Introduction : Une utilisation non-optimale du fauteuil roulant manuel (FRM) peut avoir des répercussions sur différents aspects de la vie des enfants et jeunes qui utilisent cette aide à la mobilité. Malgré la disponibilité et l'efficacité du Wheelchair Skills Program (WSP), l'entraînement des habiletés en FRM est parfois inadéquat ou absent en pratique. Pour combler cette lacune entre les connaissances et la pratique, ce mémoire vise à identifier les besoins et les enjeux concernant l’évaluation et l’entraînement des habiletés en FRM en réadaptation pédiatrique. Méthodes: Guidé par le cadre Knowledge to Action, une étude à devis mixte séquentiel explicatif a été conduite dans un centre de réadaptation pédiatrique et ses écoles affiliées. La phase quantitative comprenait une enquête en ligne auprès d'ergothérapeutes et un questionnaire papier auprès d’usagers pédiatriques et de leurs parents. La phase qualitative comprenait des groupes de discussion avec les ergothérapeutes. L’analyse a utilisé des statistiques descriptives et une méthode déductive basée sur le Consolidated Framework for Implementation Research. Résultats : Les résultats du sondage aux ergothérapeutes (n=35) montrent une divergence entre l’importance perçue à l’égard de l’évaluation et l’entraînement des habiletés en FRM (94% jugent important) et leur prévalence dans la pratique. Peu d’ergothérapeutes utilisent des outils standardisés et forment principalement les enfants aux habiletés de base (c.-à.-d., d’intérieur) et les parents à l'entretien du FRM. Les réponses du questionnaire aux usagers corroborent ces résultats alors que les enfants et parents décrivent des difficultés à l’utilisation du FRM dans la communauté, en plus de rapporter des chutes. Les résultats des groupes de discussion révèlent des barrières à l’utilisation du WSP qui expliquent les lacunes observées dans la pratique. Conclusion : Pour surmonter les barrières à l’utilisation du WSP en réadaptation pédiatrique, des adaptations au WSP et la production d'outils pour le transfert de connaissances (TC) ont été proposées avec la création de nouvelles connaissances par la recherche. / Introduction : Suboptimal manual wheelchair use can have repercussions on different aspects of the lives of children and adolescents who use this mobility aid. Despite the availability and effectiveness of the Wheelchair Skill Program (WSP), manual wheelchair skills training is often inadequate or absent in clinical practice among occupational therapists (OTs). To bridge this evidence-practice gap, this thesis aims to identify and understand the needs and challenges regarding manual wheelchair skills testing and training practices in pediatric rehabilitation. Methods: Guided by the Knowledge to Action Framework, an explanatory sequential mixed methods design was employed. The quantitative phase involved an online survey with OTs working in a pediatric rehabilitation center and its affiliated schools and a paper survey with pediatric manual wheelchair users and their parents. The qualitative phase involved focus groups with the OTs. Data were analyzed using descriptive statistics and a deductive analysis based on the Consolidated Framework for Implementation Research. Results: According to the OT survey results (n=35), there is a discrepancy between the perceived importance of wheelchair skills testing and training (94% consider it important) and their prevalence in practice. Of the training provided, children are primarily trained indoor skills, while parents are primarily educated about wheelchair maintenance. Standardized, evidence-based tools are rarely used. The child survey results corroborate these findings as the children and parent described difficulties with many community and advanced wheelchair skills, as well as falls experienced in these situations. The focus group findings identified barriers to using the WSP which explained the gaps observed in practice. Conclusion: To address the identified barriers, recommendations of WSP adaptations and knowledge translation (KT) tools production were proposed with creation of new knowledge. Findings from this thesis establish a first step towards bridging the evidence-practice gap in manual wheelchair skills testing and training.

Text in Afrikaans / The importance of the emotional and social development of a human being is highlighted by this research study, while the ability of the human spirit to transcend the human body has inspired the researcher to investigate movement activities as a potential key to the emotional and social development of wheelchair-bound learners. The researcher has chosen participation in wheelchair dancing to determine whether wheelchair-bound learners show development on emotional and social levels by investigating their intra- and interpersonal abilities before and after participating in wheelchair dancing. Intra- and interpersonal abilities are interdependent abilities and are regarded important components of emotional intelligence. In the interest of validity and reliability, the researcher used purposeful sampling in the selection of her participants. The participants had to meet certain requirements. She undertook a constructivist investigation, from an interpretive perspective, as a (primarily) qualitative study, with an interactive case study design and multimethod strategies. The smaller, quantitative component of the research study is the Piers-Harris Children’s Self-Concept Scale, Second Edition (Piers-Harris 2), which offers as pre- and post-test a baseline assessment for the participants’ emotional and social development in respect of self-concept. The theoretical approach for this study is a combination of the medical deficit model and the social model, with stronger emphasis on the development and healing approach of the social model, than on the deficit-and-control approach of the medical deficit model. The focus of the study is not on the constraints suffered by the wheelchair-bound learners, but rather on the possible development that may take place in the learners through their participation in movement activities. The researcher strongly relies on the social model in an attempt to gain understanding of the problems that wheelchair-bound learners currently experience in the education system, so that schools can be developed that would meet learners’ needs. The research results offer answers to the primary and secondary research questions and the general objective of this research study has been achieved. The researcher has determined that wheelchair-bound learners show emotional and social development after participation in movement activities. The emotional intelligence of all the participants has increased and each experienced increased self-actualisation since having participated in wheelchair dancing. The research results reflect more growth in respect of the learners’ intrapersonal abilities than in their interpersonal abilities. The researcher’s specific objectives would be achieved, when she submits the research results of this study to policy makers in the Department of Education, thus expanding the boundaries of existing knowledge about the relationship between wheelchair-bound learners’ participation in movement activities and their emotional and social development. / Die belangrikheid van die emosionele en sosiale ontwikkelingsgang in die mens se ontwikkeling word deur die navorsingstudie uitgelig, terwyl die vermoë van die menslike gees tot transendensie van die menslike liggaam, die navorser inspireer het om bewegingsaktiwiteite te ondersoek as ’n moontlike sleutel tot rolstoelgebonde leerders se emosionele en sosiale ontwikkeling. Die navorser het deelname aan rolstoeldanse gekies om te bepaal of rolstoelgebonde leerders op ’n emosionele en sosiale vlak ontwikkeling toon deur hul intra- en interpersoonlike vermoëns voor en ná deelname aan rolstoeldanse te ondersoek. Intra- en interpersoonlike vermoëns is interafhanklike vermoëns en word as belangrike komponente van emosionele intelligensie beskou. Die navorser het ’n doelgerigte steekproefneming gebruik in die seleksie van haar deelnemers om geldigheid en betroubaarheid in die hand te werk. Die deelnemers moes aan sekere vereistes voldoen. Sy loods ’n konstruktivistiese ondersoek vanuit ’n interpretivistiese perspektief as ’n (hoofsaaklik) kwalitatiewe ondersoek, met ’n interaktiewe gevallestudie-ontwerp en veelmetodestrategie. Die kleiner, kwantitatiewe komponent van die navorsingstudie is die Piers-Harris Children’s Self-Concept Scale, Second Edition (Piers-Harris 2). Dit bied, as voor- en nátoets, ’n basislynassessering vir die deelnemers se emosionele en sosiale ontwikkeling ten opsigte van selfkonsep. Die teoretiese raamwerk waaruit die navorser hierdie navorsingsprobleem benader, is ’n vermenging van die mediesetekort- en die sosiale model, met sterker klem op die ontwikkelings- en helende benadering van die sosiale model, as die tekortkominge-en-beheer-benadering van die mediesetekort-model. Die fokus van die studie is nie op rolstoelgebonde leerders se inperkinge nie, maar juis op die moontlike ontwikkeling wat deur hul deelname aan bewegingsaktiwiteite in die leerders mag plaasvind. Die navorser steun sterk op die sosiale model in ’n poging om begrip vir die probleme wat rolstoelgebonde leerders tans in die onderwys ervaar, te verkry, sodat skole ontwikkel kan word wat in leerderbehoeftes voorsien. Die navorsingsresultate bied antwoorde op die primêre en sekondêre navorsingsvrae en die algemene doelstelling van hierdie navorsingstudie is bereik. Die navorser het vasgestel dat rolstoelgebonde leerders, deur hul deelname aan bewegingsaktiwiteite, emosionele en sosiale ontwikkeling toon. Al die deelnemers se emosionele intelligensie het verhoog en almal beleef groter selfverwesenliking sedert hul deelname aan rolstoeldanse. Die navorsingsresultate weerspieël groter groei ten opsigte van die deelnemers se intrapersoonlike as hulle interpersoonlike vermoëns. Die navorser se spesifieke doelstellings word bereik, wanneer die navorser die navorsingsresultate van hierdie studie aan beleidmakers in die Departement van Onderwys voorlê en daardeur die grense van bestaande kennis omtrent die verband tussen rolstoelgebonde leerders se deelname aan bewegingsaktiwiteite en hul emosionele en sosiale ontwikkeling kan uitbrei. / Inclusive Education / M. Ed. (Inklusiewe Onderwys)

In my thesis, The Life of a Handicapped Person, I tried to chart what influences the future of such person and how problems trouble him in life. In the first chapters I defined and separated the types of disabilities, their different impact and problems in diagnosis. The central part of the work is the chapter on systems that influence the life of a disabled person. These systems are mostly influenced by the family because, by accepting the child, the parent, as well as the selected type of upbringing, affects the future of the person and likewise the disabled child has a vital influence on the family. Also included is a chapter on health care, social services and education. The quality of life of a disabled person is also influenced by friends, hence a social process, and partnerships, and equally important is the person's professional role. The fourth chapter relates to research which was carried out by a questionnaire on a group of 46 people with physical disabilities. On the basis of the answers, I verified the validity of the six pre-defined hypotheses.

Title: The comparative kineziologic analysis of forward stroke on wheelchair and crawling. Objectives of the Thesis: The aim of the thesis is to compare muscle activity of selected muscles in shoulder girdle during forward stroke on wheelchair and crawling. Method: Surface electromyography combinated with kinematography analysis used synchronized video recording. Results and Conclusions: As the research shows, there is a difference in muscle activity (timing) between forward stroke on wheelchair and during crawling. It was proved that the activity of forward stroke on wheelchair does not have natural locomotive character. Keywords: Forward stroke on wheelchair, crawling, shoulder girdle, surface electromyography, kinematics analysis.

Title: Evaluation of wheelchair adjustments and their impact on proper propulsion pattern upper extremities and sitting posture in patients with spinal cord lesions. Objectives: The objective of this work was to evaluate the adjustments of wheelchair and to determine their impact on the work of the upper limbs and posture while sitting. This work was done on a group of patients with spinal lesions with their own wheelchairs. Another objective was to assess how education of proper propulsion pattern and form and type of a grip of handrim affects the correct propulsion pattern. Methods: In the group of 26 patients with spinal cord injuries in different levels of the spinal cord, I tested the adjusments of wheelchair, in particular the centre of gravity and maximum seat height from the ground. I also investigated what education on correct propulsion pattern the patients received, and observed any home-made adjustments to handrim, as well as patients' techniques of handrim grip. Finally, I examined how the subjects drove his/her wheelchair. During all the tests, I recorded video and photo documentation. The results were statistically evaluated using the Fisher test. Results: Despite the fact that only a small group was investigated, I showed the effect of wheelchair seatings on the correct posture. I...

Title: The effect of box (parabox) on respiratory functions in wheelchair dependent. Aim of thesis: The main objective of this thesis is to present a new kind of sport, a qualitative pilot case study exploring the impact of boxing on respiratory functions in people dependent on wheelchairs. Next prepare a proper research methodology and finally make independent measurements including subjective feeling records of participants. The thesis is divided into two parts. In the first theoretical part, I tried to find out the latest information based on studies and research on the topic. Unfortunately, in the available literature the problem of people in wheelchairs has not yet been completely summarize and a significant number of publications relate exclusively to people with spinal cord lesions. In the second part of my thesis I include the aforementioned research monitories the chase in respiratory function, also depending on the subjective feelings of participants and their overall life valuation. Methodology: The research group consists of 3 participants - men fully attached to wheelchairs, training box once-twice a week. To fulfil the purpose of the research I used both clinical (spirometric measurements) and questionnaire (SQUALA) methods. Data was collected over a period of 2.5 months in the fall...

This study aims to evaluate the importance of proper back support for patients with spinal damage after long-term sitting in a mechanical wheelchair. The subject of this thesis was to analyze Czech and foreign literature and offer the most accurate and still missing information when selecting and compiling the selection of mechanical wheelchair seating unit. The thesis describes the differences between right and wrong sitting posture of mechanical wheelchair users. It analyzes the available information on the possibility of objective assessment, as well as trying to justify the importance of the support of the trunk on the resulting stability and functionality during activities of daily living. It refers to the most common secondary changes and their chaining caused by poor sitting posture. A subjective evaluation of the comfort of users sitting in mechanical wheelchairs in the form of a questionnaire was chosen to assess the urgency of the theme. The research carried out confirmed the hypotheses of clinical practice, which are included in the work. Based on the collected information, this work may allow occupational therapists, physiotherapists and doctors to more easily determine in a broader context whether an indication of the fixed backrest is appropriate and desirable (required) when dealing...

Trata-se de um estudo de alternativas de reforma de residências para deficiente físico em cadeira de rodas, propondo-as como micro-fator de reinserção social, considerado, como macro-fator, o circular na cidade para uma participação efetiva do deficiente físico na vida da comunidade. As barreiras arquitetônicas, entendidas como uma estrutura do meio ambiente edificado que se opõe à independência parcial ou total das pessoas de mobilidade reduzida, são amplamente estudadas, pois subsidiam as reformas. Estas procuram otimizar o binômio espaço habitado/qualidade de vida, através da racionalização e adequação do espaço às exigências dimensionais do usuário deficiente e da cadeira de rodas, seu meio locomotor, bem como possibilitando o acesso a todo ambiente da residência e o uso dos seus equipamentos. Um estudo sumário sobre o alcance do deficiente físico quando em cadeira de rodas, bem como sobre as exigências dimensionais para a circulação desse seu veículo é mostrado na segunda parte da tese, composta, aliás, de três grandes capítulos. Não é um trabalho inédito quanto a temática. Contudo, enquanto resenha bibliográfica e estatística dimensional de espaços e suas instalações, pode servir de ponto de partida e marco referencial para estudos de normatização e definição de padrões condizentes com a escala e realidade brasileira que começa a demandar soluções para a problemática. / The subject study refers to alternatives to be used in homes of physically handicapped people in wheeling chairs, proposed as micro-factors of social insertion, and at the same time as a macro-factor to allow him to circulated in town for an effective participation in the community\'s life. The built environmental structure that opposes partial or totally the people\'s reduced mobility are the architectural barriers witch are fully studied here to subsidize the modifications proposed. They seek to optimize the inhabited space/life quality binomial through rationalization and adequacy of space, to the demands of the handicapped user and wheeling chairs, his locomotor expedient, as well as access possibility to the home ambient and the utilization of its equipment. The sketched out analysis over the reaching of the physically handicapped when in wheeling chairs, as well as the dimensional demands for the circulation of that vehicle, is shown in the second part of this Thesis, in three chapters. It is not an inedited work thematically viewed. However, while bibliographic inventory and dimensional statistics of space and pertinent installations, it serves as a starting point for standards and pattern definitions suitable to the Brazilian reality and scale, that begins now to demand solutions for the problem of the handicapped people in wheeling chairs.

A articulação do ombro é muito solicitada em indivíduos com lesão medular usuários de cadeira de rodas, seja no deslocamento diário, na propulsão da cadeira de rodas ou na prática paradesportiva. Diante dessa realidade, este estudo teve por objetivo avaliar e comparar o desempenho muscular através do pico de torque corrigido pela a massa corporal, o trabalho e a potência dos grupos musculares do manguito rotador, relacionados aos movimentos de rotação interna e externa dos ombros, em atletas de basquetebol em cadeira de rodas, com trauma raquimedular, comparando-os com indivíduos com trauma raquimedular, sedentários, utilizando como instrumento o dinamômetro isocinético da marca 4 BIODEX®. Foram avaliados 36 indivíduos com trauma raquimedular, com níveis de lesão completa abaixo de T1 e idades entre 18 e 45 anos. Sendo 18 indivíduos atletas de basquetebol em cadeira de rodas e 18 indivíduos cadeirantes sedentários. Os testes isocinéticos foram realizados na posição sentada, com o ombro em 45° de abdução no plano da escápula e 30° de flexão no plano frontal, com amplitude de movimento de 70°, sendo 40° em rotação externa e 30° para rotação interna. O protocolo foi realizado por meio do teste isocinético com cinco repetições para as velocidades de 60°/s e 180°/s, com propósito de avaliar o pico de torque/peso e o trabalho, e 10 repetições em 300°/s para avaliar a potência muscular, em ambos os ombros, com intervalo de 1 minuto, entre as repetições. As comparações entre as variáveis foram analisadas com o teste do quiquadrado ou teste exato de Fisher. Para a análise das diferenças entre as médias das variáveis contínuas, utilizou-se o teste t, com nível de significância de 5%. Como resultado, observou-se semelhança das variáveis antropométrica entre os grupos; o pico de torque/peso, o trabalho e a potência muscular dos rotadores internos e externos de ambos os ombros dos atletas de basquetebol em cadeira de rodas foram significativamente maiores quando comparados com o grupo controle, em todas as velocidades testadas (P <0,001); também foi encontrada uma correlação do ganho de força muscular com o tempo de lesão medular. Conclui-se que os atletas cadeirantes apresentaram maior desempenho muscular em relação aos cadeirantes que não praticavam nenhum tipo de esporte. / The shoulder joint is much, requested in individuals with spinal cord injury wheelchair users, at offset journal, in wheelchair propulsion, as well as in practice to-sports. Facing this reality, the present research aimed to evaluate and compare the performance through muscle peak torque fixed by body mass, the work and the power of the rotator cuff muscle groups, related to the movements of internal and external rotation of the shoulder, in basketball, wheelchair athletes with spinal cord injury, comparing them to individuals with spinal cord injury, sedentary using as an instrument the isokinetic dynamometer 4 BIODEX® brand. 36 individuals were evaluated with spinal cord injury, with complete injury levels below T1 and between the ages of 18 to 45 years. Being 18 individuals athletes of wheelchair basketball and wheelchair accessible, sedentary individuals 18. The isokinetic tests were performed in a sitting position, with the shoulder in 45° of abduction in scapula and 30° of flexion in the frontal plane, with range of motion of 70°, and 40° in external rotation and 30° for internal rotation. The Protocol was carried out through the isokinetic test with 5 reps for 60°/s speeds and 180°/s with purpose to assess the peak torque/weight and work, and 10 repetitions at 300°/s to assess muscle power, in both shoulders, with 1 minute interval between repetitions. The comparisons between the variables were assessed the Chi-square test or Fisher\'s exact test. For the analysis of the differences between the media of the variables keep, used the t test, with a significance level of 5%. As a result, it was observed there similarity between the groups Anthropometric, that the peak torque/weight work and muscle power of internal and external rotators of both shoulders of the athletes of wheelchair basketball was significantly higher when compared with the control group, the tested velocities (P < 0.001) and correlation of muscle strength gain with time of spinal cord injury. It is concluded that the wheelchair athletes has increased muscle performance in relation to wheelchair users who do not practice any kind of sport.

Pediatric powered mobility training teaches a child useful skills to become effectively mobile with the aid of their powered wheelchair. The staff at the Massachusetts Hospital School (MHS) desired a powered mobility training protocol that could be used for training children who were considered to be marginal wheelchair drivers with respect to basic maneuvering skills. The primary objective of the protocol was to reduce the subject's reliance on verbal cuing and replace this dependence by external cues provided by the environment. The specific aim of this pilot study was to investigate the use of a ranging device mounted on a powered wheelchair to provide an auditory feedback to the subject when an obstacle within its range was detected. The first goal of this study was to verify that the ranging device was capable of providing useful auditory feedback to the MHS patients that had met criteria to be candidates for the study. The second goal was to determine to what extent the device was beneficial in improving the subject's everyday mobility skills. The final goal was to observe if there was an internalization of the ranging device cues such that the subject's mobility skills improved upon removal of the device. Three subjects participated in this study. Each subject participated in pre-training, training and post-training evaluations through which the improvement of their mobility skills was measured. The results of this pilot study demonstrated that the use of a ranging device, with auditory feedback, can potentially be used effectively in the powered mobility training of children with disabilities. Further, it appeared that marginal wheelchair drivers were able to internalize some of the ranging device's auditory cues such that their performance improved when the sensing device was removed from their wheelchair. Recommendations for improving this study include using a more appropriate ranging device, redefining criteria for qualified candidates participating in the study, and eliminating variations in data between different evaluators.