Purpose of Work. Pushrim Activated and Power Assist Wheelchairs (PAPAWs) are typically manual wheelchairs with a motor linked to the pushrim in each rear hub, where the pushrim input is sensed and amplified proportionally by the motor. The study evaluates the impact of PAPAWs on mobility, community participation, satisfaction, and psychosocial impact among individuals with tetraplegia.

Subjects/Procedures. Fifteen manual wheelchair users with tetraplegia completed a two-week trial in their own chair as well as a two-week trial in the PAPAW. They did have the freedom to choose to use their own chair during the two-week period when they had the PAPAW. The mobility levels with both wheelchairs were recorded by a wheel rotation data logging device. Participants completed daily questionnaires regarding community participation and their satisfaction with the wheelchair used. The Psychosocial Impact of Assistive Devices Survey (PIADS) was conducted to compare the psychosocial impact of PAPAWs with their personal wheelchairs.

Results. Participants chose to use PAPAWs and their personal wheelchairs at a similar frequency, but traveled further and spent more time using PAPAWs. They also traveled significantly faster with PAPAWs. PAPAWs resulted in greater satisfaction and psychosocial impacts than the personal wheelchairs.

Relevance to Wheelchair Users. PAPAWs provide independent mobility both indoors and outdoors. They may require fewer modifications to home and motor vehicles than power wheelchairs, and are more capable of traversing a variety of difficult terrain than manual wheelchairs. However, transportability could be a problem with PAPAWs due to the heavy weight of the wheels, and difficulty in disassembly. A user’s preference, life style, physical conditions, transportation issues, and environmental factors should be considered in prescribing such a device.

-Ana Souza, MS

Purpose of the Work: There is compelling evidence that suggests mobility,

access to the community, and social integration enhances quality of life. In fact, social participation is a more important predictor of quality of life than physical functioning or extent of injury. This study investigated the research question: does a higher quality wheelchair improve quality of life? Or, can a poorly designed wheelchair limit a user’s potential for community access, thus increasing disability?

Subjects: Existing veteran records from Veterans Administration databases were merged to create a dataset of 61,428 veterans who received a wheelchair. There was no information in the datasets that could identify individual veterans.

Results: The veterans who received higher quality manual wheelchairs reported significantly more physical disability and significantly less mental disability and better general health than veterans who received lower quality depot manual wheel chairs. In contrast, the veterans who received high quality power wheelchairs reported less disability than veterans who received standard power wheelchairs.

Relevance to Wheelchair Users:

Prescription of wheelchairs should be based on user need. Results of this study suggest that both user need and clinical practice are factors effecting provision. The results of this study support training in seating and mobility and establishment of clinical practice guidelines as a means of increasing equity in the provision of wheelchairs.

-Sandra Hubbard Winkler, PhD, OTR/L, ATP

Shoulder Ultrasound Abnormalities, Physical Examination Findings and Pain in Manual Wheelchair Users with Spinal Cord Injury

Steven W. Brose, DO, Michael L. Boninger, MD, Bradley Fullerton, MD, Thane McCann, MD,Jennifer L. Collinger, BSE, Bradley G. Impink, BSE, Trevor A. Dyson-Hudson, MD

Full article published in Archives of Physical Medicine and Rehabilitation, pp. 2086-2093, Vol. 89, No. 11, November 2008.

Purpose of the work: To investigate the presence of ultrasound abnormalities in manual wheelchair users with spinal cord injury (SCI) using a quantitative Ultrasound Shoulder Pathology Rating Scale (USPRS). To investigate physical examination (PE) findings using a quantitative Physical Examination of the Shoulder Scale (PESS), and to obtain data about pain and other subject characteristics such as age, years with SCI, and weight.

Subjects and Procedures: Forty-nine individuals with SCI who used a manual wheelchair as their primary means of mobility were recruited at the National Veterans Wheelchair Games. Participants answered questionnaires and had both physical and ultrasound examinations of the shoulders.

Results: Higher USPRS scores, meaning more abnormalities, were more common in individuals with greater age, years with SCI, and weight. Heavier participants were more likely to have shoulder pain. Higher PESS scores were more common in individuals reporting shoulder pain during daily activities.

Relevance to Wheelchair Users: As individuals with SCI age and spend more time propelling a manual wheelchair, the likelihood of developing rotator cuff abnormalities and pain increases. It appears that increased body weight is a contributing factor and therefore maintaining an ideal body weight may be one means of preventing shoulder pain and pathology. Untreated shoulder pain is common in manual wheelchair users with SCI, and further investigation of this pain is needed.

-Brad Impink, BS

State of the Science Symposia on Ultrasound Techniques and Polytrauma

Civilian, veteran, and military populations can benefit from the exchange of the state of the science in clinical practice, research, and development. The rapid revolution currently taking place in medical, surgical, and rehabilitative care has become increasingly difficult for practitioners to keep up with. Given the overall goal to provide world-class care to our injured soldiers and veterans, the purpose of the HERL/Walter Reed Army Medical Center Symposia Series is to bring expert scientists conducting state of the art research to the Army Medical Department, to help severely injured soldiers requiring medical rehabilitation. A secondary goal is to increase research in medical rehabilitation in the Army Medical Corp through collaboration with proven scientists. Many severely injured GWOT soldiers will need to adapt to physical impairments for years to come. State of the science care, advanced technology, and the dedication and skill of Army, Department of Veterans Affairs (VA), and affiliated personnel are crucial for the successful reintegration of soldiers into their communities and when possible back to active or reserve service in the Army.

Another important component is to ensure that the Army, Navy, VA and U.S. academic and private sector research community are effectively communicating and planning for the long-term care of soldiers leaving active duty due to the injuries that they incurred in the service of our country. The Army Medical Department is working with the VA to ensure that the process of moving patients from one healthcare system to the other is as seamless as possible. The symposia bring together key Army, Navy, VA, and Academic and federal rehabilitation leaders. This unique State-of-the-Science workshop series is made possible through grant funding from the Telemedicine and Advanced Technology Research Center (TATRC). Paralyzed Veterans of America also supports the series and is a valued partner.

The final 2 symposia of our 2008 series covered the areas of Ultrasound Techniques (diagnostics, guided injections, instruction), and Polytrauma Medicine (Pharmokinetics, Clinical Trials, Vocational Outcomes, Psycho-Social Issues, Acute Management).

Ultrasound Techniques, a two day event at WRAMC on September 25-26, served to inform attendees about the innovations in current clinical practices and research studies associated with diagnostic ultrasound. The symposium showcased some of the country’s foremost authorities on ultrasound technology and speakers covered topics ranging from current clinical practices to new initiatives in the early phases of research. Diagnostic ultrasound has proven itself as a useful and reliable technology in the evaluation and intervention of a number of neuromuscular abnormalities. Proper use by a trained clinician can lead to the early detection and treatment of various neuromuscular conditions before they become chronic and debilitating, saving billons in related health care costs while preserving function of the individual.

While the symposium provided the audience with a unique learning opportunity to observe state of the science information, the fun part was discovered in the hands-on workshop the following day. The attendees were divided into four groups and each group was assigned to a “station” where participants were able to interact with the instructors and learn practical hints on how to perform ultrasound evaluations of different parts of the body. At the end of each hour, the participants rotated between stations, and by the end of the workshop, every attendee had a chance to “get their hands dirty” with some gel, performing ultrasonic examinations under the guidance of the experts.

In 2008, there may be no topic as hot as polytrauma medicine, due to the influx of veterans returning from OIF/OEF. On November 7, professionals from various disciplines traveled to Walter Reed to present the state of the science on polytrauma, highlighting the complexity of these injuries military service members and veterans are currently facing. Polytrauma consists of a multitude of injuries including traumatic brain injury (TBI), amputations, burns, blast trauma, sensory organ injuries, Post-Traumatic Stress Disorder, and other mental health injuries. While the costs of war reaches far beyond a monetary sum, one positive outcome is the advancement in medical and rehabilitative care to treat our military service members which translates into best care practices throughout the general population. Currently, there are two concepts of interest to researchers to help explain why certain individuals who are exposed to severe blasts and have mild impairments in function – resilience and protective factors. Researchers have attributed these two ideas to the individual’s strengths, expectations, locus of control, social supports, and premorbid history.

Assistive technology examples for enhancing communication and facilitating mobility for veterans with polytrauma were also discussed. The importance surrounding community reintegration and return to duty was another important theme conveyed at the workshop. This generation of service members is returning to active duty at a rate higher than any previous generation. In addition to veterans seeking employment in the civilian sector, another means to promote community integration is through sporting and recreation opportunities for military veterans. Highlights of the 2008 Paralympic Games were shared with the audience; close to 10% of the athletes that competed in this year’s games were military veterans.

HERL and WRAMC will continue the State of the Science workshops through next year. The 2009-2010 symposia series will consist of five single day courses and workshops, which will cover topics of extreme relevance to the Army Medical Department – Rehabilitation Medicine Component (AMD-RMC). The topics are to include: Activity Based Rehabilitation Strategies (e.g., functional electrical stimulation, robot assisted therapies, sports and recreation, core-strengthening, exergaming), Prosthetics and Amputee Care (e.g. prosthetics engineering, haptic devices, brain control interfaces, surgical techniques), Regenerative Rehabilitation (e.g., tissue engineering, limb salvage, tissue regeneration), Virtual Reality in Rehabilitation (e.g., VR for PTSD, VR for TBI, VR for AT Assessment, VR for Amputee Rehab), and Appropriate Technology and Community-Based Rehabilitation (delivery of rehabilitation services in developing countries, assistive technology fabrication, low-cost prosthetics fitting, cultural competency). These topic areas were selected based upon the injuries being experienced by soldiers serving in the Army that often result in the need for long-term medical rehabilitation, as well as the support of the Army’s humanitarian mission. World-class clinician scientists conducting relevant research will be invited to present. This will provide important benefits for the AMD-RMC, including the training programs at Walter Reed Army Medical Center and the National Capital Consortium, and for other government agencies, and the public at-large.

The next scheduled symposia will be Activity Based Rehabilitation Strategies on January 23, 2009. All of the symposia will continue to be free and all civilians, government, patient, family member, provider, academics, industry, and researchers are invited. CEUs and CMEs will continue to be offered through the University of Pittsburgh at no-cost to symposia participants.

Workshop registrations are posted on www.herlpitt.org. For more information about the workshops, contact Mary Goldberg at 412-954-5287 or mrh35@pitt.edu. Sign up for e-mail announcements for future State-of-the-Science workshops at http://listserv.herlpitt.org.

-Mary Goldberg, M.Ed., WRAMC Symposia Coordinator

HERL PUBLICATIONS

Hubbard SL, Fitzgerald SG, Boninger ML, Cooper RA, Relationship Between Quality of Wheelchair and Quality of Life, Topics in Geriatric Rehabilitation, Vol. 24, No. 3, pp. 264-278, July-September 2008

Ohnabe H, The Role of Information Sharing by the Conference of Rehabilitation and Assistive Technology, Rehabilitation Engineering, pp. 128-131, Vol. 23, No. 3, August 2008.

Ding D, Souza A, Cooper RA, Fitzgerald SG, Cooper RM, Kelleher AR, Boninger ML, Preliminary Study on the Impact of Pushrim Activated Power Assist Wheelchairs Among Individuals with Tetraplegia, American Journal of Physical Medicine and Rehabilitation, pp. 821-829, Vol. 87, No. 10, October 2008.

Brose SW, Boninger ML, Fullerton B, McCann T, Collinger JL, Impink B, Dyson-Hudson TA, Shoulder Ultrasound Abnormalities, Physical Examination Findings and Pain in Manual Wheelchair Users with Spinal Cord Injury, Archives of Physical Medicine and Rehabilitation, pp. 2086-2093, Vol. 89, No. 11, November 2008.

Cooper RA, Dicianno BE, Brewer B, LoPresti E, Ding D, Simpson RC, Grindle GG, Wang H, A Perspective on Intelligent Devices and Environments in Medical Rehabilitation, Medical Engineering and Physics, pp. 1387-1398, Vol. 30, No. 10, December 2008.

Cooper RA, Tolerico M, Kaminski B, Spaeth D, Ding D, Cooper RM, Quantifying Wheelchair Activity of Children: A Pilot Study, American Journal of Physical Medicine and Rehabilitation, pp. 977-983, Vol. 87, No. 12, December 2008.

Dicianno BE, Kurowski BG, Yang J, Chancellor MB, Benjjani GK, Fairman AD, Lewis N, Sotirake J, Rehabilitation and Medical Management of the Adult with Spina Bifida, American Journal of Physical Medicine and Rehabilitation, pp. 1026-1050, Vol. 87, No. 12, December 2008.

HERL IN THE NEWS

Everyone at HERL would like to wish all our newsletter subscribers and research participants a safe and happy holiday season. We would also like to make everyone aware of a few important changes.

Due to the VA’s new phone system installation, we have a new phone and fax number. Our new phone number is (412) 954-5287 and our new fax number is (412) 954-5340. Please be aware that callers who dial our old phone number will be redirected to the main VA Pittsburgh Healthcare System phone number. We don’t want to miss your calls if you are trying to reach us; please make a note of our new numbers.

Also, we are using a new method to distribute this newsletter by e-mail. Instead of sending the newsletter to readers through my e-mail account, we are now using our own listserv to send out the newsletter announcements. Listserv is mass e-mail distribution software that allows users to manage their own subscriptions and automatically maintains subscriber lists. Readers can join or leave the HERL newsletter e-mail distribution by either of the following methods:

1.WEB: Visit http://listserv.herlpitt.org

2.E-MAIL:HERL_NEWSLETTER_ANNOUNCE @LISTSERV.HERLPITT.ORG with the word SUBSCRIBE or UNSUBSCRIBE in the body of the e-mail.

As a precaution, please add the e-mail address HERL_NEWSLETTER_ANNOUNCE@LISTSERV.HERLPITT.ORG to your address book or configure your e-mail to allow incoming messages from this address to continue to receive our newsletter without interruption. This new software should improve our efforts to successfully deliver our

newsletter to your inbox.

We are also using Listserv to distribute announcements about our State of the Science workshops at Walter Reed Army Medical Center (WORKSHOP_ANNOUNCEMENTS@LISTSERV.HERLPITT.ORG) and to recruit for our undergraduate intern programs (REU_RECRUITMENT@LISTSERV.HERLPITT.ORG). People may join those lists as well by visiting http://listserv.herlpitt.org or by e-mailing either list with the word SUBSCRIBE or UNSUBSCRIBE in the body of the e-mail.

-Christine Heiner, editor

Upcoming Events

The International Symposium on Quality of Life Technology will be held June 30-July 1, 2009 at University Club in Oakland, Pittsburgh, PA. The symposium is aimed at research scientists, industry engineers, health care clinicians, graduate students, and other professionals interested in the service technologies and applications of human daily activities. Symposium Sessions will include plenary and poster presentations, a Future Challenges in Quality of Life Technologies Panel, and an Exhibition.

Submissions for papers and posters are due by February 5. Requested paper topics are Rehabilitation Engineering, Robotics, Human System Interaction, and Impact of Technology on Quality of Life.

Learn more and register for the conference at http://www.shrs.pitt.edu/cms/QoLT/QoLT.asp?id=821

HERL in the Community

Education and Outreach Coordinator Mary Goldberg attended the premiere of “Voices of our Region”, an oral documentary made from testimonials of several people living with disabilities in southwestern PA. The event was hosted by Allegheny County Disability Connection on November 20. about the event and many of the interviews are available on www.voicesofourregion.com.

HERL was honored to be included in the Mobility Works Expo at the Pittsburgh Mobility Works Dealership on October 16th. This yearly event unites people with disabilities with representatives from local disability agencies and assistive technology vendors. Over 300 people attended the expo, which also included food, door prizes, and raffles. Among the 20+ exhibitors were our affiliates the Center for Assistive Technology and Keystone Paralyzed Veterans of America.

Mobility Works has announced the date for next year’s Expo: Thursday, October 15, 2009. HERL plans to attend again. We hope to see you there!

ARE YOU INTERESTED IN WHEELCHAIR RESEARCH?

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 Emily, Annmarie, or Michelle for more information.

This Publication Is A Service Of:

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

In This Issue...

2008 CEATI Conference

ACCOMPLISHMENTS AND AWARDS

Submissions for papers and posters are due by February 5. Requested paper topics are Rehabilitation Engineering, Robotics, Human System Interaction, and Impact of Technology on Quality of Life.

ARE YOU INTERESTED IN WHEELCHAIR RESEARCH?

This Publication Is A Service Of: