Upper limb strength in individuals with spinal cord injury who use manual wheelchairs.

Introduction: Manual wheelchair users have been found to be at risk for secondary upper extremity injuries.

Purpose: The primary goal of this study was to compare shoulder strength and muscle imbalance of individuals with paraplegia to case-wise matched unimpaired controls (UC). A secondary goal was to evaluate the impact of age and neurologic level of injury (NLI) on weight-normalized strength (WNS).

Development of a clinical prediction rule for the diagnosis of carpal tunnel syndrome.

Objectives: To develop a clinical prediction rule (CPR) and to assess the reliability and diagnostic accuracy of individual clinical examination items for the diagnosis of carpal tunnel syndrome (CTS).

Design: Prospective diagnostic test study with blind comparison to a reference criterion of a compatible clinical presentation and abnormal electrophysiologic findings.

Setting: Multicenter medical center and community hospital with patient referrals from ambulatory primary care and specialty practice settings.

Effect of a pushrim-activated power-assist wheelchair on the functional capabilities of persons with tetraplegia.

Objectives: To test the differences between a pushrim-activated power-assisted wheelchair (PAPAW) and a traditional manual wheelchair while performing common driving activities and to assess their relative merits for people with tetraplegia.

Design: Repeated measures.

Setting: An activities of daily living (ADL) laboratory within a rehabilitation research center.

Using wavelet analysis to characterize the thermoregulatory mechanisms of sacral skin blood flow.

Pressure-induced skin blood flow responses measured via laser Doppler flowmetry are commonly reported in the time domain. The usefulness of spectral analysis in examining blood flow control mechanisms has been demonstrated, but traditional Fourier analysis does not provide sufficient resolution to reveal characteristic low frequencies. Time-frequency (wavelet) analysis was performed on 10 subjects' sacral skin blood flow responses to heating (45 degrees C) with improved resolution.

Evaluation of selected sidewalk pavement surfaces for vibration experienced by users of manual and powered wheelchairs.

Background: Obstacles such as bumps, curb descents, and uneven driving surfaces cause vibrations that affect the wheelchair, and in turn, the wheelchair user. Chronic exposure can cause low-back pain, disk degeneration, and other harmful effects. Little research has been conducted to assess the vibrations experienced by wheelchair users.

The GAME(Cycle) exercise system: comparison with standard ergometry.

Background: It is well established that physical activity is beneficial to health. For the individual in a wheelchair, a regular exercise program might not be available or may be too difficult to participate in physically and/or psychologically. Many exercise devices and regimes are boring.

Fatigue testing of selected suspension manual wheelchairs using ANSI/RESNA standards.

Objectives: To evaluate the durability and value of 3 common suspension manual wheelchairs and to compare the results with those of previously tested lightweight and ultra-lightweight folding-frame wheelchairs.

Design: Standardized fatigue testing and cost analysis of 3 suspension manual wheelchairs from 3 different manufacturers.

Setting: A rehabilitation engineering center.

Using the absorbed power method to evaluate effectiveness of vibration absorption of selected seat cushions during manual wheelchair propulsion.

Although wheelchair users are frequently subjected to oscillatory and shock vibrations, little research has been conducted to assess the whole-body vibration exposure of wheelchair users. The purpose of this study was to determine if selected wheelchair cushions alter potentially harmful whole-body vibrations transferred to wheelchair users. Thirty-two participants, who use wheelchairs as their primary mode of mobility, contributed to this study.

Impact of a pushrim-activated power-assisted wheelchair on the metabolic demands, stroke frequency, and range of motion among subjects with tetraplegia.

Objectives: To determine differences in metabolic demands, stroke frequency, and upper-extremity joint range of motion (ROM) during pushrim-activated power-assisted wheelchair (PAPAW) propulsion and traditional manual wheelchair propulsion among subjects with tetraplegia.

Design: Repeated measures.

Setting: A biomechanics laboratory within a Veterans Affairs medical center.

Demographic and socioeconomic factors associated with disparity in wheelchair customizability among people with traumatic spinal cord injury.

Objectives: To determine if a standard of care for wheelchair provision exists within the participating centers and if there is disparity in wheelchair customizability among the study sample.

Design: Convenience sample survey.

Setting: Thirteen Model Spinal Cord Injury Systems that provide comprehensive rehabilitation for people with traumatic spinal cord injury (SCI) and that are part of the national database funded through the US Department of Education.

Assessing the influence of wheelchair technology on perception of participation in spinal cord injury.

Objective: To investigate factors related to the wheelchair, impairment, and environment that affect perception of participation of persons with spinal cord injury (SCI) in activities performed in 3 settings: in the home, in the community, and during transportation.

Design: Cross-sectional study.

Setting: Research centers and a specialized assistive technology (AT) clinic in Pittsburgh (Pitt).

Relation between median and ulnar nerve function and wrist kinematics during wheelchair propulsion.

Objective: To investigate the relation between median and ulnar nerve health and wrist kinematics in wheelchair users.

Design: Case series.

Setting: Biomechanics laboratory and electrodiagnostic laboratory at a Veterans Health Administration medical center and a university hospital, respectively.

Preliminary assessment of a prototype advanced mobility device in the work environment of veterans with spinal cord injury.

The INDEPENDENCE 3000 IBOT Transporter (IBOT) is an electronically stabilizing device for people with disabilities. The purpose of this study was to collect qualitative data on the potential for the IBOT to improve employment satisfaction of veterans who use wheelchairs to work. This study was based upon observations by trained clinicians, and responses to a survey completed by four men with traumatic spinal cord injury, who worked in an office environment.

Manual wheelchair pushrim dynamics in people with multiple sclerosis.

Objectives: To define differences in pushrim dynamics during manual wheelchair propulsion by users with multiple sclerosis (MS) relative to 2 control groups of subjects with spinal cord injury (SCI) and no disability (ND) and to investigate changes in propulsion biomechanics at different speeds and with fatigue.

Design: Case-control.

Setting: Biomechanics laboratory.

Analysis of whole-body vibration during manual wheelchair propulsion: a comparison of seat cushions and back supports for individuals without a disability.

Whole-body vibration exposure has been found to be detrimental to the health of humans owing to effects such as degraded comfort, disc degeneration, and lower back pain. The purpose of this study was to determine if selected seat cushions and back supports minimize the transmission of vibrations during manual wheelchair propulsion. Ten unimpaired participants traversed an activities of daily living course using four seat cushions and four back supports.

A pilot study on community usage of a pushrim-activated, power-assisted wheelchair.

Manual wheelchair propulsion combined with other stresses to the upper extremities may result in secondary injury. Possible solutions would be to devise alternative methods of propulsion, such as a pushrim-activated, power-assist wheelchair (PAPAW). The goals of this study were to examine the usage of the PAPAW in a real world setting and to characterize the driving habits of manual wheelchair users.

Durability, value, and reliability of selected electric powered wheelchairs.

Objective: To compare the durability, value, and reliability of selected electric powered wheelchairs (EPWs), purchased in 1998.

Design: Engineering standards tests of quality and performance.

Setting: A rehabilitation engineering center.

Evaluation of selected electric-powered wheelchairs using the ANSI/RESNA standards.

Objectives: To compare the performance characteristics of different electric-powered wheelchairs (EPWs) and to evaluate the effectiveness of the American National Standards Institute/Rehabilitation Engineering and Assistive Technology Society of North America (ANSI/RESNA) wheelchair standards.

Design: Five types of EPWs were selected. Three wheelchairs of each type were tested according to the ANSI/RESNA wheelchair standards.

Intelligent walkers for the elderly: performance and safety testing of VA-PAMAID robotic walker.

A walker that could help navigate and avoid collisions with obstacles could help reduce health costs and increase the quality of care and independence of thousands of people. This study evaluated the safety and performance of the Veterans Affairs Personal Adaptive Mobility Aid (VA-PAMAID). We performed engineering tests on the VA-PAMAID to determine safety factors, including stability, energy consumption, fatigue life, and sensor and control malfunctions.

Autonomic dysreflexia: incidence in persons with neurologically complete and incomplete tetraplegia.

Background: Autonomic dysreflexia (AD) is a common problem in patients with spinal cord injury (SCI) above the T6 neurologic level and may cause serious medical complications if untreated. Previous studies have focused on patients with complete SCI.

Design: Prospective analysis of a historic cohort.

Shoulder magnetic resonance imaging abnormalities, wheelchair propulsion, and gender.

Objective: To investigate the relationship between pushrim forces and the progression of shoulder injuries in manual wheelchair users.

Design: Longitudinal case series.

Setting: Biomechanics laboratory and magnetic resonance imaging (MRI) facility at a Veterans Health Administration medical center and university hospital, respectively.

Whole-body vibration during manual wheelchair propulsion with selected seat cushions and back supports.

Although the exposure to whole-body vibrations (WBV) has been shown to be detrimental to seated humans, the effects of wheelchairs and seating systems on the transmission of vibration to an individual have not been thoroughly examined. The purpose of this study was to determine if the selected wheelchair seat cushions and back supports minimize the transmission of vibrations. Thirty-two wheelchair users traversed an activities of daily living course three times using 16 randomly selected seating systems as well as their own.

Peer review: issues in physical medicine and rehabilitation.

Peer review, although the standard for evaluating scientific research, is not without flaws. Peer reviewers have been shown to be inconsistent and to miss major strengths and deficiencies in studies. Both reviewer and author biases, including conflicts of interest and positive outcome publication biases, are frequent topics of study and debate.