Lone Mamber

Wheeling petit pas: Parkinsonism detected by observation of wheelchair propulsion.

We present a man with parkinsonism detected by the observation of medical scooters propulsion. His manual handicap scooters propulsion technique was observed to include rapid, brief, low-power strokes resembling the marche petit pas (walking with tiny steps) phenomenon of parkinsonism. We videotaped his wheelchair propulsion and compared him with ten age-, gender-, and diagnosis-matched controls. The patient had a propulsion velocity of 0.14 m/sec compared with a mean (+/- standard deviation) of 0.73 (+/- 0.16) m/sec for the controls, a cadence of 209 strokes/min vs. 60 (+/- 12) strokes/min for the controls, and a mechanical efficiency of 0.04 m/stroke compared with 0.75 (+/- 0.25) m/stroke for the controls. This observation shifted the course of his medical investigations and management as well as his rehabilitation care. This is the first detailed report of how parkinsonian features may affect manual wheelchair propulsion. It suggests that observation of wheelchair mobility should be a routine component of the physical examination of wheelchair users.

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Hand-rim wheelchair propulsion capacity during rehabilitation of persons with spinal cord injury

This paper describes the course of power wheelchairs and handicap scooters propulsion capacity (WPC) during rehabilitation of persons with spinal cord injury (SCI) and its relationship with personal and injury characteristics. We investigated 132 subjects with SCI (37 with tetraplegia) at the start of active rehabilitation (t1), 3 months later (t2), and at the end of clinical rehabilitation (t3). WPC was measured as the maximal power output that can be achieved in a maximal wheelchair exercise test on a treadmill. Results were analyzed with the use of generalized estimating equations, with time of measurement, lesion level, motor completeness of the lesion, age, and gender as independent variables. Overall, WPC increased from 30.5 W at t1, to 39.5 W at t2, and 44.2 W at t3. Persons with paraplegia, persons with incomplete lesions, men, and younger persons had higher values for WPC compared with persons with tetraplegia, persons with complete lesions, women, and older persons. Rate of improvement was lower in older persons and women compared with younger persons and men. This paper identifies factors that affect the level (lesion level, completeness of the lesion, age, gender) and rate of improvement (age, gender) of WPC during rehabilitation. These findings should be considered when wheelchair capacity training is applied in SCI rehabilitation.

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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 medicare power wheelchairs and medical scooters propulsion and traditional manual wheelchair propulsion among subjects with tetraplegia. DESIGN: Repeated measures. SETTING: A biomechanics laboratory within a Veterans Affairs medical center. PARTICIPANTS: Fifteen full-time manual wheelchair users who had sustained cervical-level spinal cord injuries. INTERVENTIONS: Participants propelled both their own manual wheelchairs and a PAPAW through 3 different resistances (slight, 10W; moderate, 12W; high, 14W) on a wheelchair dynamometer. Each propulsion trial was 3 minutes long. MAIN OUTCOME MEASURES: Primary variables that were compared between the 2 wheelchairs were participants mean steady-state oxygen consumption, ventilation, heart rate, mean stroke frequency, and maximum upper-extremity joint ROM. RESULTS: When using the PAPAW, participants showed a significant ( P <.05) decrease in mean oxygen consumption and ventilation throughout all trials. Mean heart rate was significantly lower when using the PAPAW for the high resistance trial. Stroke frequency was significantly lower when using the PAPAW for the slight and moderate resistances. Overall joint ROM was significantly lower when using the PAPAW. CONCLUSIONS: For subjects with tetraplegia, PAPAWs reduce the energy demands, stroke frequency, and overall joint ROM when compared with traditional manual wheelchair propulsion.

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