A Comparative Analysis of Tractor Seating for Individuals with Spinal Cord Injury Using a Pressure Mapping System

Purpose: Research is limited in addressing the many factors and variables associated with enabling farmers/ranchers with disabilities and health impairments to sit within and operate dynamic agricultural equipment safely, comfortably, and without integument and musculoskeletal injury. As an initial foray into investigating this problem, an independent study project by graduate students in an occupational therapy program compared the seated pressure distribution of two people with paraplegia. Six testing conditions were completed while participants were seated upon two different tractor seats under static conditions. Methodology: Using a quantitative cross-over design, two adult subjects with paraplegia meeting the inclusion criteria were recruited using a convenience sampling method to participate in this study. The subjects reported having a complete injury of a motor and sensory function below the level of the lesion T5 and T8. Utilizing a clinical protocol for pressure mapping from XSensor®, each participant completed six trials on two different tractor seats: without a cushion, with a Low Profile® ROHO ® air bladder cushion, and with a Mid Profile® ROHO® airbladder cushion. Analysis of the data was conducted through selected clinical methods. Results: Of the six testing conditions in this particular study, incorporating a Mid Profile® ROHO® cushion is indicated for use on both tractor seats by both subjects in the study to achieve lower overall average pressures, distribute body weight over a greater surface area, increase immersion and flotation on the seating surface, and lower pressures under bony prominences such as the ischial tuberosities. Conclusion: Due to limited participants in this exploratory study, statistical conclusions cannot be made and generalization of the results to a larger population cannot be drawn at this time. The findings do support the need for future tractor seating studies with people with different disabilities and health impairments within static and dynamic systems. For purposes of clinical decision-making, the independent study provides important information for farm operators with disabilities and health impairments and the professionals providing services to them to better understand the many factors and variables associated with seating in agricultural machinery. Pressure mapping is clearly one clinical tool to be used when considering the seating needs of people with disabilities in agricultural equipment

Effects of Seat and Axle Position on Pain, Pathology, and Independence in Pediatric Manual Wheelchair Users with Spinal Cord Injury

Manual wheelchair (MWC) users with spinal cord injury (SCI) rely heavily on their upperextremities to complete daily occupations. Due to repetitive shoulder use during wheelchair mobility and propulsion, MWC users are at greater risk of shoulder pain and shoulder pathology, and thus decreased independence, and lower quality of life. The relative fit of the wheelchair and its parameters are critical and can further impact the user’s propulsion biomechanics. Parameters such as seat angle and axle position may put the user in detrimental shoulder positions for longer periods of time, impacting health outcomes even more. Although the effects of wheelchair setup on health outcomes have been explored in adult populations, little is known about the impact on pediatric MWC users, which is unfortunate because these children will live with the secondary medical conditions of an SCI longer than their adult counterparts. Limited research also exists on the wheelchair parameters currently being used by pediatric MWC users with SCI, and there are very few recommendations for wheelchair setup and fit specific to the pediatric population. This study aims to explore the seat and axle positions that are currently being used by pediatric MWC users with SCI, to identify the presence of shoulder pain and pathology in this population, and to determine if the relative fit of the pediatric wheelchair is related to pain, pathology, or independence scores in children with SCI. A total of 9 pediatric MWC users with SCI, ages 6-21, participated in this study. Three-dimension (3D) kinematics data were collected using 14-camera Vicon (Oxford Metric Group, Oxford, UK) Vantage and TS motion analysis systems. Shoulder pathologies were identified using diagnostic and quantitative ultrasound. Pain and independence outcomes were analyzed using the Wheelchair Users Shoulder Pain Index (WUSPI) and the Spinal Cord Independence Measure (SCIM). The mean seat angle used by the group was 5.16 degrees of elevation. Of the 9 participants, 7 used rearward axle positions in relation to their shoulders, while 2 used the adult recommended, forward axle position. Similarly, 4 of the participants followed the adult guideline to have an elbow flexion angle between 100-120 degrees, while 5 of the participants had their axles positioned non-optimally in the vertical direction according to adult guidelines. Shoulder pathologies were identified in 44% of the participants, and the average occupation ratio (percentage of the subacromial space occupied by the supraspinatus tendon) for the supraspinatus tendon was 69.62%. The average WUSPI score for the group was a 3.40 out of 150, and 4 of the 9 participants reported experiencing some level of shoulder pain on the assessment. The average SCIM score for all participants was a 67.13 out of 100, with age and time since injury strongly and significantly correlating with independence scores. After analyzing the data, a strong negative correlation between seat angle and occupation ratio was found. There was also a moderate correlation between the use of a non-optimal elbow angle and a higher WUSPI score. Finally, there was a strong positive correlation between seat angle and SCIM independence scores. Only weak correlations were found between horizontal axle positioning and the various outcomes, unlike the adult population. Results of this study will help to inform clinical decision-making when prescribing wheelchairs to children with SCI and when making wheelchair setup recommendations to pediatric MWC users and their families

Future bathroom: A study of user-centred design principles affecting usability, safety and satisfaction in bathrooms for people living with disabilities

Research and development work relating to assistive technology 2010-11 (Department of Health) Presented to Parliament pursuant to Section 22 of the Chronically Sick and Disabled Persons Act 197

The Design of Compliant Seating for Children with Severe Whole Body Extensor Spasms

Children with cerebral palsy and powerful whole body extensor spasms find sitting in a rigid seat uncomfortable and sometimes painful due to the large forces they apply to their constraints. They are usually unable to speak and communication is difficult. The spasms affect every aspect of their lives. This thesis describes the genesis of a new functional dynamic seat for children with severe whole body extensor spasms, and the novel method used to design it. This novel seat technology is known as 'Whole Body Dynamic Seating'. The thesis describes the clinical need this seat addresses, and the design and technology context in which this research takes place. The user evaluation, observation, measurement, analysis and reasoning that led to a successful seat design are described in detail. Children with cerebral palsy sometimes have whole body spasms that mean they cannot be seated in conventional static seating that positions a child in a fixed posture. For this research the children were classified as functioning at Chailey Sitting Ability Level 1 and Gross Motor Functional Classification System Level V. Such children spend much of their time being held by a person, or lying on a mat, bed or pad. This results in difficulty with social engagement and physical functioning, particularly in school. This research created a seat that such children could sit in, providing a comfortable and functional seat for use in a home or school classroom environment. This seat was designed with the direct and essential involvement of disabled children, their parents, therapists, teachers and carers. The work is part of a larger programme of research into seating and support technology that will enhance a child's ability to gain functional movement and communication skills that can be employed to enable the child's free self expression and social participation. The research investigated means of supporting children with whole body extensor spasms through a progressive iterative method utilizing direct user evaluation of a series of prototypes incrementing in complexity and fidelity towards a fully functional physical seat. An iterative method was used to design, build and evaluate three dynamic seats. This method incorporated two new approaches to prototyping developed for the research programme in response to difficulties encountered in designing dynamic systems for children with highly complex neuromotor disability. Soft and Semi-soft prototyping and evaluation methods provided essential feedback on dynamic seating concepts that guided proposed solutions, without requiring costly and time-consuming manufacture. Video was used to create a record of the children's movements and responses for subsequent analysis. Instrumentation was built into the seats to enable direct objective measurement of the reaction forces and seat movement caused by extensor spasms. This thesis presents several unique features created through this research programme: 1. Independent and virtually hinged anatomical dynamic thigh supports; 2. Independent anatomical dynamic foot supports; 3. A virtually hinged dynamic back support; 4. An anatomical dynamic head support concept. 4 III The final Whole Body Dynamic Seat was child-centred in its functionality and aesthetic design, and was favourably commented upon by parents, children and school staff. Use of the new dynamic seating by three children (including one from a previous work programme) showed that children with severe whole body extensor spasms can be seated comfortably. The children also demonstrated gains in physical and social function as a result of using the dynamic seats. The two fully independent dynamic seats made advances in comfort over static seating for children with whole body extensor spasms. One of the children especially liked the seat and resisted being put back into his usual seating. An adult with severe cerebral palsy and extensor spasms evaluated a dynamic foot support concept and reported very significant reductions in spasticity and pain, and gains in physical function. The Whole Body Dynamic Seats showed gains in postural symmetry and in hand and head function over the usual static seats when used by the children with spasms. These gains were reported by staff during long term evaluations and measured specifically during the final evaluation. Two children learned to control the movement of seats in which they were sat, and were able to control their posture and use that control to carry out functions such as switch pressing. Such learning through the use of dynamic seating by children with severe dystonic cerebral palsy and whole body extensor spasms has not previously been documented. The seats did not just affect the children - school staff were affected too. School staff working around the children in the dynamic seats were observed to be more inclusive towards the children, and to expect more interaction from them. The ability of the children to move altered staff expectations of their ability to participate and communicate. This new seating has improved the quality of life of the children that use it. Future implementation of this technology in commercially produced seating offers the possibility of similar gains to many more severely disabled children who are currently less comfortable and less functional than they need to be. 5EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Markerless Kinematics of Pediatric Manual Wheelchair Mobility

Pediatric manual wheelchair users face substantial risk of orthopaedic injury to the upper extremities, particularly the shoulders, during transition to wheelchair use and during growth and development. Propulsion strategy can influence mobility efficiency, activity participation, and quality of life. The current forefront of wheelchair biomechanics research includes translating findings from adult to pediatric populations, improving the quality and efficiency of care under constrained clinical funding, and understanding injury mechanisms and risk factors. Typically, clinicians evaluate wheelchair mobility using marker-based motion capture and instrumentation systems that are precise and accurate but also time-consuming, inconvenient, and expensive for repeated assessments. There is a substantial need for technology that evaluates and improves wheelchair mobility outside of the laboratory to provide better outcomes for wheelchair users, enhancing clinical data. Advancement in this area gives physical therapists better tools and the supporting research necessary to improve treatment efficacy, mobility, and quality of life in pediatric wheelchair users. This dissertation reports on research studies that evaluate the effect of physiotherapeutic training on manual wheelchair mobility. In particular, these studies (1) develop and characterize a novel markerless motion capture-musculoskeletal model systems interface for kinematic assessment of manual wheelchair propulsion biomechanics, (2) conduct a longitudinal investigation of pediatric manual wheelchair users undergoing intensive community-based therapy to determine predictors of kinematic response, and (3) evaluate propulsion pattern-dependent training efficacy and musculoskeletal behavior using visual biofeedback.Results of the research studies show that taking a systems approach to the kinematic interface produces an effective and reliable system for kinematic assessment and training of manual wheelchair propulsion. The studies also show that the therapeutic outcomes and orthopaedic injury risk of pediatric manual wheelchair users are significantly related to the propulsion pattern employed. Further, these subjects can change their propulsion pattern in response to therapy even in the absence of wheelchair-based training, and have pattern-dependent differences in joint kinematics, musculotendon excursion, and training response. Further clinical research in this area is suggested, with a focus on refining physiotherapeutic training strategies for pediatric manual wheelchair users to develop safer and more effective propulsion patterns