INVESTIGATION OF TRANSFER TECHNIQUE BIOMECHANICS AMONG PERSONS WITH TETRAPLEGIA AND PARAPLEGIA

Due to lower limb paralysis people with SCI rely heavily on their upper extremities (UEs) for performing activities of daily living (ADL) of which wheelchair transfers lists as one of the ADL’s that are particularly taxing on the UEs. Preservation of UE function is extremely important to maintain independence and quality of life amongst people with Spinal Cord Injury. Although the Paralyzed Veterans of America developed Clinical Practice Guidelines to preserve UE function, limited research/recommendations are available for optimal transfer strategies that reduce loading on UE joints. Specific aims of this dissertation were to 1) Describe biomechanical strategies for preferred methods of transferring amongst persons with paraplegia and tetraplegia (Chapter 2), 2) Determine how taught transfer techniques and self-selected transferring reduce mechanical loading at the UE (Chapter 3), 3) Investigate how upper limb strength and balance impact loading at the UE joints during transfers (Chapter 4). 20 participants took part in the study, only 18 (17 male and 1 female) could execute the taught techniques. The group consisted of 12 persons with paraplegia (6 with complete & 6 with incomplete injury) and 6 with tetraplegia (all with incomplete injury). A custom transfer measurement system was used to capture kinetic and kinematic measures of the UEs and feet while participants performed wheelchair transfers. Participants performed self-selected transfers & three transfer techniques that varied on leading hand placement and trunk flexion. Functional measures recorded included: Strength, balance, anthropometrics and pain scores. Comparison of mechanical loading between the group with paraplegia and tetraplegia shed light on potential risk of injuries that may occur for each individual group. Taught technique comparison pointed towards a tradeoff, among force and moment components, at the leading and trailing arms, influenced by leading hand placement compared to amount of trunk flexion. Primarily a modified trunk upright technique was employed, trunk remained upright and hand placed close to the body, as preferred method of transferring. Impact of functional measures on transfer kinetics showed that transfer strategy may override functional capacity. Findings of this study will assist in refining clinical practice guidelines on safe level sitting pivot transfer strategies

A conceptual framework to assess effectiveness in wheelchair provision

Background: Currently, inadequate wheelchair provision has forced many people with disabilities to be trapped in a cycle of poverty and deprivation, limiting their ability to access education, work and social facilities. This issue is in part because of the lack of collaboration among various stakeholders who need to work together to design, manufacture and deliver such assistive mobility devices. This in turn has led to inadequate evidence about intervention effectiveness, disability prevalence and subsequent costeffectiveness that would help facilitate appropriate provision and support for people with disabilities. Objectives: In this paper, we describe a novel conceptual framework that can be tested across the globe to study and evaluate the effectiveness of wheelchair provision. Method: The Comparative Effectiveness Research Subcommittee (CER-SC), consisting of the authors of this article, housed within the Evidence-Based Practice Working Group (EBP-WG) of the International Society of Wheelchair Professionals (ISWP), conducted a scoping review of scientific literature and standard practices used during wheelchair service provision. The literature review was followed by a series of discussion groups. Results: The three iterations of the conceptual framework are described in this manuscript. Conclusion: We believe that adoption of this conceptual framework could have broad applications in wheelchair provision globally to develop evidence-based practices. Such a perspective will help in the comparison of different strategies employed in wheelchair provision and further improve clinical guidelines. Further work is being conducted to test the efficacy of this conceptual framework to evaluate effectiveness of wheelchair service provision in various settings across the globe

Measuring met and unmet assistive technology needs at the national level: Comparing national database collection tools across eight case countries

The development and implementation of assistive technology policy that meets the needs of citizens is dependent on accurate data collection and reporting of assistive technology use and unmet needs on a national level. This study reviews the methodology from instruments intended to capture national statistics on assistive technology use across eight case countries from varying regions and income levels. Recommendations are provided, which highlight the need for mandatory, census level data collection according to international standards for data collection in the areas of disability and assistive technology