Availability and need of home adaptations for personal mobility among individuals with spinal cord injury

<p><b>Objective</b>: To identify the availability and unmet need of home adaptations (HAs) among the Swiss population with spinal cord injury (SCI).</p> <p><b>Design</b>: Cross-sectional study.</p> <p><b>Setting</b>: Swiss Spinal Cord Injury Community Survey 2012.</p> <p><b>Participants</b>: Individuals aged 16 or older with chronic SCI living in Switzerland.</p> <p><b>Interventions</b>: Not applicable.</p> <p><b>Outcome measures</b>: The availability of ten HAs (self-report) was analyzed by sex, age, living situation, indoor mobility, SCI severity, SCI etiology and time since SCI. The unmet need (self-report of not having a HA but needing it) of HAs was analyzed by financial hardship.</p> <p><b>Results</b>: Among the 482 study participants (mean age 55.2 years, standard deviation 15.0 years, 71.6% males), 85.1% had at least one HA. The most frequent HA was a wheelchair accessible shower (62.7%). Availability of HAs markedly varied with indoor mobility (e.g. 38.4% of participants using a wheelchair had a stair lift compared to 17.4% of those walking) and with SCI severity (e.g. 54.8% of those with complete paraplegia had a wheelchair accessible kitchen worktop compared to 26.0% of those with incomplete paraplegia). Unmet need was highest for adjustable kitchen worktops (78.7% of those with a need) and adjustable kitchen cabinets (75.7%) and lowest for wheelchair accessible showers (9.4%) and grab bars next to the toilet (8.5%). No significant differences in unmet need were found when stratifying for financial hardship.</p> <p><b>Conclusion</b>: Availability of HAs is dependent on indoor mobility and SCI severity. There is a considerable degree of unmet need for selected HAs, which couldn't be explained by financial hardship.</p

Shoulder tendon adaptations following a graded exercise test to exhaustion in highly trained wheelchair rugby athletes with different impairments

Objective: This study aimed to identify acute changes in biceps and supraspinatus tendon characteristics before and after a graded exercise test to exhaustion (GXT) in highly trained wheelchair rugby (WR) athletes. A secondary aspect was to define chronic tendon adaptations related to the impairment of the athlete and the occupation of the tendon within the subacromial space (occupation ratio). Methods: Twelve WR athletes with different impairments (age = 32 ± 6 years; body mass = 67.2 ± 11.2 kg; 9.0 ± 3.6 years competing) volunteered for this study. Performance Corrected Wheelchair Users Shoulder Pain Index was used to quantify shoulder pain. Quantitative Ultrasound Protocols were used to define supraspinatus and biceps tendon thickness, echogenicity, and echogenicity ratio of both dominant and non-dominant shoulder before and after the GXT including 22 ± 3.1 min submaximal propulsion and 10.2 ± 1.7 min maximal propulsion on a treadmill. Furthermore, the acromio-humeral distance defined from ultrasound images was used to calculate the occupation ratios. Results: A mixed-effect multilevel analysis that included shoulder as grouping variable, demonstrated a significant reduction in the echogenicity of the biceps following GXT whilst controlling for impairment (spinal cord injury (SCI) and non-SCI) and the occupation ratio (β = -9.01, SEβ = 2.72, p = 0.001, 95% CI = [-14.34;-3.68]). This points towards fluid inflow into the tendon that may be related to overload and acute inflammation. In addition, persons with a SCI (n = 8) had a thicker supraspinatus tendon in comparison to persons with non-SCI (n = 3) which may be related to chronic tendon adaptations (β = - 0.53mm, SEβ = 0.26, p = 0.038, 95% CI = [-1.04;-0.03]). Finally, a greater occupation ratio was associated with signs of tendinopathy (i.e., greater biceps and supraspinatus tendon thickness, and lower supraspinatus echogenicity and echogenicity ratio). Conclusion: Acute biceps tendon adaptations in response to the GXT in highly trained WR athletes were evident with chronic adaptations in the supraspinatus tendon being related to the impairment of the athlete. Ultrasound can be used to monitor tendon adaptations in WR athletes for medical diagnosis to assist the scheduling and type of training.</div

Power output and energy cost: crucial measures to understand motor skill learning in handrim wheelchair propulsion

BACKGROUND: This current opinion is a call for standardization of measurements of manual wheeling ability among larger and diverse populations to support our understanding of motor control and learning. VIEW OF THE PAST: Handrim wheelchair propulsion remains the most common mode of wheeled ambulation and has stood the test of time as a practical upper-body alternative to walking. CURRENT STATE: Two theoretical models appeared useful in understanding the demands on the wheelchair-user combination and the role of motor skill acquisition: Power Balance Model and Constraint-based Approach. FUTURE PERSPECTIVE: Power output and energy cost measures are crucial mediators in the development of a motor control theory of cyclic motions in rehabilitation, adapted sports and beyond.</p