AA

Summary

There is level 4 evidence (from two repeated measures studies,  one case series study and one pre-post study; Mulroy et al. 2005; Samuelsson et al. 2004; Boninger et al. 2000; Freixes et al. 2012) that the more forward position of the rear wheel improves pushrim biomechanics, shoulder joint forces, push frequency and stroke angle.

There is level 4 evidence (from one prospective controlled study; Bednarczky & Sanderson, 1995) that adding 5-10 kg to the weight of a particular wheelchair will not affect the wheeling style under level wheeling, low speed conditions.

There is level 4 evidence (from one pre-post study; Beekman et al. 1999) that the use of an ultralight wheelchair will improve the propulsion efficiency for SCI users.

There is level 4 evidence (from two case series studies; Boninger et al. 1999; Collinger et al. 2008) that user weight is directly related to pushrim forces, the risk of median nerve injury and the prevalence of shoulder pain and injury.

There is level 4 (from one case series study; Boninger et al. 2002) evidence that the “semicircular” and “arcing” wheelchair propelling patterns reduce cadence and time spent in each phase of propulsion. Thus using these patterns may reduce the risk of median nerve injury.

There is level 4 evidence (from one case series study; Ritcher et al. 2007) that there is no difference in propulsion biomechanics between the different stroke patterns. Thus there may be no advantage to using one pattern over another.

There is level 2 evidence (from one cohort study; Kilkens et al. 2005) that exercise training (at physical capacity) and upper extremity strengthening influence wheelchair skill performance during inpatient rehabilitation.

There is level 4 evidence (from one case series study; Richter et al. 2007b) that wheeling cross slope results in increased loading on users’ arms and may lead to overuse injuries.

There is level 2 evidence (from one randomized controlled trial; Vorrink et al. 2008) that the use of Spinergy wheels verses standard steel-spoked wheels was no more effective in reducing spasticity by absorbing vibration forces when wheeling.

There is level 4 evidence (from one repeated measures study; Sawatsky et al. 2005) that tire pressure effects energy expenditure only after the tire has been deflated by 50%.

There is level 4 evidence (from one case series study; Richter et al. 2006) that a flexible handrim will reduce wrist and finger flexor activity during wheelchair propulsion.

There is level 4 evidence (from one repeated measures study; Corfman et al. 2003) that the use of a PAPAW will reduce upper extremity ROM in individuals with paraplegia during wheelchair propulsion.

There is level 4 evidence (from three repeated measures studies; Algood et al. 2005; Cooper et al. 2001; Fitzgerald et al. 2003) that use of a PAPAW may improve the ability of individuals with tetraplegia to use their wheelchair in a variety of environments and for typical activities. 

There is level 4 evidence (from one repeated measures study; Cooper et al. 2001) that the use of a PAPAW may reduce metabolic energy costs for individuals with paraplegia during propulsion and has higher ergonomic rating by users.

There is level 4 evidence (from one pre-post study; Algood et al. 2004) that the PAPAW reduces upper extremity ROM in individuals with tetraplegia during wheelchair propulsion. Metabolic energy expenditure and stroke frequency may be reduced.

There is level 1b evidence (from one randomized controlled trial; Nash et al. 2008) that the use of PAPAWs allows individuals with a spinal cord injury (paraplegia and tetraplegia levels) who have long standing shoulder pain to propel their wheelchair further while decreasing energy costs and perceived exertion.

There is level 1b evidence (from one randomized controlled trial; Giesbrecht et al. 2009) that for individuals requiring power mobility, the pushrim-activated, power assisted wheelchair may provide an alternative to power wheelchair use.

There is level 5 evidence (from one observational study; Hunt et al. 2004) that to meet full mobility needs, a wide variety of mobility devices are often used in conjunction with power wheelchairs.

There is level 5 evidence (from one observational study; Biering-Sorensen et al. 2004) that neurological level alone is not indicative of power versus manual wheelchair use.

There is level 5 evidence (from one observational study; Sonenblum et al. 2008) that there are no typical patterns of power wheelchair use in daily life but small bouts of movement were more frequently used.

There is level 5 evidence (from one observational study; Cooper et al. 2002) that power wheelchair users drive a high speeds for most movements but typically for short distances

There is level 4 evidence (from one repeated measures study by Lin et al. 2013) that a bimanual power wheelchair controller may be an alternative to a power add on for manual wheelchairs.

There is level 5 evidence (one observational study, one descriptive study; Sonenblum et al. 2009, Sonenblum & Sprigle, 2011b) suggesting that on a daily basis, power positioning devices are used for a variety of reasons but predominantly in the small ranges of amplitude, and with great variability of frequency and duration.

There is level 4 evidence (from one post-test study; Sawatzky et al. 2007) that a series of short duration training sessions enables individuals with limited walking ability to safely operate a Segway Personal Transporter.

There is level 4 evidence from one post-test study; Sawatzky et al. 2009) that use of a Segway Personal Transporter does not decrease the time required to complete an obstacle course compared to other mobility devices.

There is level 5 evidence (from one observational study; Taule, et al. 2013) to suggest that pressure mapping can be used to augment clinical decision-making related to pressure management.

There is level 2 evidence (from one prospective controlled trial and one pre-post study; Hobson & Tooms 1992; Mao et al. 2006) that the typical SCI seated posture has spinal and pelvic changes/abnormalities.

There is level 2 evidence (from two prospective controlled studies; Hobson 1992; Shields & Cook 1992) that in sitting postures typically assumed by people with SCI, maximum sitting pressures are higher than in able-bodied people.

There is level 4 evidence (from one pre-post study; Mao et al. 2006) that use of lateral trunk supports in specialized seating improve spinal alignment, reduce lumbar angles and reduce muscular effort for postural control.

There is level 2 evidence (from one prospective controlled trial; Shields & Cook 1992) that the use of lumbar supports does not affect buttock pressure.

There is level 3 evidence (from one case control study; Janssen-Potten et al. 2001) that there is no difference in balance and postural muscle control between static positions on a level surface and a 10° forward incline for people with SCI; the pelvic position does not change as compared to able-bodied participants.

There is level 3 evidence (from three repeated measures studies and one case control study; May et al. 2004; Hastings et al. 2003; Sprigle et al. 2003; Janssen-Potten et al. 2002) to support the evaluation of functional performance to facilitate the decision making process for assessment and prescription of wheelchair and seating equipment options providing objective information about performance.

There is level 2 evidence (from one prospective controlled trial and one case control study; Kamper et al. 1999; Janssen-Potten et al. 2000) to support that pelvic positioning especially related to pelvic tilt and the relationship between the pelvis on the trunk, affects upper extremity and reaching activities, performance of activities of daily living and postural stability.

There is level 2 evidence (from one prospective controlled trial and several supporting studies; Burns & Betz 1999) that various cushions or seating systems (e.g. dynamic versus static) are associated with potentially beneficial reduction in seating interface pressure or pressure ulcer risk factors such as skin temperature.

There is level 2 evidence (from one randomized controlled trial and several supporting studies; Gil-Agudo et al. 2009) to support the air cushion as producing low average ischial tuberosity pressures and a large area for pressure distribution. However, not all cushions have been studied and pressure performance is not the only parameter for consideration in cushion selection.

There is level 2 evidence (from one prospective controlled trial and two repeated measures studies; Brienza & Karg 1998) to support that custom contoured cushions (CCC) have attributes that promote their use as a safe sitting surface for the SCI population. However, disadvantages and cautions are identified for the actual use of CCC.

There is level 4 evidence (from one post-test; Kernozek & Lewin 1998) to support that dynamic peak pressures are greater than static but the cumulative loading is comparable between dynamic and static loading.

There is level 2 evidence (from one prospective controlled trial; Tam et al. 2003) to support that peak pressures are located slightly anterior to the ischial tuberosities.

There is level 4 evidence (from one pre-post study; Stinson et al. 2013) to support the use and incorporation of forward reaching into daily activities as a means to promote pressure redistribution, provided the reach distance is adequate for an effective weight shift.

There is level 2 evidence (from one prospective control trial, one case control study and three case series studies; Hobson 1992; Makhsous et al. 2007a; Smit et al., 2013; Coggrave & Rose 2003; Hendersen et al. 1994) to support position changes to temporarily redistribute interface pressure at the ischial tuberosities and sacrum by leaning forward greater than 45° or to the side greater than 15°.

There is level 4 evidence (from three case series studies; Smit et al. 2013; Coggrave & Rose 2003; Hendersen et al. 1994) to support that a minimum 2 minute duration of forward leaning, side leaning or push-up must be sustained to raise tissue oxygen to unloaded levels.

There is level 3 evidence (from one case control study and two case series studies; Makhsous et al. 2007a; Smit et al., 2013; Coggrave & Rose 2003) to support limiting the use of push-ups as a means for unweighting the sitting surface for pressure management.

There is level 4 evidence (one pre-post study Makhsous et al. 2007, one repeated measures Maurer & Sprigle, 2004) to suggest the back support plays an important role in supporting the pelvis thereby increasing the area for pressure redistribution through the inclusion of the back surface.

There is level 4 evidence (one pre-post study and one repeated measures study; Makhsous et al. 2007; Maurer & Sprigle 2004) that sitting surface interface pressure decreases at the posterior aspect of the buttock as it is un-weighted however there is an increase in total force on the seat.

There is level 4 evidence (one post-test, Hobson 1992) to suggest that back support recline to 120° decreases average maximum pressure in the ischial tuberosity area but also causes the greatest ischial tuberosity shift (up to 6 cm) and a 25% increase in tangentially induced shear forces.

There is level 4 evidence (one post-test Hobson 1992, two repeated measures case series study Henderson 1994 and Giesbrecht 2011, one pre-post study Spijkerman 1995, and one observational study Sonenblum & Sprigle 2011a) suggesting that there is an inverse relationship between tilt angle and pressure at the sitting surface and that significant reductions in interface pressure begins around 30° of tilt with maximum tilt providing maximum reduction of interface pressures. The amount of reduction realized was variable by person.

There is level 4 evidence (from two repeated measures studies, one pre-post study, and one observational study; Jan et al. 2010; Jan et al. 2013a; Jan & Crane 2013) to suggest that larger amounts of tilt alone or 15° tilt and greater in combination with 100° or 120° recline result in increased blood flow and decreased interface pressure at the ischial tuberosities. There is inconsistency in the minimum amount of tilt needed to significantly increase both blood flow and interface pressure reduction.

There is level 4 evidence (from one repeated measure study and one observational study; Jan et al. 2013b; Sonenblum & Sprigle 2011a) to suggest that it cannot be assumed that changes in interface pressure through use of recline and/or tilt equates to an increase in blood flow at the ischial tuberosities or the sacrum.

There is level 4 evidence (from one repeated measure study and one observational study; Jan et al. 2013b; Sonenblum & Sprigle 2011a) to suggest that muscle perfusion requires greater amplitudes of body position changes than that required for skin perfusion.