Two approaches to manual wheelchair configuration and effects on function for individuals with acquired brain injury

• Published in: NeuroRehabilitation (Reading, Mass.) Vol. 35; no. 3; pp. 467 - 473
• Main Authors: Dillbeck Regier, Angela, Berryman, Amy, Hays, Kaitlin, Smith, Cindy, Staniszewski, Kristi, Gerber, Don
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.01.2014
• Subjects: Activities of Daily Living; Adult; Brain Injuries - complications; Brain Injuries - rehabilitation; Cranial Fossa, Posterior - anatomy & histology; Cross-Over Studies; Equipment Design; Female; Humans; Male; Middle Aged; Paresis - etiology; Paresis - rehabilitation; Personal Autonomy; Psychomotor Performance; Range of Motion, Articular; Stroke - complications; Stroke Rehabilitation; Treatment Outcome; Wheelchairs; Young Adult; Wheelchairs; acquired brain injuries; activities of daily living
• ISSN: 1053-8135; 1878-6448
• DOI: 10.3233/NRE-141138

Objective: To determine whether manual wheelchair configuration impacts how well a person who has acquired brain injury (ABI) related hemiparesis performs functional tasks from his or her wheelchair. Design: Multi-treatment cross-over design. Setting: Inpatient rehabilitation hospital. Participants: Nineteen patients with ABI resulting in hemiparesis undergoing inpatient rehabilitation (average of 75 days post-injury (± 29.2 days); age range, 21–64; 9 with mechanical brain injury, 10 with cerebral vascular accident). Interventions: Participants in the study were placed in two different wheelchair configurations (position one and position two) and were randomized as to which position they were placed in first. All outcome measures were taken twice on each individual within each wheelchair configuration during two consecutive days. Main outcome measures: Timed Forward Wheeling (TFW), Modified Functional Reach test (MFR), Visual Analogue Scale for Comfort (VAS), transfer score from the Functional Independence Measure (FIM), measurement of popliteal fossa to front of cushion. Results: The position two seating group's TFW was significantly faster than the position one seating group at both time points. There were no significant differences in the MFR scores, VAS comfort scale scores, and FIM transfer score between the two groups. Conclusion: A wheelchair configuration with no seat slope, solid backrest mounted at 95 degree (± 3 degrees) seat to back angle, and use of a solid seat insert with a flat foam cushion (position two) results in greater efficiency in foot propulsion for individuals with ABI than a wheelchair configuration with one inch of seat slope, solid backrest mounted at 105 degree (± 3 degrees) seat to back angle, and no solid seat insert with a gel/foam contoured cushion (position 1).