Compared to individuals with spinal cord injury (SCI), propulsion by older adults is poorly defined. The goal of this project is to examine the impact of wheelchair, surface, and user characteristics on propulsion mechanics in older adults and individuals with SCI. All participants self-propelled over a series of surfaces at a self-selected velocity and kinetic data collection were provided by the SmartWheel. We described a standard clinical protocol (SCP) for objective assessment of manual wheelchair propulsion and defined reference values for individuals with SCI based this protocol (N=128). The SCP requires self-propulsion over tile, low pile carpet, and up an ADA ramp. In addition we provided a decision framework based on graphical reference data; guiding clinicians through an objective assessment of propulsion, identifying opportunities for intervention and follow-up. We then compared propulsion of individuals with paraplegia (IP, N=54) and older adults (OA, N=53). OA propelled slower than IP; used a greater push frequency and minimum Mz, shorter stroke length, and similar resultant force. When surface difficulty increased, the IP group responded with increased work. This may indicate a lack of capacity in OA to respond to increased resistance. For our cohort of older adults we defined the impact of surface type, wheelchair weight, and rear axle position (N=53). As surface difficulty or chair weight increased, velocity decreased. Controlling for velocity, push frequency, resultant and tangential force increased as surface difficulty increased; heavier chairs had decreased stroke length and increased resultant and tangential force; and posterior axle positions had increased velocity. Controlling for velocity, posterior axle positions had increased forces.
Finally, we examined the impact of strength and gender. Body-weight normalized grip strength was collected. Stronger individuals propel faster than weaker individuals. On low pile carpet, both genders decreased velocity versus tile, but women decreased push frequency while men increased. Surface type has a substantial impact on propulsion velocity and force; magnifying any differences between users and wheelchair configurations. Wheelchair weight and axle position independently affect propulsion mechanics. Gender and strength appear to influence propulsion. Older adults are marginal self-propellers at best; powered mobility may be a more appropriate mobility solution.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-12062007-081607 |
| Date | 19 December 2007 |
| Creators | Cowan, Rachel E |
| Contributors | Stephanie Studenski, MD, MPH, Shirley Fitzgerald, PhD, Alicia Koontz, PhD, Michael Boninger, MD |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-12062007-081607/ |
| Rights | restricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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