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Volume 4, Issue 1, Spring 2005
HERL recently began a collaborative relationship with Walter Reed Army Medical Center (WRAMC) to promote research, translate research into clinical practice, and provide research education. The ultimate goal of this partnership is to start joint HERL-WRAMC research and development activities to improve coordination and provide state-of-the-science assistive technology services between and within the VA and Department of Defense (DoD).
Walter
Reed Army Medical Center (WRAMC) is
the Army’s primary care provider for ill or injured service members who are
evacuated to the medical center for specialty treatment. WRAMC sends its own
staff into harm’s way to provide their quality care. By the end of 2004, the
medical staff at WRAMC has treated more then 4,100 wounded, ill or injured
soldiers from both Operation Iraqi Freedom (OIF) and Operation Enduring Freedom
(OEF), including over 1,050 whose wounds or injuries resulted from enemy action.
Many of the battle field casualties are soldiers who have had amputated limbs.
There have been about 84 medical evacuations from the theatre of war to WRAMC
for spinal cord or column injuries. Army physicians nationally recognized for
their skill, training and experience lead Walter Reed’s departments and
services.
Because
of the high number of soldiers who have had to have limbs amputated, Congress
appropriated funds for a specialty Amputee Care Program and construction of an
Amputee Patient Care Center. The Amputee Care Program is under the medical
directorship of LTC Paul F. Pasquina, MD, physiatrist and Chief of the Physical
Medicine and Rehabilitation (PM&R) Service.
The Amputee Care Program is supported by PM&R, orthopedic surgery,
occupational and physical therapy, social work, psychiatry, nursing, prosthetics
and orthotics, anesthesiology, and Department of Veterans Affairs counselors.
HERL director Rory A. Cooper, Ph.D. and Dr. Pasquina met in December, 2003 when the VA Prosthetics and Special Disabilities Populations Advisory Committee made a visit to Ward 57 at WRAMC. Orthopedics and rehabilitation services have responsibility for Ward 57. They met again in July of 2004 during congressional testimony about the progress of medical rehabilitation of OEF and OIF soldiers and the possible use of research available from the VA Rehabilitation Research & Development Centers. In October, 2004, they met again at the White House Conference on Assistive Technology and the New Freedom Initiative sponsored by the VA and the White House Office of Science and Technology. In November, 2004 Dr. Cooper presented “Grand Rounds” for WRAMC PM&R. This led to the idea of holding a more comprehensive workshop on wheelchairs and seating, as many of the soldiers being treated by WRMAC-PM&R are provided wheelchairs. In December, 2004, Drs. Cooper and Pasquina met and communicated frequently to plan the workshop.
This
workshop, entitled “State-of-the-Science Workshop: Wheelchair Research and
Clinical Practice,” was
at WRAMC in Washington, DC on January 14, 2005.
About 120 people attended the conference, including staff from WRAMC, Bethesda
Naval Medical Center, VA, National Institutes of Health, Agency for Healthcare
Research and Quality, and the National Institute for Disability and
Rehabilitation Research. The workshop was simultaneously broadcast through the
WRAMC education services, and medical centers in Texas, Georgia, and New York
participated remotely. The entire workshop was videotaped and will be made
available to VA and DoD facilities for educational purposes. The presentations
are posted on the HERL web-site (www.herlpitt.org).
The
Workshop was kicked-off by a welcome by Dr. Pasquina, who gave an overview of
the services provided by PM&R and affiliated services at WRAMC. HERL Medical
Director Michael L. Boninger, MD gave a presentation about training of
physiatrists and other rehabilitation professionals in research and assistive
technology service delivery. Alicia M. Koontz, PhD, RET, a HERL research
scientist, was the second speaker and she presented manual wheelchair selection
and fitting as well as transfers. HERL Clinical Coordinator Rosemarie Cooper,
MPT, ATP followed and spoke on pressure management and seating systems. Erik J.
Wolf, MS, a HERL Ph.D. candidate, was the final speaker who addressed electric
powered wheelchair research and clinical practice.
Research
coordinator Paula Stankovic and doctoral student Jon Pearlman from HERL also
volunteered for the workshop, coordinating registration/continuing education
paperwork for the seminar and assisting with the slalom competition later that
afternoon.
The
Workshop adjourned for lunch, which was provided to all of the participants by
the Paralyzed Veterans of America. Dr. Cooper presented during lunch, providing
an overview of the VA Rehabilitation Research and Development Centers.
For
the afternoon’s slalom and wheelchair skills training session, HERL had
constructed several obstacles, such as stairs, a horizontal ladder, ramps,
platforms, doorway, a large hemp rope, and a piece of plywood with obstacles
screwed to it. Rosemarie Cooper explained each of the obstacles and the
importance of training mobility skills. Rory Cooper went through the course and
described how to maneuver through each obstacle. He was then timed while racing
through the course, to many hoops, hollers and shouts of “Hooah”. The
wounded soldiers were impressed and motivated to overcome these obstacles to
daily living.
The need to teach and learn “wheelie” skills was emphasized when working with the young athletic patients often being seen at WRAMC and other DoD medical facilities. The course was modified for power wheelchairs and the power chair users discovered that many obstacles can be overcome by using an electric powered wheelchair. After the wheelchair skills demonstrations, people (including OIF/OEF patients) were paired to learn and teach each other manual and powered mobility skills. After gaining greater experience, some of the patients and clinicians attempted the slalom course, achieving a greater appreciation for what can be done in a wheelchair and the importance for proper selection and fitting.
A second HERL/WRAMC “State-of-the-Science Workshop” focusing on Traumatic Brain Injury is scheduled to be held at WRAMC on April 22, 2005. Details and registration for the workshop will be available on www.herlpitt.org.
-written by Christine Heiner and Rory Cooper, Ph.D.
The GAMECycle Exercise System: A Comparison to Standard Ergometry
Shirley G. Fitzgerald, Ph.D., Rory A. Cooper, Ph.D., Tricia Thorman, MOT, Rosemarie Cooper, MPT,
SongFeng Guo, PhD,
Michael L. Boninger, MD
Full Article
Appeared in Journal of Spinal Cord
Medicine, Vol. 27, No. 5, pp. 453-459, 2004.
Purpose of work: Physical activity
is well established to be beneficial to health. For individuals who use
wheelchairs, a regular exercise program might not be available or may be too
difficult to participate in physically and/or psychologically. Many exercise
devices and regimes can be boring. The goal was to develop a device that made
exercise more exciting. A person may have more motivation to exercise or may
exercise for a longer period of time yielding increased energy expenditure when
an activity is more exciting. To this end, our laboratory developed an interface
between an arm cycle and a computer game that allows the user to control game
play on the screen as if using a joystick. This device was called GAMECycle.
The purpose of this study was to determine whether the GAMECycle
would elicit an exercise effect similar to arm cycle.
Subjects/Procedures: Thirteen
individuals who used wheelchairs participated in the study. Subjects were asked
to exercise for two separate, nineteen-minute sessions. For one session, a GAMECycle
system was used; for the other session, the same arm cycle was used, but without
the computer game being played. Data on heart rate, oxygen consumption, and the
subjects feelings regarding amount of exercise they were doing was collected.
Results: Significant differences
for oxygen consumption were found between playing the game and not playing the
game. No differences were found
between the two trials with respect to the subjects’ feelings of exercising.
Relevance to Wheelchair Users: GAMECycle appears to be similar in nature to amount of energy that used to exercise as compared to an arm cycle. The use of outside influences (such as game play) may increase the desire to exercise, which would ultimately benefit one’s health.
-Shirley Fitzgerald, Ph.D.
Assessing
the Influence of Wheelchair Technology on Perception of Participation in Spinal
Cord Injury
Eliana
S.Chaves, M.S., Michael L. Boninger, M.D., Rosemarie
Cooper A.T.P
Shirley
G. Fitzgerald, Ph.D., David B.Gray, Ph.D., and Rory A. Cooper, PhD
Full
Article appeared in Archives of
Physical Medicine and Rehabilitation (Model
Systems Issue),
Vol.
85, No. 11, pp. 1854-1858, November 2004.
Purpose
of Work. Factors related to the wheelchair,
impairment, and environment that affect perception of participation of
individuals with spinal cord injury (SCI) were investigated. Activities
performed in three settings included the home, community, and transportation.
Subjects/Procedures.
Seventy wheelchair users with SCI who used wheelchairs participated in the
study; their average age was 41 years and
average years since spinal cord injury was 14.
Twenty nine percent had tetraplegia and had 38% paraplegia. Thirty seven
individuals from Pittsburgh (Pitt) and thirty three from St. Louis (SL)
completed a written survey of assistive technology usage in daily activities.
Results.
The wheelchair was most often cited as limiting participation in each of the
three settings, followed by physical impairment and then the environment. Twenty
one percent of individuals with paraplegia reported significantly more pain as a
limiting factor for their transportation use (p =. 047) than individuals with
tetraplegia (3%). A higher percentage of (SL=24% Pitt=5% p=. 025) individuals
from SL reported wheelchair seating as a perceived limiting factor; whereas for
transportation, SL participants (SL=15% Pitt=3% p=. 061) were more likely to
report fatigue to be a limiting factor when leaving home. SL individuals were
more likely to indicate that wheelchair seating (SL=24% Pitt=5% p=. 028), social
attitudes (SL=18% Pitt=0% p=. 007) and self-concept (SL=15% Pitt=0% p=. 015)
were limiting factors. For factors affecting transportation, a greater number of
participants from SL reported social attitudes (SL=15% Pitt=0% p=. 017) as a
limiting factor.
Relevance to wheelchair users. For the individuals who use them, the wheelchair is their most important mobility device, yet the one most associated with barriers. Providing a wheelchair that fits well and is simple to operate without addressing environmental access may limit the potential benefits of the devices. Similarly, an accessible environment is of no benefit if the equipment is difficult for the user to operate.
-Eliana Chaves, MS
Demographic and Socioeconomic Factors Associated With Disparity in Wheelchair Customizability Among People With Traumatic Spinal Cord Injury
Peter
Cody Hunt, MPH; Michael L. Boninger, MD; Rory A. Cooper, PhD;
Ross
D. Zafonte, DO; Shirley G. Fitzgerald, PhD
Full
Article Appeared in Archives of
Physical Medicine and Rehabilitation (Model Systems Issue),
Vol.
85, No. 11, pp. 1859-1864, November 2004.
Purpose of the Work. This study
determined if a standard of care for wheelchair provision exists within the
National Model Spinal Cord Injury Systems (NMSCIS) and if wheelchair users of
minority decent and from low socioeconomic backgrounds have difficulty obtaining
customizable wheelchairs, wheelchairs with adjustable design features.
Subjects.
Four hundred and twelve individuals with traumatic spinal cord injury
(SCI), who use a wheelchair over 40 hours a week participated in this study.
Procedures. Participants were
recruited from the current 16 NMSCIS, which provide acute and rehabilitative
care for individuals with SCI. The NSCIMS are funded by the Department of
Education and maintain the world’s largest database on SCI rehabilitation.
Participants completed an annual follow-up questionnaire, which included
information on age, race, education, income, employment status, health care
insurance, wheelchair funding sources, and manufacturer and model of
wheelchairs.
Results. Ninety-seven percent of
manual wheelchair users and 54% of power wheelchair users had customizable
wheelchairs. No power wheelchair
user received a wheelchair without programmable controls. Minorities with low
socioeconomic backgrounds (low income, Medicaid/Medicare recipients, less
educated) were more likely to have standard manual and standard programmable
power wheelchairs. Older individuals were also more likely to have standard
programmable power wheelchairs.
Relevance to Wheelchair Users. The
standard of care for manual wheelchair users with spinal cord injury is
lightweight and customizable. The standard of care for power wheelchairs users
has programmable controls. Unfortunately socioeconomically disadvantaged
individuals were less likely to receive customizable wheelchairs.
-Peter
Cody Hunt, MPH
Technical
Perspective: Evaluation of Selected Sidewalk Pavement Surfaces for Vibration
Experienced by Users of Manual and Powered Wheelchairs
Rory A
Cooper, PhD, Erik J Wolf, MS, Shirley G Fitzgerald, PhD, Annmarie Kelleher, OTR/L,
William A Ammer, BS, Michael L Boninger MD, Rosemarie Cooper, MPT ATP
Full
Article Appeared in the Journal of
Spinal Cord Medicine, Vol. 27, No. 5, pp.
468-475, 2004.
Purpose of Work: The goal was
to record vibrations while traveling over selected sidewalk surfaces in an
electric powered wheelchair (EPW) and a manual wheelchair (MW). This study also
examined how much effort was required to cross each surface in a MWs. The study
should provide support for determining the criteria for defining a wheelchair
pedestrian access route that does not require excessive propulsive work, or
expose people using wheelchairs to potentially harmful vibrations.
Subjects and Procedures: Six
different sidewalk surfaces were tested, including a poured concrete surface
that acted as the norm, and five interlocking concrete and brick surfaces of
varying bevels (0 mm, 2 mm, 4 mm, and 8 mm) and patterns (90 degree herringbone
and 45 degree herringbone pattern). Ten
unimpaired individuals used a MW equipped
with SMARTWheels,
and an EPW during data collection. Vibration
levels were measured at the seat and the footrest of both wheelchairs,
using two accelerometers, and mechanical work was determined from the
SMARTWheels.
Results:
The surface with the highest bevel (8 mm) produced significantly higher
vibrations than the rest of the surfaces. The
other surfaces showed either no significant difference or a lower vibration
level than the standard poured concrete surface. No significant differences were
found for the work to propel over the sidewalks.
Relevance to Wheelchair Users: Surfaces other than poured concrete can be used for pedestrian access routes without causing higher amounts of vibrations to wheelchair users. Additionally, no extra work is required to propel over interlocking concrete surfaces and will not produce higher strains on the upper extremities of the wheelchair user.
-Erik Wolf, MS
Heiner CM, Stankovic PL, Decade of Excellence, Paraplegia News, pp. 47-54, December 2004.
Wolf
EJ, Cooper RA, DiGiovine CP, Boninger ML, Guo S, Using the Absorbed Power Method
to Evaluate Effectiveness of Vibration Absorption of Selected Seat Cushions
During Manual Wheelchair Propulsion, Medical
Engineering and Physics, Vol. 26, No. 9, pp.
799-806, November 2004.
Fitzgerald
SG, Cooper RA, Thorman T, Cooper R, Guo S, Boninger ML, The GAMECycle
Exercise System: A Comparison to Standard
Ergometry, Journal of Spinal
Cord Medicine, Vol. 27, No. 5, pp. 453-459,
2004.
Cooper
RA, Wolf EJ, Fitzgerald SG, Kelleher AR, Ammer WA, Boninger ML, Cooper R,
Technical Perspective: Evaluation of Selected Sidewalk Pavement Surfaces for
Vibration Experienced by Users of Manual and Powered Wheelchairs, Journal
of Spinal Cord Medicine, Vol. 27, No. 5, pp.
468-475, 2004.
Kwarciak
AM, Cooper RA, Ammer WA, Fitzgerald SG, Boninger ML, Cooper R, Fatigue Testing
of Selected Suspension Manual Wheelchairs Using ANSI/RESNA Standards, Archives
of Physical Medicine and Rehabilitation, Vol.
86, No. 1, pp. 123-129, January 2005.
PVA Newsroom, November 2004: PVA
Member Rory Cooper, Appointed to be First Holder of FISA Foundation/PVA Chair
for Rehab Engineering
Pittsburgh Post-Gazette, Dec. 5, 2004, Page C-1:'Legos Up' on the Competition
Pittsburgh Tribune-Review, Dec. 5, 2004: Building
Blocks of the Future
Pitt Chronicle, Dec. 6, 2004, Page 3: Awards
and More: Rory Cooper
University Times, Thurs. Dec. 9, 2004, Page 22: People
of the Times
Pitt Chronicle, Monday January 10, 2005, Page 11: Pitt
in the News: Shirley Fitzgerald
Walter Reed Army Medical Center Newsletter, January 2005:
Walter Reed Workshop Demonstrates Wheelchair Challenges, Solutions
VA RR&D Update, Winter 2005, Page 2: WaRE
Investigators Present at Walter Reed
PVA Newsroom, January 2005: Wheelchair
Research, Mobility Training Workshop Will Help Newly Disabled Troops at Walter
Reed Army Medical Center
The 2005 International Conference on Posture and Wheeled Mobility will
be taking place in Exeter in the South West of England 11-15th April, 2005. The
underlying theme is to examine posture and mobility from a holistic point of
view. What do individuals need and want to do with their lives, and how can
their postural management and wheeled mobility systems answer these needs in an
integrated way?
The
first day of the conference is dedicated to half day and full day instructional
courses. The next three and a half days are dedicated to five tracks addressing
specific areas of interest in posture, and wheeled mobility. These streams
concentrate on Posture Management, Users’ Needs, Wheeled Mobility, Tissue
Integrity, and Service
Delivery. Each track has a plenary session dedicated to it, as well as five parallel sessions spread out through the week. The conference details are available on the website www.mobility2005.org where you are invited to book your attendance. Please go to this site to see the presenters’ abstracts as they are submitted,and to see the most recent version of the program.
**********
Wheelchair
and Scooter users! When you visit new places, do you often feel like you are sailing
off into the unknown? Do you wonder if you will actually reach your destination?
A research team at the University of California at Santa Barbara wants to learn
about your travel experiences, the information you use to plan your trips, and
the problems you are encountering.
To contribute to this
work, please complete an anonymous online survey and visit http://research.survey.ucsb.edu/access/
Contact Person:
Andrea Nuernberger,
Ph.D. student and co-investigator
**********
A new
employee has joined the HERL front office staff! Amie Struble has been of invaluable assistance during the last few months, while
HERL has been understaffed. If you have called HERL recently, you have probably
heard Amie’s friendly voice on the line. Amie has agreed to work with us for a
while, assisting with numerous clerical duties such as grant preparation, data
entry, participant payments, and continuing education. Amie has also contributed
several articles to this newsletter as well as our last issue.
**********
HERL
will be at the next Abilities Expo on April 15-17, 2005 at the New Jersey Convention and Expo Center in Edison, NJ. We
will have a table/display as well as HERL faculty/staff in attendance to educate
people about our research facilities and about the studies we conduct.
To learn more, visit the
Abilities Expo website at http://nyc.abilitiesexpo.com.
On-site admission to the expo is $5; children under 12 are free.
The
National Spinal Cord Injury Association (NSCIA) is a non-profit organization
developed to help those individuals with spinal cord injuries and diseases.
The NSCIA was founded in 1948 and now has over 40 chapters and support
groups throughout the United States. Their
mission is to “enable people with spinal cord injury and disease to achieve
their highest level of independence, health, and personal fulfillment by
providing resources, services, and peer support.”
Local
and nationally supported activities are available for NSCIA members, such as
support groups where individuals are connected across the country to provide
motivation and support to each other. A
support group called “In Touch with Kids” specifically designed for children
18 years of age and younger is also available.
“In Touch with Kids” allows the children to be in touch with other
children going through the same experiences.
It also allows the parents to communicate with each other regarding
issues of raising a child with a spinal cord injury or disease.
The
NSCIA works with local and national officials to promote and encourage better
programs and services for those individuals with spinal cord injury and
diseases. They are committed to
improving the care of individuals with spinal cord injuries through education;
this is being accomplished by educating professionals on proper methods of
rehabilitation. Public education
programs also exist which concentrate on prevention of spinal cord injuries.
NSCIA funds research with the aim of developing a cure for spinal cord
injury and disease.
NSCIA membership is open to anyone. Membership
is free to individuals with spinal cord injuries.
For more information about membership, or the NSCIA, please visit their
website at www.spinalcord.org.
-Amie Struble
Brad
began working as an undergraduate intern at the Human Engineering Research
Laboratories during the summer of 2001. At
this time, he worked with Dr. Shirley Fitzgerald on a wheelchair maintenance
study. Brad then graduated with his
Bachelor of Science degree in Engineering, concentration in Bioengineering, from
the University of Pittsburgh in the spring of 2002.
After graduating he continued working at HERL under the direction of Dr.
Michael Boninger. Brad has since been working in the biolab on the CULP SCI
study along with the “Ultrasonografic Evaluation of the Median Nerve in Manual
Wheelchair Users” study.
Brad has played an active role at HERL serving as a lead student researcher
on several research studies, recruiting subjects for studies, participating in
the National Veterans Wheelchair Games twice, and serving as a mentor in the
Tech-Link program. In October of
2004 he was awarded with the National Science Foundation’s IGERT Fellowship in
Assistive Technology. Currently Brad
is pursuing a Ph.D. in Bioengineering at the University of Pittsburgh.
-Amie Struble
James Joseph is the Administrative Assistant at the Human Engineering Research Laboratories. He has been working at HERL since June of 2004. Jim performs many activities to facilitate the daily operations of the lab such as processing participant payments, parts and supplies procurement, and the general upkeep of office machines. Jim also works with computer software installation and maintenance, along with server and workstation upgrades.
Jim is a retired Marine Corps Gunnery Sergeant. He served as the Electro-Optical repair chief and also a Breach Guide for the Direct Support Group 2, 1st FSSG, in Saudi Arabia during Operation Desert Storm. In his 22 year career in the military, Jim has been stationed many places throughout the world. His favorite place was Okinawa, Japan, where he served as the platoon shop chief. Jim most enjoyed his service time when he was managing shop facilities and instructing young marines. Jim has received many medals and decorations including the Kuwait Liberation Medal.
Jim is currently attending Point Park University majoring in Information Technology. He expects to graduate in December, 2005 with a Bachelor of Science degree. Jim has a wife, Lauren, and six children ranging in age from 6-18 years old.
-Amie Struble
The Tech-Link Lego-League Robotics Competition concluded on
December 4, 2004 at the National Robotics Engineering Consortium at Carnegie
Mellon University. Both HERL teams brought home trophies for software design and
grouppresentation.
**********
On Saturday, December 11, 2004, HERL faculty, staff, and their families teamed up with the Keystone Paralyzed Veterans of America to sing Christmas Carols and visit with Veterans at the Aspinwall Division of the VA Pittsburgh Healthcare System.
**********
Volunteers from HERL participated in the HOPE Network/Healthsports Adapted Snow Ski Classic at Hidden Valley Ski Resort on January 24-26, 2005. This was the event’s 23rd consecutive year, where skiers of all abilities and levels of experience join for fun in the snow.
Faculty
at the Department of Physical Medicine and Rehabilitation, University of
Pittsburgh, recently had a journal paper published:
Amy
K. Wagner, MD; Anthony Fabio, PhD; Ava M Puccio, RN, MSN; Ronald Hirschberg, MD;
Wei Li, PhD; Ross D. Zafonte, DO; Donald W. Marion, MD:
Gender Associations with Cerebrospinal Glutamate and Lactate/Pyruvate
Levels After Severe Traumatic Brain Injury. Critical
Care Medicine, Vol. 33, No. 2, pp. 407-413, February 2005.
“Lightweight,Durable,
Adjustable Composite Backrest.” Principle Investigator: Todd Hargroder.
National Institute of Disability andRehabilitation
Research (NIDRR), September 1, 2004—February 28, 2005, $75,000.
The Human Engineering Research Laboratories is recruiting individuals interested in participating in research studies for the WHEELCHAIR USERS REGISTRY. If you would like to be notified of Wheelchair related Research Studies for which you may be eligible to participate, contact The Human Engineering Research Laboratories and join the Wheelchair Users Registry. This is an informational resource and notification of a study does not obligate you to participate. You do not need to be located in nor are you required to travel to Pittsburgh in order to participate in research studies. If you are at least 18 years of age, and use a wheelchair or scooter, please contact Rosi or Annmarie for more information.
VA PGH Healthcare System 7180 Highland Drive Pittsburgh, PA 15206
412-365-4850 registry@herlpitt.org www.herlpitt.org
Human Engineering Research Laboratories
VA Pittsburgh Healthcare System
7180 Highland Drive
Building 4, 2nd Floor East Wing, 151R-1
Pittsburgh, Pa, 15206
Phone: 412-365-4850
Fax: 412-365-4858
E-mail any comments, corrections, or questions concerning the newsletter to the editor, Christine Heiner
at heinercm@pitt.edu
Home | Introduction | Research | Laboratories | Publications | Education | Affiliations
Standards & Patents | Personnel | Activities | VA WheelchairInfo | Newsletter