RESNA position on the application of ultralight manual wheelchairs.

The purpose of this RESNA Position Paper is to provide evidence from the literature and share typical clinical applications supporting the application of ultralight manual wheelchairs (ULWCs) to assist practitioners in decision-making and justification of wheelchair recommendations.

Rolling resistance of casters increases significantly after two years of simulated use.

Introduction: Manual wheelchair propulsion is associated with upper limb pain and injury, and clinical guidelines recommend minimizing propulsive force to lower health risks. One of the strategies to reduce propulsive force is by minimizing rolling resistance (RR). Product testing studies suggest that RR of casters is affected by wear and tear which could have implications on the health risk of wheelchair users.

A high prevalence of manual wheelchair rear-wheel misalignment could be leading to increased risk of repetitive strain injuries.

Purpose: To determine the prevalence and severity of manual wheelchair rear wheel misalignment in community-dwelling manual wheelchair users and estimate the associated increases in rolling resistance (RR) and risk of repetitive strain injuries (RSIs).

Materials And Methods: Data were collected in an outpatient rehabilitation clinic, a university research laboratory, and at adaptive sporting events in the United States. Two hundred active, self-propelling manual wheelchair users were recruited.

Scoping review of the rolling resistance testing methods and factors that impact manual wheelchairs.

Introduction: Rolling resistance (RR) is a drag force acting on manual wheelchairs that is associated with increased propulsion force and is linked to secondary disabling conditions of the upper limbs. A scoping review was conducted to understand how RR of manual wheelchairs has been measured and to identify limitations of those test methods and the factors tested.

Methods: A total of 42 papers were identified and reviewed, and test methods were categorized based on the measurement style of RR, testing level, and if multiple parameters could be tested.

Evaluation of rolling resistance in manual wheelchair wheels and casters using drum-based testing.

Purpose: Rolling resistance is a drag force that increases the required propulsion force of manual wheelchair users (MWU) and increases the risk of upper extremity pain and injury.

Materials And Methods: To understand the influence of different design, environmental, and setup factors on rolling resistance (RR), a series of tests were performed on a range of wheels and casters using a drum-based equipment with the capability to measure RR forces. Independent factors were varied including load, camber, toe, speed, tire pressure, and surface, using ranges anticipated in the community.

Development of wheelchair caster testing equipment and preliminary testing of caster models.

Background: Because of the adverse environmental conditions present in less-resourced environments (LREs), the World Health Organization (WHO) has recommended that specialised wheelchair test methods may need to be developed to support product quality standards in these environments. A group of experts identified caster test methods as a high priority because of their common failure in LREs, and the insufficiency of existing test methods described in the International Organization for Standardization (ISO) Wheelchair Testing Standards (ISO 7176).

Objectives: To develop and demonstrate the feasibility of a caster system test method.

Dose calculation accuracy of the Monte Carlo algorithm for CyberKnife compared with other commercially available dose calculation algorithms.

Monte Carlo dose calculation algorithms have the potential for greater accuracy than traditional model-based algorithms. This enhanced accuracy is particularly evident in regions of lateral scatter disequilibrium, which can develop during treatments incorporating small field sizes and low-density tissue. A heterogeneous slab phantom was used to evaluate the accuracy of several commercially available dose calculation algorithms, including Monte Carlo dose calculation for CyberKnife, Analytical Anisotropic Algorithm and Pencil Beam convolution for the Eclipse planning system, and convolution-superposition for the Xio planning system.

Clinical implications of adopting Monte Carlo treatment planning for CyberKnife.

It is documented that well-modeled Monte Carlo dose calculation algorithms are more accurate than traditional correction-based algorithms or convolution algorithms at predicting dose distributions delivered to heterogeneous volumes. This increased accuracy has clinical implications for CyberKnife, particularly when comparing dose distributions between the ray-tracing and Monte Carlo algorithms. Differences between ray-tracing and Monte Carlo calculations are exacerbated for highly heterogeneous volumes and small field sizes.

Commissioning and acceptance testing of a CyberKnife linear accelerator.

Acceptance testing and commissioning of a CyberKnife robotic stereotactic radiosurgery system was performed in April 2006. The CyberKnife linear accelerator produces a photon beam of 6 MV nominal energy, without the use of a flattening filter. Clinically measured tissue-phantom ratios, off-center ratios, and output factors are presented and compared with similar data from other CyberKnife sites throughout the United States.