Original article: Sawatzky B, Hers N, MacGillivray MK. Relationships between wheeling parameters and wheelchair skills in adults and children with SCI. Spinal Cord. 2015, February. Find the original article here.
Isn’t amazing how wheelchair technology has changed over the past 50 years? Gone are the days of one size that fit all—the heavy steel folding-frame chair that comfortably sat two. Assessment in those days was easy—no multiple page order form—no decisions needed. In today’s environment, the ever-active wheelchair user has hundreds of options—deciding which options are suitable is a major hurdle! Usually a medical practitioner is needed to assist in evaluating the user’s requirements to determine what wheelchair options are appropriate. In an ideal world the best clinical tools would be used, but in today’s environment where time and resources are limited, this becomes quite a challenge.
What was the purpose of this study?
There is a need for wheelchair fitting assessments to be easy and reflect skill level using the wheelchair. The aim of study was to assess which skill tests were best suited when time and resources are limited.
Two primary validated and reliable tests were selected for the study:
- Wheelchair Skills Test (WST). A series of 32 skill tests used to evaluate the user’s ability to propel and manoeuvre their manual wheelchair in different environmental conditions. Skills tested include: opening/closing a hinged door, transfer on/off a bench, maneuver ramps with 5˚ and 10˚ inclines, traversing a 15 cm pot-hole, mounting/dismounting a 2 cm threshold, moving over 5 cm level change, mounting/dismounting 15 cm curb.
- SmartWheel Clinical Protocol (SCP). The SmartWheel is a special wheel is attached to an adult or child sized wheelchair and is able to measure how much force one puts at the hand-rim, frequency of pushes and distance traveled during wheeling. The SCP involves measuring someone’s wheeling at their own comfortable speed on tile, carpet and a ramp with a 5˚ incline.
A secondary measure was also considered in the study. The Wheelchair Propulsion Test (WPT) is a ‘low-tech’ version of the SCP that can be used for all wheelchair users including hand and foot propellers and young children whose small diameter wheels may not be compatible with the SmartWheel. This method only requires a tape measure and stop watch to calculate the user’s speed (meters/second), push frequency (pushes/second) and push effectiveness (meters/push) over 10 meters.
Researchers examined the relationship between the SCP and WST scores among adults and children with spinal cord injury. A secondary goal was to examine the relationship between the WPT score and the SCP’s push effectiveness.
Who took part in the study?
Sixteen adults and 8 children were selected for this study. Each provided demographic and clinical background including: age, sex, and diagnosis/level of injury, height, weight, and type of wheelchair used.
How were participants tested?
The researchers assessed participants using the WST (Version 4.1) and the SCP.
Wheelchair Skills Test assessment
Each participant was asked to complete 29 of the 32 skills listed in the WST. There were three skills excluded from the study—getting from ground into wheelchair and climbing/descending stairs. These exclusions were due to both time constraints and lack of adequate spotting for safety. Scoring was the percentage of the skills completed and done safely.
SmartWheel Clinical Protocol assessment
Prior to testing using the SCP, the SmartWheel was attached to the participant’s wheelchair on the side of their dominant arm and the user was asked to acquaint themselves with its operation. Participants then wheeled a maximum distance of 10 meters at a self-selected speed or for 10 seconds, whichever occurred first. This test was performed on three surfaces; tile, carpet, and a ramp with a 5˚ incline. In addition to the SCP on three surfaces, WPT’s push effectiveness (meters/push) was determined using the SmartWheel data (distance travelled/push frequency).
How was the analysis performed?
Multiple regressions were used to determine whether the score on one test was able to predict the score on another test (for example, can performance on the SCP predict an individual’s WST?). Separate analyses were completed for the three SmartWheel surfaces: tile, carpet and ramp. In addition, correlations were performed between the SCP’s push effectiveness and the WST score for each of the three surfaces. Independent analyses were done on adult and paediatric participants to ensure that they were similar and could be combined into one group.
What were the conclusions?
This study indicates that, regardless of wheeling surface, the speed at which the user pushes their wheelchair is the most significant predictor of the Wheelchair Skills Test score. The ramp and carpet increase the user’s effort and power output especially when compared to those done on a tile surface. To decrease time spent using the SmartWheel Clinical Protocol, the study suggests that using only the ramp or carpet trials might be a valid predictor of skill levels. The results of these trials could also be a good gauge of a user’s wheelchair skills. When time and resources are limited, a practitioner could simply have the user push themselves up a ramp and over a carpet to evaluate and identify options required for a new wheelchair.