We studied 41 shoulders (37 patients), including 27 men (65.9%) and 14 women (34.1%). At the time of MRI, the mean age was 41.9 years and the mean duration of SCI was 9.4 years. The analysis of the relationship between the duration of trauma and severity of the rotator cuff lesion (RCL), as well as between age and the severity of the shoulder injury showed a statistically significant difference (p< 0.001), with a positive association in both cases. No statistically significant difference (p= 0.095) was observed between the neurological level of the SCI and RCL. Conclusion In this study, a progressive increase in the severity of the shoulder lesions can be noted with advancing age and a longer duration of SCI. However, level of the SCI does not seem to interfere with RCL. Level of Evidence Level IV, case series.

Resumo Objetivo Descrever as características de ressonância magnética (RM) dos ombros de pacientes com lesão medular (LM) e correlacionar esses achados com idade, duração da LM e nível neurológico. Método A amostra do presente estudo incluiu pacientes maiores de 18 anos com LM torácica, que eram cadeirantes ativos e haviam sido submetidos a uma ressonância magnética do ombro de janeiro de 2004 a dezembro de 2015. Resultados Foram estudados 41 ombros (37 pacientes), incluindo 27 de pacientes do sexo masculino (65,9%) e 14 de pacientes do sexo feminino (34,1%). Na época da ressonância magnética, a média de idade era de 41,9 anos e a duração média da LM era de 9,4 anos. A análise da relação entre a duração do trauma e a gravidade da lesão do manguito rotador (LMR), bem como entre a idade e a gravidade da lesão do ombro mostrou diferença estatisticamente significativa (p< 0,001), com associação positiva em ambos os casos. Não foi observada diferença estatisticamente significativa (p= 0,095) entre o nível neurológico da LM e da LMR. Conclusão Neste estudo, pode-se notar um aumento progressivo da gravidade das lesões do ombro com o avanço da idade e uma maior duração da LM. No entanto, o nível da LM não parece interferir com a LMR. Nível de Evidência Nível IV, série de casos.

Performance of Impedance Control-Based Strategies in Power-Assisted Wheelchairs: A Predictive Simulation Study.

Manual wheelchair propulsion is known to be inefficient and causes upper extremity pain, fatigue, and injury. Power-assisted wheelchairs can mitigate these effects through motors that reduce users' effort and load during propulsion. Among the different control strategies proposed to govern the user-wheelchair interaction, impedance control-based ones appear to be the most natural and effective. It can change the apparent dynamical properties of the wheelchair, particularly mass and friction, and automatically compensate for external disturbances such as terrain conditions. This study investigates the advantages and disadvantages of this control strategy employing predictive simulations of locomotion with power-assisted wheelchairs in different scenarios. The simulations are generated using a biomechanically realistic model of the upper extremities and their interaction with the power-assisted wheelchair by solving an optimal control problem. Investigated scenarios include steady-state locomotion vs. a transient maneuver starting from rest, movement on a ramp vs. a level surface, and different choices of reference model parameters. The results reveal that the investigated impedance control-based strategy can effectively reproduce the reference model and reduce the user's effort, with a more significant effect of inertia in the transient maneuver and of friction in steady-state locomotion. However, the simulations also show that imposing a first-order, linear reference model with constant parameters can produce disadvantageous locomotion patterns, particularly in the recovery phase, leading to unnecessary energy dissipation and consequent increase in energy consumption from the batteries. These observations indicate there is room for improvement, for instance, by exploring energy regeneration in the recovery phase or by switching reference model nature or parameters along the cycle. To the best of our knowledge, this is the first investigation of impedance control-based strategies for power-assisted wheelchairs using predictive simulations and a realistic, nonlinear model of the user-wheelchair system.

Effectiveness of a Web-Based Direct-to-User Transfer Training Program: A Randomized Controlled Trial.

OBJECTIVE: To determine the effectiveness of a web-based, direct-to-user transfer training program in improving transfer quality and maintaining improvements for up to 1 month after training as compared with a control group. DESIGN: Randomized controlled trial with participants randomized to an immediate intervention group (IIG) or waitlist control group (WLCG) that received the training after a 6-month delay. SETTING: Wherever the participants accessed the web-based training, likely the home environment. PARTICIPANTS: Convenience sample of full-time wheelchair users (N=72; IIG, n=34; WLCG, n=38 for between-group analysis, n=48 for combined within-group analysis) with spinal cord injury or disorder who were able to independently perform a lateral scoot transfer. INTERVENTIONS: Self-paced, web-based transfer training module. MAIN OUTCOME MEASURES: Transfer Assessment Instrument Questionnaire (TAI-Q) score at baseline, 1 month, and 6 months postbaseline (WLCG only), immediately posttraining, and 1 month posttraining. The TAI-Q is an 18-item self-assessment that covers several aspects of a quality transfer. RESULTS: The IIG significantly increased particpants' baseline TAI-Q score from 6.91±0.98 to 7.79±1.12 (P<.001) by 1 month posttraining. The WLCG also increased from baseline to the 1-month postbaseline assessment (from 6.52±1.13 to 7.00±1.09; P=.014), potentially from learning effects secondary to self-assessment with the TAI-Q. The extent of change over time did not differ significantly between the IIG and WLCG from baseline to 1 month (P=.169). However, significant improvements in TAI-Q scores were still evident after the training for the WLCG (P<.001). Those with a lower pretraining TAI-Q score and more shoulder pain were most likely to benefit from the training. CONCLUSIONS: Repeated TAI-Q self-assessments likely contributed to improved transfer quality, with web-based training having an additive effect. Wheelchair users are likely to benefit from transfer training and self-assessment of transfer quality in their home environments. This has the potential to decrease injury risk while avoiding barriers to in-person training.

Effect of the Assistive Technology Professional on the Provision of Mobility Assistive Equipment.

OBJECTIVE: The purpose of this study was to examine factors associated with variability in satisfaction with functional mobility (as measured by the Functional Mobility Assessment [FMA]) in users of mobility devices. Our primary hypothesis was that device type and Assistive Technology Professional (ATP) involvement will be the most significant predictors of FMA score. Our secondary hypothesis was that ATP involvement is associated with use of more custom-fitted manual wheelchairs and group 3 and 4 power wheelchairs. DESIGN: Retrospective cohort study. SETTING: Data were collected from equipment suppliers who collaborate with clinicians to administer the FMA and associated Uniform Data Set within various settings (ie, rehabilitation clinic, school, supplier place of business). PARTICIPANTS: A data set of 4743 cases was included in the analysis (N=4743). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FMA questionnaire collected at baseline, client age, gender, primary diagnosis, years since disability onset, device type, device age, living situation, ATP involvement, and geographic area. RESULTS: Ordinal logistic regression modeling showed that geographic area, device type, ATP involvement, primary diagnosis, gender, age, device age, and years since onset of disability significantly predicted the variance in FMA scores at P<.05. Device type was the most significant predictor of variance in FMA score. Involvement of an ATP had a significant effect on the type of device that participants used (χ220=1739.18, P<.001; odds ratio, 0.589; 95% confidence interval, 0.49-0.708). If an ATP was involved, there were significantly higher proportions (all P<.05) of individuals using custom-fitted manual wheelchair and high-end groups 3 and 4 power wheelchairs prescribed compared with when no ATP was involved or when involvement was uncertain. CONCLUSIONS: The relationship between ATP involvement and functional outcome supports the concept that ATP certification recognizes demonstrated competence in analyzing the needs of consumers with disabilities and selection of appropriate mobility assistive equipment with improved functional outcomes.

Development of a Wheelchair Repair Registry.

OBJECTIVE: To describe the development of a wheelchair repair registry from large datasets to attain an understanding of wheelchair failures and service repairs. DESIGN: Guidelines for registry development were applied and anchored around Labor-Tracker, a web-based information management system for wheelchair suppliers to manage and track wheelchair repairs. The registry was designed using online analytical processing, allowing for rapid data queries from multiple dimensions that enable complex data analysis and discovery. SETTING: The Wheelchair Repair Registry (WRR) was developed through an industry and academic collaboration whereby repair data were collected in the field, entered into the Labor-Tracker system, deidentified, and then transferred to the registry and made available for analyses. PARTICIPANTS: Wheelchair supplier service technicians reported data from repair services provided to individuals who use power wheelchairs, manual wheelchairs, and scooters. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Wheelchair failure and repair data, including variables related to scheduling, equipment information (eg, manufacturer, model, serial number, purchase date), labor, parts, and reasons for repairs. RESULTS: The WRR was developed to analyze wheelchair repairs and failures from the Labor-Tracker system. Currently, the registry has more than 60,000 repairs conducted on more than 5000 wheelchair devices from 25 manufacturers. The devices include 60% power wheelchairs, 35% manual wheelchairs, and 5% scooters. CONCLUSIONS: The WWR creates opportunities to apply large-data analytical methodologies that will serve to inform quality standards, practice, equipment selection, preventative maintenance routines, product design, and policy.

Seating and positioning system in wheelchairs of people with disabilities: a retrospective study.

OBJECTIVE: To characterize and quantify the seating and positioning items in wheelchairs prescribed and dispensed from 2005-2018 in relation to the necessities of the diagnoses served. METHODS: A convenience cross-sectional sample survey was used in the setting of an occupational therapy service from a specialized orthopaedic hospital. Records of people with disabilities who use a wheelchair (n = 1730) were surveyed for the following data: sociodemographic information (gender and age), diagnosis, whether a new wheelchair was received, whether wheelchair seating and positioning system were received, and the prescribed items. RESULTS: Of the 1730 users, 73.7% received a new wheelchair and 26.3% already had one donated by other services and/or purchased by the patient. Almost all the wheelchairs needed seating and positioning system in their structure (82.3%), and only 307 wheelchairs (17.7%) did not require any. The most frequent item was the hip belt (82.3%), followed by the removable solid wooden seat, and removable solid wooden backrest (81.3 and 80.9%, respectively). CONCLUSIONS: It is noted that the sample studied required many seating and positioning items for their wheelchairs. Despite the high demand for these assistive technological resources, research in this area is scarce. Little is known about which seating and positioning system is ideal for each user profile, which makes it difficult to organize the services that act in the provision of such equipment and the professional practice based on evidence.Implications for RehabilitationSeating and positioning system in wheelchair provide the user with the postural control necessary for daily activities, the maintenance of independence, and interaction with the environment.Indicating the best seating and positioning system is one of the most challenging tasks for healthcare professionals specializing in its prescription because it can be difficult to assess which components best meet the needs of an individual.The research proposed by this study has produced important evidences for the clinical practice of professionals that act on the prescription of wheelchairs and seating and positioning items for people with disabilities, presenting data that contribute to a better indication of these equipment's.

Prescription and development of adapted seating devices: learning from practice / Prescrição e desenvolvimento de assentos adaptados: aprendizados da prática

Abstract Introduction: A significant part of the professional activity of physiotherapists and occupational therapists who assist people with motor disabilities is the prescription and sometimes the construction of adapted seats for wheelchairs. This is a complex task that involves practice, continued education, and material and technical resources. These work together to provide the patient's access to the adapted product. Objective: To understand how the prescription and adaptation of wheelchair seats occur in practice in a public institution. Methods: This study had a qualitative approach, applied nature, and exploratory objective. We utilized the case study strategy, conducted through semi-structured interviews, with seven professionals from a public state institution. The data obtained and analyzed were professionals' practical experiences on seat adaptation for their patients. Results: We found divergences between practice and theory in the institution. The context in which the professionals operate, issues related to the institution, the production capacity of the adaptations, financial and time limitations, custom, lack of protocols and training in the area, and social and patient pressure are some of the causes of these divergencies. Conclusion: On the basis, we drew an overview of the prescription and construction of adapted seats by the institution and described the main elements that influence this practice. We believe that the training and updating of professionals, providing more resources, and a better process planning can reduce the divergences between practice and theory.

Resumo Introdução: Parte significativa da atividade profissional de fisioterapeutas e terapeutas ocupacionais que atendem pessoas com deficiência motora é a prescrição, e até mesmo o desenvolvimento, de assentos adaptados para cadeiras de rodas. Essa é uma tarefa complexa que envolve prática, formação continuada e recursos materiais e técnicos que atuam em conjunto para proporcionar o acesso do produto adaptado para o paciente. Objetivo: Compreender como o processo de prescrição e adaptação de assentos para cadeiras de rodas se dá na prática em uma instituição pública. Métodos: Esta pesquisa tem abordagem qualitativa, natureza aplicada e objetivo exploratório. Utilizou-se a estratégia de estudo de caso, realizado através de entrevistas semiestruturadas com sete profissionais de uma instituição pública estadual. Os dados obtidos e analisados foram resultados de experiências práticas dos profissionais acerca de adaptações de assentos que fizeram para seus pacientes. Resultados: Encontrou-se na instituição divergências entre a prática e a teoria, divergências. Essas são causadas pelo contexto em que operam os profissionais, por questões relacionadas com a instituição, capacidade produtiva das adaptações, limitações financeiras e temporais, costume, falta de protocolos e formação na área e pressão social e do paciente. Conclusão: Foi possível traçar um panorama da prescrição e desenvolvimento de assentos adaptados realizados pela instituição, bem como descrever os principais elementos que influenciam esta prática. Acredita-se que o treinamento e atualização dos profissionais, disponibilização de mais recursos e melhor planejamento do processo podem ser soluções para a diminuição das divergências entre a prática e teoria.

[Seating, postural support, safety and satisfaction of users of wheelchairs in a CABA Rehabilitation Institute. Descriptive study]. / Calce, apoyo postural, seguridad y satisfacción de usuarios de sillas de ruedas en un Instituto de Rehabilitación de CABA. Estudio descriptivo.

Introduction: In the world, 75 million people require a wheelchair (W/C) but only between 5% and 15% of them have one. The WHO defines a W/C as adequate if it meets the needs of the user and their environment, offers appropriate seating and postural support and if it is safe and durable. Objective: The primary objective is to describe the seating, postural support and safety of W/Cs users who attend the I.Re.P kinesiology service. The secondary objective is to learn about their satisfaction with their W/Cs and related services. Subjects and method: The subjects were W/C users who attend the I.Re.P. kinesiology service. The W/Cs were evaluated following the WHO guidelines, and the satisfaction using the QUEST 2.0 questionnaire. Results: Within 30 patients, 21 were men aged around 48.17 years. Only 1 subject had all the correct measures of safety, seating and posture adjustment. 6 had all the correct measures for an adequate seating and 5 had all the safety measures. Regarding satisfaction, high scores have been found with respect to W/C and low scores with respect to related services. All in all, the total satisfaction got mostly medium and high scores. Conclusion: Only 1 subject out of the 30 evaluated complied with all the seating, postural adjustment and safety requirements necessary to consider an adequate W/C. Most subjects reported being more satisfied with their W/C than with the related services.

Introducción: En el mundo, 75 millones de personas requieren una silla de ruedas (SDR) pero entre el 5% y el 15% de ellas disponen de una. La OMS define SDR adecuada como aquella satisface las necesidades del usuario y su entorno, ofrece calce y apoyo postural apropiados, es segura y duradera. Objetivo: El objetivo primario es describir el calce, apoyo postural y seguridad de los usuarios de SDR que concurren al servicio de kinesiología del I.Re.P. El objetivo secundario es conocer la satisfacción respecto a su SDR y los servicios relacionados. Sujetos y método: Se incluyeron usuarios de SDR que concurran al servicio de kinesiología del I.Re.P. Las SDR fueron evaluadas siguiendo los lineamientos de la OMS, y la satisfacción utilizando el cuestionario QUEST 2.0. Resultados: De 30 sujetos incluidos, 21 fueron hombres con una edad media de 48,17 años. Sólo 1 sujeto contó con todas las medidas correctas de seguridad, calce y ajuste postural, 6 sujetos contaban con todas las medidas correctas para un calce adecuado y 5 con todas las medidas de seguridad. En cuanto a la satisfacción, se han encontrado puntajes elevados respecto a las SDR y puntajes bajos respecto a los servicios relacionados. La Satisfacción total recibió en su mayoría puntajes medios y altos. Conclusión: Sólo 1 sujeto de los 30 evaluados cumplió con todos los requisitos de calce, ajuste postural y seguridad necesarios para considerar una SDR adecuada. La mayoría de los sujetos reportaron estar más satisfechos con su SDR que con los servicios relacionados.

A mobilidade funcional com cadeiras de rodas em sujeitos com lesão medular / The functional mobility with wheelchairs in individuals with spinal cord injury

Resumo Introdução A mobilidade funcional é aspecto comumente comprometido em sujeitos com lesão medular, requerendo o uso de uma cadeira de rodas. Embora esse recurso seja fundamental na reabilitação desses sujeitos, diversos aspectos relacionados ao ambiente físico podem interferir nos níveis de mobilidade funcional. Objetivo Descrever os aspectos relacionados à mobilidade funcional com o uso de cadeiras de rodas entre sujeitos com lesão medular. Método Tratou-se de um estudo descritivo com amostra de conveniência composta por 11 sujeitos com lesão medular advindos de uma associação de pessoas com deficiência de uma cidade de médio porte do interior do Estado de São Paulo. Para coleta de dados, utilizou-se um Formulário de Identificação do Sujeito com Lesão Medular. Os dados foram submetidos a uma análise descritiva simples. Resultados A maioria da amostra fazia uso de cadeira de rodas motorizada (63,63%; n=7) e reportou a presença de barreiras no ambiente domiciliar (81,81%; n=9), sendo na calçada (90,90%; n=10) e no quarteirão do domicílio (90,90%; n=10). A despeito dessas barreiras, 100% (n=11) relatou independência para a mobilidade no domicílio e 90,90% (n=10) em locais externos. Dentre as dificuldades de mobilidade reportadas, estavam as limitações para as transferências para o carro (54,54%; n=6) e transferências para superfícies da mesma altura (36,36%; n=4), além de transporte da cadeira de rodas em veículo próprio (63,63%; n=7). Conclusão Os achados demonstram a relevância de intervenções voltadas à promoção da mobilidade funcional em sujeito com lesão medular, com ênfase no ambiente físico e recurso de tecnologia assistiva.

Abstract Introduction Functional mobility is a common aspect involved in spinal cord injured patients, requiring the use of a wheelchair. Although this resource is fundamental in the rehabilitation of these individuals, several aspects related to the physical environment can interfere with the levels of functional mobility. Objective To describe aspects related to functional mobility with a wheelchair in patients with spinal cord injury. Method This is a descriptive study with samples composed of 11 patients with spinal cord injuries from an association of people with disabilities in a medium-sized city of São Paulo State. For data collection, a Spinal Cord Injury Identification Form was used. Data were analyzed through simple descriptive analysis. Results Most of the sample used a motorized wheelchair (63.63%; n = 7) and reported barriers in the home environment (81.81%; n = 9), on the sidewalk (90.90%; n = 10) and in the block of the household (90.90%; n = 10). Despite these barriers, 100% (n = 11) reported independence for mobility at home and 90.90% (n = 10) outside. Among the reported mobility difficulties, there were limitations for transfers to the car (54.54%; n = 6), transfers to surfaces of the same height (36.36%; n = 4), and transportation of the wheelchair in own vehicle (63.63%; n = 7). Conclusion The findings demonstrate the relevance of interventions aimed at promoting functional mobility in individuals with spinal cord injury with an emphasis on the physical environment and assistive technology resources.

Validação de um instrumento de avaliação de habilidades de manejo de cadeira de rodas / Validation of a skill assessment instrument wheelchair management

Habilidades de manejo em cadeira de rodas são fundamentais para independência funcional de pessoas usuárias de cadeira de rodas. Ensiná-las, requer dos profissionais instrumentos que possam aferir a condição inicial do aprendiz permitindo verificar sua evolução durante o processo de intervenção. Objetivo: Validar um protocolo de avaliação de HMCR, com critérios dentro de conceitos e conhecimentos científicos existentes da psicometria. Método: Para construção e validação do instrumento, utilizamos o método Delphi de Survey e validade de conteúdo. Os participantes da pesquisa foram seis especialistas na área de atividades em cadeira de rodas com titulação de mestres ou doutores, usamos para medir a consistência interna do instrumento o alfa de Cronbach (α), índice de validade de conteúdo (IVC), Coeficiente de correlação intraclasse (CCI) e teste T de uma amostra com nível de 5% de significância. Resultados: Nos 17 itens obtivemos os critérios de clareza (CVI= 0,865±0,059; α= 0,834; CCI= 0,828; P<0,05), pertinência (CVI= 0,902±0,071; α= 0,774; CCI= 0,779; P<0,05), simplicidade (CVI= 0,918±0,054; α= 0,705; CCI= 0,694; P<0,05), objetividade (CVI= 0,888±0,067; α= 0,856; CCI= 0,850; P<0,05) e precisão (CVI= 0,922±0,060; α= 0,742; CCI= 0,721; P<0,05). Conclusão: Os itens na construção do instrumento de avaliação demonstram por meio da psicometria ser válido e garante medir aquilo que se propõe medir. A consistência interna dos itens garante que o desenvolvimento de uma escala se faz necessária para avaliação de pessoas com LM que utilizam CR, o que propõe novos estudos de aplicação do teste para concluirmos o processo de validação

Wheelchair management skills are essential for the functional independence of people using wheelchairs. Teaching them requires professionals to assess the initial condition of the apprentice, allowing them to verify their evolution during the intervention process. Objective: Validate an HMCR evaluation protocol, with criteria within existing concepts and scientific knowledge of psychometry. Method: For construction and validation of the instrument, we used the Delphi Survey method and content validity. The research participants were six specialists in the area of wheelchair activities with a master's or doctor's degree. We used Cronbach's alpha (α), content validity index (CVI), correlation coefficient to measure the internal consistency of the instrument intraclass (ICC) and T test of a sample with a 5% significance level. Results: 17 items we obtained for the criteria of clarity (CVI= 0.865 ± 0.059; α= 0.834; ICC= 0.828; P <0.05), relevance (CVI= 0.902 ± 0.071; α= 0.774; CCI= 0.779; P <0 , 05), simplicity (CVI= 0.918 ± 0.054; α= 0.705; CCI= 0.694; P <0.05), objectivity (CVI= 0.888 ± 0.067; α= 0.856; CCI= 0.850; P <0.05) and accuracy (CVI= 0.922 ± 0.060; α= 0.742; CCI= 0.721; P <0.05). Conclusion: Items in the construction of the assessment instrument demonstrate, by means of psychometry, to be valid and guarantee to measure what it is proposed to measure. Internal consistency of the items ensures that the development of a scale is necessary for the evaluation of people with SCI who use CR, which proposes new studies of application of the test to conclude the validation process

Perfil da força muscular isométrica em atletas de rugby em cadeira de rodas / Profile of isometric muscle strength in athletes of wheelchair rugby

Objetivo: Analisar os níveis de força muscular em atletas de rugby em cadeira de rodas (RCR). Método: A amostra foi composta por 10 atletas (homens) com lesão da medula espinhal em nível cervical (tetraplegia) com média de idade de 31,1±5,06 anos. Os atletas foram recrutados na equipe de RCR do Projeto de Atividade Motora e Esporte Adaptado da Universidade Estadual de Campinas (ADEACAMP/UNICAMP). Resultados: Para analisar os níveis de força muscular isométrica (flexão e extensão dos ombros e cotovelos) foi utilizado dinamômetro isométrico, enquanto ultrassom foi usado para avaliação da espessura muscular (flexores e extensores do cotovelo, ambos os lados), utilizando 7,3 MHz da sonda linear-matriz. Correlação ponto-bisserial foi utilizada para verificar a associação entre os níveis de força de acordo com a posição de jogo; enquanto a correlação de Spearman verificou a associação entre os níveis de força entre membros dominantes e não dominantes, além da relação músculo agonista versus antagonista. Ainda, o teste Mann Whitney U foi utilizado para comparar os jogadores titulares e reservas quanto à força e espessura muscular. Conclusão: Podemos concluir que quanto maior a classificação funcional, maiores são os valores de força voluntária isométrica máxima; e que a força isométrica tem correlação com o desempenho de atletas de RCR

Objective: The aim of this study was to analyze muscle strength levels in wheelchair rugby athletes. Methods: The sample was 10 athletes (men) with spinal cord injury at cervical level (tetraplegia) with mean age of 31.1 ± 5.06 years. The athletes were recruited in the rugby team in wheelchair of the Motor Activity and Adapted Sport Project of the University of Campinas (ADEACAMP/UNICAMP). Results: In order to analyze the isometric muscular strength levels (flexion/extension of the shoulders and elbows), dynamometer was used, while muscle thickness was verified by ultrasound (flexors and extensors of the elbow, both sides), using 7.3 MHz of the linear-array probe. Point bi-serial correlation was applied to verify associations of game position and strength; while Spearman's correlation verified associations of strength and dominant and nondominant sides, and the relationship of agonist versus antagonist muscles. Moreover, the Mann Whitney U test was used to compare first to second-string players regarding strength and muscle thickness. Conclusion: We concluded that the higher the functional classification, higher the values of maximum isometric voluntary strength; and that the isometric strength correlates with their rugby performances

Treinamento de habilidades com cadeiras de rodas manuais: uma revisão integrativa da literatura / Training of the manual wheelchair skill: an integrating literature review

Resumo O treinamento de habilidades com cadeiras de rodas é um aspecto fundamental na reabilitação de sujeitos com deficiência, sendo considerado um passo imprescindível nos serviços de prescrição/dispensação de cadeiras de rodas. Este estudo teve por objetivos: (1) realizar o mapeamento das intervenções voltadas ao treinamento de habilidades com cadeiras de rodas manuais disponíveis na literatura dos últimos 10 anos (2008-2018); e (2) identificar os melhores níveis de evidências científicas sobre essa prática. Tratou-se de uma revisão integrativa da literatura realizada na biblioteca virtual Scientific Eletronic Library Online (SciELO) e nas bases de dados Literatura Latino-Americana e do Caribe de Ciências da Saúde (LILACS) e PubMed/MEDLINE, com artigos nas línguas inglesa, espanhola e portuguesa, entre os anos de 2008 e 2018. Foram encontrados sete ensaios clínicos controlados randomizados, todos disponíveis na língua inglesa e a maioria de afiliação canadense. O protocolo do Wheelchair Skills Training Program - WSTP foi o que apresentou o maior número de estudos (n=5), com eficácia comprovada quanto ao desempenho e confiança em habilidades com cadeiras de rodas e alcance de metas de treinamento. Este protocolo também se mostrou eficaz em abordagens individuais e grupais, em contextos de serviços especializados de reabilitação e na comunidade, com público diversificado e tempo de treinamento variável entre duas e 24 horas. Conclui-se que o WSTP demonstrou ser uma estratégia com altos níveis de evidências sobre o treinamento de habilidades com cadeiras de rodas, sendo necessárias novas investigações para avaliar a eficácia dessa prática em aspectos ainda não investigados.

Abstract Wheelchairs skills training is fundamental in the rehabilitation of disabled people and is considered an essential step in wheelchair prescription/dispensing services. The objective of this study was: (1) to map the interventions for manual wheelchairs skills training available in the literature of the last 10 years (2008-2018); and (2) identify the best levels of scientific evidence on this practice. This was an integrative review of the literature in the Virtual Electronic Library Online (SciELO) and in the Biblioteca Virtual em Saúde (BVS), Literatura Latino-Americana e do Caribe de Ciências da Saúde (LILACS), and PubMed / MEDLINE, with articles in English, Spanish and Portuguese between 2006 and 2018. We found seven randomized controlled trials, all available in the English language and most of Canadian affiliation. The protocol of the Wheelchair Skills Training Program - WSTP presented the largest number of studies (n=4) with proven efficacy and confidence in wheelchair skills and attainment of training goals. This protocol has also proved to be effective in individual and group approaches, in contexts of specialized rehabilitation and community services, with a diversified public and a variable training time between two and 24 hours. It is concluded that WSTP has been shown to be a strategy with high levels of evidence on wheelchair skills training, and further research is needed to evaluate the effectiveness of this practice in aspects not yet investigated.