A Wheelchair Propulsion Training Program (HS)

The Washington University

Status: Completed

Conditions: Spina Bifida; Spinal Cord Injuries; Multiple Sclerosis; Amputation

Treatments: Behavioral: In-person wheelchair propulsion training program; Behavioral: 30-minute education session

Study type: Interventional

Funder types: Other

Identifiers

NCT04009187

201711056

Details and patient eligibility

About

The overall purpose of this project is to test the feasibility of a manual wheelchair propulsion program which aims to reduce the chance of development of upper limbs pain and injury.

Full description

The purpose of this project is to develop a feasible wheelchair propulsion training that can fit into an in-patient rehabilitation schedule, and determine the effectiveness of the training protocol. This project consists of a randomized control trial (RCT) for manual wheelchair users (MWUs) that examines the number of manual wheelchair propulsion repetitions required to produce change. For the RCT, we will recruit twenty individuals who use manual wheelchairs as their primary means of mobility and who do not follow the recommended clinical guidelines for propulsion. Participants will be randomized into two independent groups: motor learning repetitions overground (Training Group; n =10), and general education on recommended propulsion techniques (Education Group; n =10). Demographics, cognition, shoulder strength, participation, and wheelchair seating may only be assessed at baseline. Participants then may be assessed from the kinematics of their wheelchair performance overground and on a motorized treadmill. Participants may be tested on their wheelchair propulsion techniques in and outside of the lab, upper extremity pain at baseline, post-intervention, and three-week follow-up; participants may also be asked qualitative questions regarding the intervention experience, the experience with the equipment and the laboratory research, the monitoring setting, and the general experience with the research study.

The primary research question is that will repetition of proper propulsion technique practiced overground result in improved manual wheelchair propulsion biomechanics?

Enrollment: 20 patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 18-65 years of age
• have a mobility limitation requiring the use of a manual wheelchair (MWC)
• be able to self-propel a MWC bilaterally with their upper extremities
• plan to use a MWC for at least 75% of their activities throughout the day
• live in the community
• understand English at a sixth-grade level or higher
• can follow multi-step instructions
• able to provide informed consent independently
• able to tolerate propelling their wheelchair independently for 10m
• be willing to participate in three assessments and six training sessions at the Enabling Mobility in the Community Laboratory (EMC Lab).

Exclusion criteria

• maneuver their MWC with their lower extremities or with only one upper extremity
• display the proper wheelchair propulsion techniques during the screening process
• MWC position inhibits them from following the CPGs
• bilateral incoordination
• upper extremity strength inequalities resulting in a 12-inch deviation from a marked pathway
• surgeries compromising the integrity of the upper extremities
• cardiovascular complications within the past year
• upper extremity or overall bodily pain is rated 8/10 or higher per the Wong-Baker FACES Numeric Pain Scale (FACES)
• currently receiving medical treatment for an acute upper extremity injury
• have a Stage IV pressure injury or are currently hospitalized

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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20 participants in 2 patient groups

Training group

Active Comparator group

Description:

Training group will first receive 30 minutes of education about biomechanically efficient propulsion techniques. They will be tested on this knowledge to make sure participants understand the material. The participant then will be asked to come into the lab for 6 sessions of training, two times per week for three weeks. The training is an hour of the proper wheelchair propulsion techniques broken into 5 parts, 7 minutes each with breaks. Based on the motor learning principles, we gradually increase the components of the training by focusing either hand reaching toward the back of the wheel or hands reaching down toward the axle.

Treatment:

Behavioral: 30-minute education session

Behavioral: In-person wheelchair propulsion training program

Control group

Active Comparator group

Description:

Control group will first receive 30 minutes of education about the biomechanically efficient propulsion. They will be tested on this knowledge to make sure participants understand the material. No further training will be implemented with this group.

Treatment:

Behavioral: 30-minute education session