The Effect of External Power Output and Its Reliability on Propulsion Technique Variables in Wheelchair Users With Spinal Cord Injury

The purpose of this study was to assess 1) how treadmill slope variance affected external power output (PO) and propulsion technique reliability; and 2) how PO is associated with propulsion technique. Eighteen individuals with spinal cord injury performed two wheelchair treadmill exercise blocks (0% and 1% treadmill slope, standardized velocity) twice on two separate days. PO, velocity, and 14 propulsion technique variables were measured. In a follow-up study, N = 29 performed wheelchair treadmill drag tests. Target and actual slope were documented and PO, intraclass correlation coefficients (ICC) and smallest detectable differences (SDD) were calculated. Within and between visits, the reliability study ICCs were perfect for velocity (1.0), weak for PO (0.33-0.46), and acceptable (>0.70) for five (0% slope) and 10 (1% slope) propulsion technique variables, resulting in SDDs of 35-196%. Measured PO explained 56-90% of the variance in key propulsion technique variables. In the follow-up, PO ICCs were weak (0.43) and SDDs high. Bias between target and actual slope appeared random. In conclusion, PO variability accounts for 50-90% of the variability in propulsion technique variables when speed and wheelchair set-up are held constant. Therefore, small differences in PO between interventions could mask the effect of the interventions on propulsion technique

Ground reaction force patterns in children with idiopathic unilateral clubfeet

Clubfoot is a common birth defect affecting 2-3 children per 100 live births. The child is born with a foot in equinus, forefoot adduction, and heel varus. The defect primarily lies within the subtalar joint, the articulation between the talus and calcaneus. Assessment of the clubfoot, to date, depends upon clinical measurement, radiographic measurements, and observations of the child's gait. The clinical measurements are subjective in nature. While the radiographic measures are more objective, they have shown to be poorly correlated with the clinical outcome. The problem in assessing clubfeet is the lack of a dynamic objective assessment which correlates well with the clinical assessment. The purpose of this study is examine the differences between ground reaction force patterns in children with normal feet versus children with clubfeet, and more specifically determine whether there is a significant correlation between subtalar motion and vertical moment. Three groups of feet were used for the study: the first group included one foot from children with normal feet (n=16), the second group included the affected clubfoot of children with unilateral clubfoot (n=7), and the third group included the intact foot of the children with clubfoot (n=7). The children's feet were clinically examined by an orthopaedic resident, measuring ankle and subtalar range of motion, and heel position on stance. Ground reaction force data was collected with 3 trials for each group for each subject. One way ANOVA's showed significant differences between the clubfoot group and the intact foot group and the normal foot group for all clinical parameters. Regression analysis showed that the net vertical moment correlated highly (r=.84) with the subtalar range of motion and heel position in the clubfoot and intact groups, however, not the normal group. For example, a more rigid, varus foot produced a greater internal net torque. The net anterior-posterior impulse correlated highly (r=.92) with ankle range of motion. Thus, an ankle with a greater range of motion produced a greater propulsive force. The rigid and varus nature of the clubfoot does reduce the foot's ability to efficiently absorb and transmit the torque produced by the leg. The restricted ankle range of motion in the clubfoot also affects the ability for the foot to produce a normal powerful propulsive force during gait. This limited propulsion may be cause by the current standard of treatment of the clubfoot. A surgeon could perform an anterior wedge osteotomy of the tibia instead of an achilles lengthening to obtain adequate dorsiflexion and maintain a strong plantarflexor muscle. Before any of these conclusions can be made with confidence, a study with more subjects needs to be undertaken.Education, Faculty ofCurriculum and Pedagogy (EDCP), Department ofGraduat

Comparison of wheelchair wheels in terms of vibration and spasticity in people with spinal cord injury

A wheelchair undergoes vibrations while traveling over obstacles and uneven surfaces, resulting in whole body vibration of the person sitting in the wheelchair. According to clinicians, people with spinal cord injury (SCI) report that vibration evokes spasticity. The relatively new Spinergy wheelchair wheels (Spinergy, Inc; San Diego, California) are claimed to absorb more road shock then conventional steel-spoked wheelchair wheels. If this claim is true, this wheel might also reduce spasticity in people with SCI. We hypothesized that Spinergy wheels would absorb vibration, reduce perceived spasticity, and improve comfort in individuals with SCI more than standard steel-spoked wheels. To test this hypothesis, 22 nondisabled subjects performed a passive ramp test so that we could more closely examine the dampening characteristics of the Spinergy versus traditional wheels. Furthermore, 13 subjects with SCI performed an obstacle test with both wheel types. Vibrations were measured with accelerometers, and spasticity and comfort were assessed with subject-reported visual analog scales. The results of the study showed that, within the current experimental setup, the Spinergy wheels neither reduced vibration or perceived spasticity nor improved comfort in people with SCI more than the conventional steel-spoked wheels

Contrasting Internet and Face-to-Face Focus Groups for Children with Chronic Health Conditions: Outcomes and Participant Experiences

In this study the authors examined Internet-mediated qualitative data collection methods among a sample of children with chronic health conditions. Specifically, focus groups via Internet technology were contrasted to traditional face-to-face focus groups. Internet focus groups consisted of asynchronous text-based chat rooms lasting a total of one week in duration. Participants comprised 23 children with cerebral palsy, spina bifida, or cystic fibrosis, who were assigned to either an Internet or face-to-face focus group. Focus group analysis and follow-up participant interviews identified a range of content outcomes and processes as well as participant experiences and preferences. Findings yielded differences in terms of the volume and nature of online and face-to-face data, and participants' affinity to focus group modality appeared to reflect differences in participant expectations for social engagement and interaction. This study identifies both benefits and limitations of asynchronous, text-based online focus groups. Implications and recommendations are discussed

Providing Accessible ReCreation Outdoors–User-Driven Research on Standards: Protocol for Mobile and Web-Based Interviews for Winter Assessments

BackgroundAlthough there have been recent efforts to improve access to Canadian national parks, many remain not fully accessible to people with disabilities. Winter conditions, in particular, present challenges that limit their participation in outdoor activities. ObjectiveThis study aimed to develop a novel method to assess park access during winter, which will inform recommendations for national park standards to meet the needs of all park visitors (regardless of ability) during winter conditions. MethodsA larger participatory mixed methods research project exploring park access was adapted. A 3-phase approach has already been proposed to achieve the study objectives. In the first phase, a scoping review of the existing accessibility standards will be conducted. In the second phase, objective audits of trails and features in 6 parks, 3 in western Canada and 3 in eastern Canada, will be conducted, as well as mobile interviews with 24 various participants in each region regarding their experiences of and recommendations for improving the park’s accessibility. In the final phase, a Delphi participatory consensus development process will be used, based on the data gathered in the first 2 phases, to prioritize recommendations for standards. This paper will focus on the second phase of the study, specifically on whether the in-person winter mobile interviews (ie, walking and wheeling interviews) with people who have a wide range of disabilities while visiting 3 parks in 2 provinces were modified. Changes were made to accommodate the extreme winter weather conditions in Quebec while using safe and informative data collection methods. ResultsIn Quebec, one park, where winter conditions are safer, has been assessed in person (n=4). Web-based interviews were used to facilitate the assessment of other winter and summer conditions in two other parks (n=8). Winter and web-based interviews were completed in April 2022. Data are currently being collected and analyzed, and results will be completed by December 2022. ConclusionsWe expect that adapting the protocol to gather further information on winter conditions and access to parks will provide high-quality and rich data to better inform park access standards. This participatory mixed methods research will inform the development of park standards that consider the accessibility needs of all people. International Registered Report Identifier (IRRID)DERR1-10.2196/3871