Employment is considered to be an important predictor of life satisfaction and success. Statistics on unemployment rates are of concern among our society, especially when the statistics involve individuals with disabilities. In an era where the American with Disabilities Act and Rehabilitation Act have pushed for the community and workforce to become more accessible, unemployment rates among individuals with disabilities still remain high. Spinal cord injury (SCI) is an interesting population in that individuals, who want to work, can work with the appropriate technology and accommodations. Yet, over half of the individuals with SCI who worked prior to their injury remain unemployed years later. Many of the past and current studies investigating employment recruit subjects who are at least 18 years of age, with some recruiting individuals who are 16 years of age. Children with disabilities have a plethora of resources and services offered to them within the school district. From Individualized Education Programs (IEP) to transition services, many individuals work with the child to help them become an active participant in society. This study looks specifically at SCI of pediatric-onset. Examining already existing data collected by the NSCID, we investigated: a) employment and education rates among individuals with pediatric-onset SCI (PO-SCI) compared with adult-onset SCI (AO-SCI); b) variables that may contribute to vocational outcomes among this population; and c) if acquiring an SCI at a young age is positively correlated with higher rates of employment and levels of education. Statistical results yielded no difference between PO-SCI and AO-SCI with respect to employment rates (working vs. not working). Differences were noted in level of education achieved between PO-SCI and AO-SCI, with individuals who had PO-SCI more likely to pursue additional education and higher levels of education post-injury. Results do indicate that post-injury level of education does correlate with post-injury employment status; higher levels of education yielded higher employment levels at follow-up. Results from the study also indicate that individuals with spinal cord injury, regardless of age at injury, still remain unemployed years after their injury. Rehabilitation counselors can play a crucial role in helping individuals with SCI overcome employment barriers.

The goal of this project was to test the influence of a pushrim activated power-assisted wheelchair (PAPAW) on the functional capabilities of individuals with cervical level spinal cord injuries (tetraplegia). This repeated measures design type study was divided into two phases, which included testing in two different laboratory settings: a biomechanics laboratory and an activities of daily living laboratory. Fifteen participants included in both phases were fulltime manual wheelchair users (MWUs) with tetraplegia. The purpose of the first phase of the study was to determine the differences in metabolic demands, stroke frequency, and upper extremity joint range of motion, during PAPAW propulsion and traditional manual wheelchair propulsion. Participants propelled both their own manual wheelchairs and a PAPAW through three different resistances (slight, moderate and high), on a computer controlled wheelchair dynamometer. Variables analyzed during this phase included: mean steady state oxygen consumption, ventilation, heart rate, mean stroke frequency, maximum upper extremity joint range of motion, and propulsion speed. Results from the first phase of the study revealed a significant improvement in kinematic, speed, and metabolic variables when participants were propelling with a PAPAW. In Phase II, participants propelled both their own manual wheelchairs and a PAPAW three times over an activities of daily living course. The course was constructed to reflect certain obstacles that a manual wheelchair user might encounter in his or her daily routine. PAPAWs received higher user ratings than the participants own manual wheelchair for 10 out of 18 obstacles. Additionally, when using a PAPAW, participants were able to complete the course in the same amount of time while maintaining a lower mean heart rate. For individuals with tetraplegia, PAPAWs have the potential to decrease metabolic demands during propulsion, while increasing or maintaining function within ADLs. Use of this device could help MWUs maintain overall physical capacity while reducing the risk for pain and injuries to the upper extremities, which are often seen among manual wheelchair users with tetraplegia. Future studies with this device should focus on the ability of MWUs with tetraplegia to perform necessary activities of daily living within their home environment and community.

The intelligent screen reader system observes a user¡¯s keystrokes when he or she is performing tasks, and infers an underlying plan structure. The system then generates an optimized script that allows the user to perform the same task more efficiently in the future. The intelligent screen reader system is particularly beneficial for visually impaired computer users. The JAWS for Windows screen reader was chosen for this prototype, since the JAWS scripting language provides flexibility to users for customizing their tasks within a specific application. The JAWS macro recorder, developed by Freedom Scientific Inc., records all the user¡¯s actions. Automated Synthesis of Plan Recognition Networks (ASPRN), developed by Intelligent Reasoning Systems Inc., takes a plan or a script representation as input and outputs a specially-constructed belief network that supports plan recognition. The Script Generation Interface, developed by the University of Pittsburgh, allows users to modify the actions recorded by the JAWS macro recorder and generate an optimized script. Development of the SGI involved integrating the SGI with the JAWS macro recorder, integrating the SGI with ASPRN, and implementing the SGI user interface. Preliminary usability testing involving the intelligent screen reader system was conducted with visually impaired users. Within limited actions and tasks, the results are satisfactory. Users felt the SGI was easy to learn and operate, and that it was efficient to create useful scripts with the intelligent screen reader system. Future work includes adding more plans to the plan library and creating a tutorial system.

The ability of a person to maintain stable posture is essential for activities of daily living. Research in this field has evolved to include sensitive assessment technology including force platforms and 3-dimensional kinematic motion analysis systems. Although many studies have investigated postural stability under the auspice of posturography and the use of force platforms, relatively few have incorporated kinematic motion analysis techniques. Furthermore, of the studies that have utilized a multivariate research model, none have sought to identify the relationship between force platform measures including both the variation of movement of the x- and y-coordinates of the center of pressure (COP), and the 3-dimensional coordinates of the total body center of mass (COM). This study used a descriptive design to evaluate the relationship between force platform measures and the kinematic measures dealing with the total body COM in 14 healthy participants (height = 1.70 ± 0.09 m, mass = 67.7 ± 9.9 kg; age = 24.9 ± 3.8 yrs). Intraclass correlations (ICC) and standard error of measurements (SEM) were determined for common variables of interest used in standard posturography models. The results suggest that the variation of the excursion of the COP coordinates best represent the variation of the total body COM in the x- and y-directions. There was a force platform measure that correlated significantly with the vertical component of total body COM in only 3 of the 8 conditions. The ICC values obtained when analyzing individual conditions revealed that the variation in the force measurements were much more reliable than those representing the variation in movement of the COP, suggesting a need for the development of higher order methods of modeling 3-dimensional COM information from force platforms.

APPLICATION OF A COMMERCIAL DATALOGGER TO ELECTRIC POWERED AND MANUAL WHEELCHAIRS OF CHILDREN Beth Ann Kaminski, BSE University of Pittsburgh, 2004 Objective: This study was conducted to investigate the usage characteristics of children wheelchair users. This was accomplished by utilizing dataloggers to quantify how far and how fast children drive or propel their wheelchairs, as well as observing the movement time data. The relationships between usage per type of wheelchair, gender, and day of the week were evaluated. Methods: 20 subjects between the ages of 6-17 years old who use a manual (n=10) or power (n=10) wheelchair for their primary source of community-based mobility were studied. The children in this study reported the disabilities of cerebral palsy (n=6), spina bifida (n=11), Duchenne muscular dystrophy (n=2), and spinal cord injury (n=1). Overall, nine females and 11 males participated in the study. All subjects, or their parents, provided demographic information and characteristics of their wheelchair. Each child¡¦s wheelchair was then instrumented with a datalogger. The datalogger was attached to wheelchair for five to seven days. During this time, the participants were instructed to go about their daily activities as usual. Results: On an average day, the manual wheelchair users traveled 1583.6 b 880.2 meters at an average speed of 0.67 b 0.16 meters/sec, while the power wheelchair users traveled 1524.5 b 1057.0 meters at 0.63 b 0.16 meters/sec. Overall, the children traveled average daily distances in the range of 8.5 meters to 3929.1 meters and at speeds between 0.39 to 1.42 meters/sec. The males in the study, on average, traveled 1910.1 b 1160.0 meters per day at 0.66 b 0.14 meters/sec while the females traveled 1118.9 b 247.9 meters at 0.60 b 0.19 meters/sec. The children were active for an average of 15 hours per day on the weekdays and 12.5 hours on the weekend days. The children traveled an average of 1738.7 b 1173.5 meters per day at 0.63 b 0.14 meters/sec on the weekdays and 1088.9 b 902.8 meters per day on the weekends. Data from nine manual wheelchair shows the subjects drove in the forward direction 93.2% of the time and backwards 6.8% of the time. Conclusions: No differences were found between the distance and speeds traveled for children manual and power wheelchair users. In comparison, the children wheelchair users show similar driving characteristics in speed and distance traveled to adult wheelchair users. The findings suggest that the male children traveled longer distances per day (P = 0.046) and at higher speeds. The children appear to be more active on weekdays as compared to the weekends. The weekday distance is significantly higher than weekend distance (P = 0.035).

This study examined the effectiveness of an online interdisciplinary course in electronic health record (EHR) technology at the University of Pittsburgh for health and rehabilitation professionals. The purpose of the study was to determine how familiar participants were with EHR technology; determine if attitudes changed toward EHR technology after taking the course; and determine if the course met the needs and expectations of the participants. The goal of the project was to educate health and rehabilitation professionals about EHR technology and to identify a model interdisciplinary course for this topic. Quantitative and qualitative data was collected through questionnaires, practice module exams, and participant interviews. Participants who took the course showed significant gains in their knowledge of almost all of the content areas. The primary strength of the course was its structure, in particular, with the audio presentation. The weaknesses of the course were with regard to the quantity of and time allotted to complete assignments, as well as the desire to have more hands-on vendor component assignments. Although participant attitudes were favorable toward EHR technology before taking the course, they improved after taking the course. Overall participants believed that it is important that EHR technology is implemented in healthcare and benefited significantly from taking the course.

With modern medicine and advances in technology, people are living longer and expecting a higher quality of life. Individuals may not be receiving the ideal assistive devices because they are not sure where to obtain the proper equipment, or what is available. An increased flow of informational publications needs to reach the consumers so they are able to make better informed decisions about their quality of life. Addressing the issue of limited resources, this study places a focus on the use of service dogs as a form of assistive technology. The main objective of this study was to collect data from individuals who had wheelchair service dogs and to compare the data to individuals who did not have a wheelchair service dog. Data were collected and analyzed on variables of assistive technology use, disability, human assistance used, depression, pain, fatigue, and activities of daily living. This information was collected as a baseline, after three months and after nine months. Of the 172 individuals who participated from the beginning of this study, 117 successfully completed all three surveys. For the baseline, there were significant relationships between the dog groups and the individuals who used assistive technology (p=0.02); between the dog group and the depression (CES-D) score (p=0.047); and between the dog group and the Pain I (Total Pain Rating Index) of the McGill Pain Questionnaire (p=0.01). Individuals in the control group used less assistive technology, and individuals in the service dog and wait list groups used the most assistive technology devices. Individuals on the wait list had significantly higher CESD scores, and individuals who had recently received a service dog had lower scores than those in the pet and control groups. Overall, depression scores increased for individuals who were on the waiting list to receive a dog, although not to a significant degree. Depression scores increased (insignificantly) at the second visit for service dog owners, but decreased at the third visit. Although not to a significant degree, pain generally decreased for service dog owners. Individuals with service dogs are able to participate in more activities of daily living, although they do still need help.

Introduction: Despite being classified together as overhead athletes, the shoulders of swimmers and baseball pitchers were expected to differ in physical characteristics due to the distinctive demands placed upon their shoulders. The purpose of this study was to compare shoulder characteristics between male swimmers, pitchers, and non-overhead athletes (controls). It was hypothesized that swimmers bilateral shoulders and pitchers dominant shoulders would present adaptive changes from participation in their respective sport. Methods: Glenohumeral range of motion (ROM), posterior shoulder tightness (PST), scapular kinematics, forward shoulder posture (FSP), and shoulder strength were compared between 15 male intercollegiate swimmers, 15 intercollegiate pitchers, and 15 controls. All subjects were free of shoulder pain. ROM and PST were measured using standard goniometer/carpenters square, and FSP was assessed using a double-square device. Strength was assessed using an isokinetic dynamometer, and scapular kinematics were assessed using an electromagnetic tracking device. Results: Pitchers dominant shoulder exhibited greater external rotation ROM, compared to their non-dominant shoulder (p= 0.049) and the controls dominant shoulder (p= 0.049). No between-group differences in internal rotation ROM and total ROM were found. Glenohumeral internal rotation deficit was greater in pitchers than in swimmers (p< 0.001) and controls (p< 0.001). External rotation gain was also greater in pitchers compared to swimmers (p=0.025). Swimmers (p= 0.002~0.004) and pitchers (p= 0.015~0.047) exhibited greater bilateral flexion ROM than controls. There were no significant between-group differences in abduction and extension ROM. PST was greater in pitchers compared to controls in supine method. No between-group or between-limb differences were found in strength variables. No between-group differences in scapular kinematic variables were found. Dominant shoulders were positioned anteriorly compared to the non-dominant shoulder (p= 0.012). Conclusions: The results of the study demonstrated differences in shoulder characteristics among swimmers, pitchers, and controls. These differences may be due to the unique demands of each sport. The ROM characteristics (GIRD, ERG, and PST) were observed only in pitchers due to their dominant use of a unilateral limb. Between-group difference in strength, scapular kinematics, and FSP were not observed in this study. Further research and advancement in assessment techniques may reveal differences in these variables.

Introduction: Previous research has stereotyped many overhead athletes as baseball pitchers. Due to the different physiological stresses in each overhead sport, it may not be appropriate to group all overhead athletes together. The objective of this study was to show sport specific physical adaptations in common overhead sports. Methods: Forty-three healthy, male athletes participated in this cross-sectional study; fifteen baseball pitchers, fifteen volleyball athletes, thirteen tennis athletes and fifteen control athletes. Internal rotation (IR) and external rotation (ER) shoulder range of motion (ROM), glenohumeral internal rotation deficit (GIRD), external rotation gain (ERG), posterior shoulder tightness (PST) (supine and side-lying methods), shoulder strength and scapular kinematics were assessed in a neuromuscular research laboratory. ROM was assessed with a goniometer while PST was assessed with a goniometer (supine) and carpenters square (side-lying). Strength was assessed with an isokinetic dynamometer and scapular kinematics with an electromagnetic tracking device. Results: Pitchers had more dominant IR ROM than tennis athletes and less dominant IR ROM than control athletes. Tennis athletes had the lowest IR ROM of all groups included in this study. Volleyball athletes had less dominant IR ROM than control athletes. Pitchers and tennis athletes had more GIRD than control athletes had. Pitchers and tennis athletes had higher between limb differences with the supine method of assessing PST. With the supine assessment, tennis athletes had increased dominant PST compared to control athletes; additionally, all overhead athletes had decreased non-dominant PST. At 90° and 120° humeral elevation, pitchers had the most scapular elevation, volleyball athletes had more elevation than tennis athletes did, and tennis athletes had less elevation than control athletes did. There were no differences in external rotation ROM, total rotation ROM, or strength measures. Conclusion: Not all overhead athletes had the same physical characteristics. The differences between sports in each of the variables could be due to the different amount of physiologic stress on the shoulder in each sport. These results may help to show healthy, sport specific adaptations in each sport. Clinicians should develop sport specific rehabilitation protocols and return to play criteria for athletes to return to play earlier and stronger.

This study examined how adults use power wheelchair seat features such as seat tilt, backrest recline, and seat elevation, during typical daily activities. A Seat Feature Data Logger (SFDL) was attached to 11 subjects wheelchairs for 10-14 days to gather data regarding daily usage of the wheelchair and these features. Subjects occupied their wheelchairs for 12.0 ± 3.0 hours per day and transferred in/out of their wheelchairs 5.0 ± 5.3 times per day. An average of 0.7 ± 1.5 hours per day was spent in an upright position. The tilt feature was accessed 18.4 ± 14.4 times per day for 8.5 ± 5.2 hours per day, and recline was accessed 11.5 ± 8.4 times per day for 8.6 ± 4.6 hours per day. Tilt and recline were used in combination for a total of 4.8 ± 4.6 hours per day. Subjects accessed the seat elevation feature 4.3 ± 4.1 times per day on average for 2.8 ± 4.6 hours day. Based on these data it was found that subjects spent significantly more time in a tilted versus an upright position (p<0.025), but that tilt was not used significantly more than recline (p=0.155) or seat elevation (p=0.046). In addition, comparison of SFDL data with pressuremapping data revealed that subjects were more likely to use small and intermediate amplitude tilt and recline angles, and positions known to result in low peak pressure were accessed more frequently and for longer durations than intermediate and high pressure positions. While subjects did not always use large angles of tilt and recline as many clinicians recommend these features were used frequently and their use resulted in lower peak pressures.