• The Adapted Manual Wheelchair Circuit (AMWC) is a performance measure consisting of 14 tasks considered essential to independent mobility in a manual wheelchair. It is a performance-based measure with the tasks designed to be performed in a fixed order and with two minutes’ rest between each item (Cowan et al. 2011).
  • The AMWC+3 version added three specific tasks (0.12-m Platform Ascent, 4-m 3% Ramp Ascent in a Wheelie, 4-m 6% Ramp Ascent in a Wheelie) that better differentiate between people with paraplegia and people with tetraplegia because of the trunk control required to complete them.

Clinical Considerations

The AMWC is a more clinic-friendly adaptation of the original wheelchair circuit (WC) as a wheelchair-accessible treadmill is no longer required (for three skills – 3% and 6% slope, 3-minute wheelchair propulsion).

ICF Domain

Activity ▶ Mobility

Administration

Participants perform the AMWC items, with two minutes’ rest between them.

Number of Items

AMWC:

  1. Figure-8
  2. .012-m doorstep crossing
  3. .04-m doorstep crossing
  4. .10-m platform ascent
  5. 15.0-m sprint
  6. 4-m artificial grass
  7. 4-m 3% ramp ascent and descent
  8. 4-m 6% ramp ascent and descent
  9. opening/closing a door
  10. 3-m 3% side slope
  11. holding a wheelie for 10 seconds
  12. propelling 3m in a wheelie
  13. making a level transfer
  14. 3-minute overground wheeling test (m)

AWMC+3:

  1. 0.12-m Platform Ascent
  2. 4-m 3% Ramp Ascent in a Wheelie
  3. 4-m 6% Ramp Ascent in a Wheelie

Equipment

  • Adjustable mat, a wood board (1.20 x .15 x .012m), a wooden platform (1.22 x 1.22 x .10m)
  • Stopwatch
  • 0.10 m platform on floor
  • Wood doorstep height 0.4 m
  • 4m 3% ramp, 4m 6% ramp
  • Open space, e.g., 15 m corridor
  • 2 pylons (set 1.5m apart for Figure 8)

Scoring

  • Ability score (sum of the scores of the 14 items, 0-14): All items performed correctly within the designated time are assigned 1 point. For 3 tasks (doorstep, platform, and transfer), 0.5 may be awarded if it is partially completed.
  • Performance score (sum of time [seconds] of the 3 timed items [figure-8, 15-m sprint, and grass performance]).

Languages

English and Brazilian-Portuguese.

Training Required

None.

Availability

The AMWC worksheets can be found in the appendix of the following articles:

Measurement Property Summary

# of studies reporting psychometric properties: 3

Interpretability

Less time = better performance.

MCID: not established in SCI
SEM: not established in SCI
MDC: not established in SCI

Reliability – High

Test-retest reliability is High for the AMWC (ICC > 0.90).

(Cowan et al. 2011; n=50; 42 males, 8 females; paraplegia and tetraplegia; ASIA A-D; mean time since injury 11.8 years)

Validity – High

  • Criterion validity is High – able to discriminate between people with paraplegia and people with tetraplegia:
    • AMWC+3 ability score presented a better sensitivity compared to AMWC ability score (lower success rate for all subgroups, 38.5% vs. 82.1% for high paraplegia; 49.0% vs. 75.5% for medium paraplegia; 78.9% vs. 94.7% for low paraplegia).
    • AMWC+3 total time was significantly lower in low paraplegia compared to medium paraplegia and high paraplegia (139.85 s vs. 242.52 s and 326.21 s, respectively, p≤0.05).

(Ribeiro Neto et al. 2020; n=126; median age 28.9 years; injury level: high paraplegia [HP], medium paraplegia [MP] and low paraplegia [LP]; ASIA A-B; median time since injury 35.3 months, AMWC+3 version)

  • Correlation with SCIM-III is High:
    • Ability score: rs = 0.74
    • Performance score: rs = -0.72
    • Total item score: rs = -0.75
    • 3-minute wheeling: rs = 0.78

(Ribeiro Neto et al. 2019; n=66; median age 30.6 years; injury level: 22 tetraplegia, 44 paraplegia; median time since injury 30.8 months, Brazilian-Portuguese version)

Responsiveness

No values were reported for the responsiveness of the AMWC for the SCI population.

Floor/Ceiling Effect

  • Floor effect: Not observed
  • Ceiling effect for the group with paraplegia = 81.8%
  • Ceiling effect for the group for tetraplegia = 15.2%

(Ribeiro Neto et al. 2019; n=66; median age 30.6 years; injury level: 22 tetraplegia, 44 paraplegia; median time since injury 30.8 months, Brazilian-Portuguese version)

Reviewers

Dr. William Miller, Dr. Carlos Leonardo Cano-Herrera, Matthew Querée

Date Last Updated

31 December 2024

Cowan RE, Nash MS, de Groot S, van der Woude LH. Adapted manual wheelchair circuit: test-retest reliability and discriminative validity in persons with spinal cord injury. Arch Phys Med Rehabil. 2011; 92: 1270-80. doi: 10.1016/j.apmr.2011.03.010.
https://pubmed.ncbi.nlm.nih.gov/21807146/

Ribeiro Neto F PhD, Costa RRG MS, Carregaro RL PT, PhD. The addition of three new items in the Adapted Manual Wheelchair Circuit improves the discrimination between different levels of spinal cord injury. Physiother Theory Pract. 2020 Dec;36(12):1329-1339. doi: 10.1080/09593985.2019.1571139
https://pubmed.ncbi.nlm.nih.gov/30686099/

Ribeiro Neto F, Costa RRG, Lopes ACG, Carregaro RL. Cross-cultural validation of a Brazilian version of the adapted manual wheelchair circuit (AMWC-Brazil). Physiother Theory Pract. 2019 Sep;35(9):860-872. doi: 10.1080/09593985.2018.1458356. Epub 2018 Apr 16. PMID: 29659301.
https://pubmed.ncbi.nlm.nih.gov/29659301/

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