Development and consumer validation of the Functional Evaluation in a Wheelchair (FEW) instrument.

PURPOSE: The purpose of the study is to develop an outcome measurement tool to investigate functional performance of consumers using seating and wheelchair systems as their primary seating and mobility device. The instrument is undergoing systematic development in three phases. The results of Phase 1 will be reported. METHOD: Manual and power wheelchair users were interviewed using a modified version of a client-centred outcome measure. An item bank was derived based on the interview data. Subjects were then asked to validate item categories of the new instrument, and finally to self-administer the first version of the instrument. RESULTS: Subjects reported 154 self-care, productivity, and leisure occupational performance issues related to their current seating-mobility system. Based on their input, 10 categories (i.e. transfers, reach, accessing task surfaces, transportation-portability, human-machine interface, architectural barriers, transportation-accessibility, transportation-securement, natural barriers and accessories) were validated for inclusion in the new outcome measure, Functional Evaluation in a Wheelchair (FEW). CONCLUSION: The items on the FEW focus on the interaction between the consumer, the technology, and the milieu. Consumers viewed the overall importance of FEW categories for seating-mobility system users differently than when they self-administered the FEW.

Technology applications in occupational therapy.

The products of today's research will be available to clinicians in the future. Many occupational therapists are involved in technology research in rehabilitation engineering and other technical programs. As part of the research teams they are designing new positioning systems and monitoring the effects of these new systems on the posture and skin of people with disabilities. They are designing new interfacing strategies for equipment. They are developing training strategies for accessing computer-based augmentative communication aids. They are providing functional design criteria for the modification of personal vehicles for use by disabled people. They are involved in the development and clinical application of robotics. In summary, the field of rehabilitation technology provides a fertile area for therapists wishing to pursue research careers. RESNA provides continuing education courses with a focus on technology application in conjunction with its annual meeting and encourages regional meetings with educational program components. RESNA is also very concerned with the issues of quality assurance. Only one formal training program for training rehabilitation engineers exists in this country, yet many engineers and others are providing technology in clinical settings. Current legislation is alerting many professionals to the value of technology, and yet there is no mechanism in place to monitor the quality of technical programs or the qualifications of many of the professionals providing the technical services. A major challenge is to address the formal training and quality assurance issues in a sensible way. The application of technology as a component of our clients' rehabilitation is an exciting development.(ABSTRACT TRUNCATED AT 250 WORDS)

Technology in the education of multiply-handicapped children.

The number of technical aids now available has allowed severely multiply-handicapped children to better participate in their education. Project TEACH (Technical-Educational Aids for Children with Handicaps), a 3-year early childhood demonstration project of the Federal Office of Education, provided ten children with seating systems, mobility aids, feeding devices, and augmentative communication aids. The children's performance of academic, motor, daily living, and communication skills as they relate to their educational program is reported as well as the model used to deliver technical services in an educational environment.

Prescription and positioning: evaluating the physically disabled individual for wheelchair seating.

Within the past 10 years, technology has provided members of the seating team with new approaches in dealing with severely physically disabled children and adults. Positioning is often the first step in overall provision of technical aids. Before physically disabled individuals can operate augmentative communication devices, computer keyboards or other assistive or rehabilitative devices, they should be provided with the optimum seated posture from which to operate. The proximal stability provided by a therapeutically designed seating system will enhance motor potential. Presently, there are many approaches to providing dynamic seating. A thorough evaluation, with input from all team members including the client and his family is necessary to define clearly the goals for the seating device. Once these goals are defined, the team can investigate the possible technical solutions. Thorough ongoing re-evaluation and follow-up of both the client's needs and the possible technical solutions will ensure that persons with physical disabilities will be in the best possible posture to perform the tasks of daily living.

A survey of persons who use integrated control devices.

Integrated devices allow users to operate multiple pieces of assistive technology items from a single input device. Through this single input device, users with severe physical limitations are able to operate several other devices such as a wheelchair, telephone, computer, and communication aid. Twenty-four integrated control users completed a telephone survey to ascertain consumer satisfaction with integrated controls. Eighteen were either satisfied or very satisfied with the evaluation for an integrated control, one was neither satisfied nor dissatisfied, two were very dissatisfied, and three did not respond to the question. Twenty were very satisfied or satisfied and four were either dissatisfied or very dissatisfied with the training they received. Twenty-two respondents indicated they were either very satisfied or satisfied with their integrated control device, one was neither satisfied nor dissatisfied, and one was very dissatisfied. In general, respondents were satisfied with their integrated control devices. Specifically, respondents were satisfied with the increase in independence and the ability to control other equipment such as television sets and computers. Simplicity, touch sensitivity, and visual/auditory feedback appeared to play important roles in satisfaction.

An interdisciplinary problem-based learning project for assistive technology education.

The purpose of this paper is to describe the development, implementation, and outcomes of an extended problem-based learning project imbedded in an interdisciplinary assistive technology course. Students representing four health care disciplines worked together in small groups to address the complex needs of clients with significant issues regarding assistive technology (seating and mobility, augmentative communication, and computer access) and adaptive function. Problem-based learning was seen as a way to enhance the students' clinical reasoning and problem-solving skills and provide a "real life" treatment in a team experience. Formal and informal course evaluation results yielded qualitative data that reflected highly favorable impressions of the problem-based learning project, as well as suggestions for the future.

Comparison of anterior trunk supports for children with cerebral palsy.

The purpose of this study was to demonstrate outcome measures of one seating component--anterior trunk supports--when used by children with cerebral palsy during a functional activity. The functional activity was pressing a single switch to activate a computer software program. Seventeen children with a mean age of 9 years were included in the study. Subjects had mild to moderate spastic or athetoid cerebral palsy. Seven had a primary diagnosis of athetoid and 10 had a primary diagnosis of spastic cerebral palsy. All subjects needed supplemental seating to maintain an upright posture. The four trunk supports tested were an anterior chest panel, a 1-inch-wide single horizontal chest strap, an anterior shoulder support, and a tray with molded chest support. Data included prehits, response time, and the length of time the subject pressed the switch. A repeated analysis of variance test was used to analyze the data. Data for athetoid and spastic cerebral palsy subject groups were analyzed separately. No statistically significant differences were found between the four trunk supports. Therefore, the choice of trunk supports for this population should be based on client preferences, ease of removal for the caregiver, cost, and aesthetics.

Occupational therapy and rehabilitation engineering.

As new and more sophisticated technology is represented in equipment and devices, occupational therapists are challenged to expand their roles as evaluators for and providers of these more complex assistive devices. Being experts in understanding disability and how to maximize function for daily activities will enable occupational therapists to be key team members in the growing specialty of providing technical aids. "Technical persons" ranging from rehabilitation engineers to carpenters, working in conjection with occupational therapists, can form a unique partnership in which the skills of each combine to solve a variety of daily living problems. This paper will discuss the relationship of one Rehabilitation Engineering Program operating as a self supporting, fee-for-service program within the Orthopaedic Department of a Medical School. A case study will illustrate problem solving strategies utilized in the delivery of technical services.

A randomized control trial to evaluate pressure-reducing seat cushions for elderly wheelchair users.

OBJECTIVE: To determine if the use of pressure-reducing wheelchair cushions for elderly nursing home resident wheelchair users who are at high risk for developing sitting-acquired pressure ulcers would result in a lower incidence rate of pressure ulcers, a greater number of days until ulceration, and lower peak interface pressures compared with the use of convoluted foam cushions over a 12-month period. To determine the feasibility of conducting a subsequent full-scale definitive trial to evaluate the use of pressure-reducing seat cushions for elderly nursing home resident wheelchair users. DESIGN: Randomized control trial SETTING: 2200-bed skilled nursing facilities (1 suburban and 1 urban academic medical center) PATIENTS: 32 male and female at-risk nursing home residents who were wheelchair users > or = 65 years of age. Participants had Braden Scale scores < or = 18, Braden Activity and Mobilitysubscale scores < or = 5, no sitting surface pressure ulcers, and a daily wheelchair sitting tolerance of more than 6 hours. All met criteria for using the ETAC Twin wheelchair. INTERVENTIONS: Seating evaluation with pressure-mapping and subsequent seating prescription. Subjects were assigned to either a foam (n=17) or pressure-reducing cushion (n=15) group and weekly assessments of skin and pressure ulcer risk were made. MAIN OUTCOME MEASURES: Incidence of pressure ulcers, days to ulceration, and peak interface pressure. MAIN RESULTS: At a 95% confidence interval, a 2-tailed analysis showed no differences between the FOAM and pressure-reducing cushion groups for pressure ulcer incidence, total days to pressure ulcer, or initial peak interface pressure. Pressure-reducing cushions were more effective in preventing sitting-acquired (ischial) pressure ulcers (P<.005). Higher interface pressures were associated with a higher incidence of pressure ulcers (P<.001). CONCLUSIONS: A definitive randomized control multicenter cushion trial is feasible with a sample size of 50 to 100 per study group. In the definitive trial, the definition of sitting-acquired pressure ulcers should be limited to lesions occurring over the ischial tuberosities.

The role of special devices in the management of the handicapped child.

With continued improvements in neonatal care many infants with severe neuromuscular disease are now being salvaged. To achieve independence in ambulation as well as in activities of daily living, such children often require considerable assistance from many allied disciplines. Because each handicapped child is unique in his particular requirements, specially designed and manufactured aids are often indicated. A multidiscipline Special Devices Clinic has been established to fulfil this need.

A modular seating system for cerebral-palsied children.

A seating system for physically handicapped children has been devised in which a series of standard components (neck supports, rolled seats, pommels) can be incorporated to make a seating system appropriate for the individual child.

The relationship between pressure ulcer incidence and buttock-seat cushion interface pressure in at-risk elderly wheelchair users.

OBJECTIVE: To investigate the relation between pressure ulcer incidence and buttock-wheelchair seat cushion interface pressure measurements. DESIGN: Secondary analysis of data from a randomized clinical trial. SETTING: Skilled nursing facility. PATIENTS: Thirty-two elderly patients (age, > or = 65 yr), with Braden score < or = 18 and Braden mobility and activity subscale score < or = 5, who used wheelchairs > or = 6 hr/d, were free of existing sitting-induced pressure ulcers, and weighed < or = 250 lb. INTERVENTIONS: Generic foam seat cushion or pressure-reducing seat cushion. MAIN OUTCOME MEASURES: The incidence of sitting-induced pressure ulcers over a 1- to 12-month period was compared with pressure measured between patients' buttocks and wheelchair seat cushions. A flexible pad with a 15 x 15 pressure sensor array was used to measure interface pressure. RESULTS: Interface pressure measured on wheelchair seat cushions was higher (p < or = .01 for both peak pressure and average of highest 4 pressures) for patients who developed sitting-acquired pressure ulcers compared with those patients who did not. CONCLUSIONS: Results indicated that higher interface pressure measurements are associated with a higher incidence of sitting-acquired pressure ulcers for high-risk elderly people who use wheelchairs.

Postural changes with aging in tetraplegia: effects on life satisfaction and pain.

OBJECTIVES: (1) To measure kyphosis and scoliosis in individuals with tetraplegia; (2) to examine the relation between kyphosis and scoliosis and years since injury; and (3) to determine the association between kyphosis and scoliosis and measures of pain, depression, and life satisfaction. DESIGN: Cross-sectional, case-control study. SETTING: University medical center and a free-standing university-affiliated rehabilitation hospital. PARTICIPANTS: (1) Ten individuals with tetraplegia I to 3 years postinjury (NT); (2) 10 individuals with tetraplegia 10 to 20 years postinjury (OT); and (3) 10 control individuals (C) matched to the other subjects on the basis of age, height, and weight. MAIN OUTCOME MEASURES: Radiographic measurements of kyphosis and scoliosis taken in a seated position, pain as measured by the short form of the McGill Pain Questionnaire (SF-MPQ), depression as measured by the Center for Epidemiological Studies-Depression Scale (CES-D), and life satisfaction as measured by the Life Satisfaction Index Assessment (LSIA) and the Craig Handicap Assessment and Reporting Technique (CHART). RESULTS: No significant differences were seen between the OT and NT groups with respect to age, height, or weight. In addition, no significant differences were found between the NT and OT groups with respect to measures of kyphosis and scoliosis. Individuals with tetraplegia had significantly higher (p < .05) measures of kyphosis (42 + 16.0 ) and scoliosis (14 degrees +/-9.2 degrees) than the C subjects (kyphosis, 32 degrees +/- 7.9 degrees ; scoliosis, 5 degrees+/-3.8 degrees). No correlation was found between scores on the SF-MPQ and degree of kyphosis or scoliosis. Significant differences were seen between the NT and OT groups on both CES-D (NT, 15.2+/-8.1; OT, 5.8+/-5.5) and LSIA (NT, 9.9+/-2.8; OT, 14.4+/-2.9). CONCLUSION: This study indicates that seated kyphosis and scoliosis develop early in individuals with tetraplegia and may not be progressive. No association was seen between pain and kyphosis or scoliosis in this relatively young sample (mean age of OT and NT combined, 34.8 years). Future research is needed to determine whether pain becomes a problem in individuals with significant kyphosis or scoliosis as they age.