Title

Wheelchair Training Program for New Manual Wheelchair Users

Author's School

Graduate School of Arts and Sciences

Author's Department/Program

Movement Science

Language

English (en)

Date of Award

Spring 5-15-2015

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Chair and Committee

Jack R Engsberg

Committee Members

Gammon Earhart, David B Gray, Joe Klaesner, Catherine Lang, Michael Mueller, Glen White

Abstract

Manual wheelchairs are commonly used for everyday mobility among people with lower limb impairments, including persons with spinal cord injury (SCI). Manual wheelchair users often experience pain and chronic overuse injuries in their upper extremities, limiting their mobility and their ability to complete daily activities. The repetitive trauma of propelling a wheelchair may be a contributing factor to upper extremity pain and injury. The anatomy of the upper extremities is not designed for the number of repetitions and the amount of force involved in everyday wheelchair propulsion. Research has been conducted to identify recommendations for decreasing the number of repetitions and the amount of force involved with manual wheelchair propulsion; however, training on how to use a wheelchair, specifically propulsion training, is often not implemented during rehabilitation. Important steps in identifying strategies for teaching wheelchair propulsion and skills include exploring devices for training, understanding health care professional and wheelchair user perspectives of wheelchair training, and training based on motor learning approaches. Therefore, the overall goal of this project was to further explore methodology for training of new manual wheelchair users. To this end, we conducted three studies (Chapters 2-4).

In study 1 (Chapter 2), we tested a wheelchair dynamometer roller system, the WheelMill System (WMS), on its use in simulating different surfaces (i.e., overground and ramps) and assessing propulsion variables that can be used for training new wheelchair users. We identified that the WMS has the ability to accurately simulate flat overground movement; however, the accuracy of the WMS was poor in simulation of ramps. Modifications to the software model and the addition of visual feedback may improve the accuracy of the simulation of ramps. The WMS was accurate in the quantification of biomechanical propulsion variables.

In study 2 (Chapter 3), we identified perspectives of health care professionals and manual wheelchair users to assist in prioritizing the focus of wheelchair skills training of new manual wheelchair users. During focus groups, health care professionals and manual wheelchair users discussed if and how wheelchair propulsion biomechanics were taught and important skills that should be included in training. Results indicate that propulsion biomechanics were introduced but not addressed in detail. Important training components discussed include propulsion techniques, transfers in an out of the wheelchair, providing maintenance to the wheelchair, and navigating barriers such as curbs, ramps, and rough terrain. Health care professionals and manual wheelchair users identified many of the same skills as important but ranked them in a different order.

In study 3 (Chapter 4), we piloted a wheelchair training program implementing aspects of motor learning for new manual wheelchair users and measured the impact of this program on wheelchair propulsion biomechanics and overall wheelchair skills. Post-training wheelchair biomechanics changed, as well as propulsion performance overground. Wheelchair skills did not change significantly post-training. Wheelchair training has the potential for change; however, there are many challenges associated with implementing training programs for new manual wheelchair users.

Together, these results contribute knowledge to evidence-based approaches to teaching new manual wheelchair users with SCI how to efficiently and effectively use their wheelchairs. Specifically, we obtained information about technology for simulating and assessing manual wheelchair propulsion, perspectives of stakeholders with regard to the manual wheelchair training process, and methodology for training new manual wheelchair users.

DOI

https://doi.org/10.7936/K7XG9P95

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