Wheelchair design for patients with spinal cord injuries
Keywords:
Orthotics, Wheelchair, Spinal Cord Injury
Abstract
Wheelchairs are the most common means of transportation for people with spinal cord injury (SCI). The needs, requirements, functional capabilities and personal preferences of the SCI patient should be clarified in order to obtain a wheelchair that will satisfactorily meet its particularities and will enjoy maximum comfort. The purpose of this study is to review the designs of wheelchairs used in the rehabilitation of patients with SCI. In the PUBMED electronic database, a search was performed with the use of the following keywords: “wheelchair” AND “spinal cord injury” AND “design”. Inclusion criteria were studies evaluating wheelchair design in patients with SCI. The search revealed 573 papers. After checking titles and excluding papers, 48 studies were left for the present review. The proper design of wheelchair is vital to the quality of life of SCI patient. The design characteristics of the seat, the backrest, the wheels, the footrests, the cushions and other accessories may help SCI patients increase their independence and functionality and prevent from pressure ulcers.
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References
1. Kamenetz HL. A brief history of the wheelchair. J Hist Med Allied Sci 1969; 24(2): 205-10.
2. Scherer S. Wheels in motion. A history of the wheelchair. Contemp Longterm Care 2003; 26(11): 26.
3. Woods B, Watson N. A short history of powered wheelchairs. Assist Technol 2003; 15(2): 164-80.
4. You JS, Kim YL, Lee SM. Effects of a standard transfer exercise program on transfer quality and activities of daily living for transfer-dependent spinal cord injury patients. J Phys Ther Sci 2017; 29(3): 478-83.
5. Tsai CY, Hogaboom NS, Boninger ML, et al. The relationship between independent transfer skills and upper limb kinetics in wheelchair users. Biomed Res Int 2014; 2014: 984526.
6. Ekiz T, Ozbudak Demir S, Ozgirgin N. Wheelchair appropriateness in patients with spinal cord injury: a Turkish experience. Spinal Cord 2014; 52(12): 901-4.
7. Sprigle S, Wootten M, Sawacha Z, et al. Relationships among cushion type, backrest height, seated posture, and reach of wheelchair users with spinal cord injury. J Spinal Cord Med 2003; 26(3): 236-43.
8. Bayley MT, Kirby RL, Farahani F, et al. Development of Wheeled Mobility indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project. J Spinal Cord Med 2019; 42(sup1): 130-40.
9. Ferguson JE, Wittig BL, Payette M, et al. Pilot study of strap-based custom wheelchair seating system in persons with spinal cord injury. J Rehabil Res Dev 2014; 51(8): 1255-64.
10. Kernozek TW, Lewin JE. Seat interface pressures of individuals with paraplegia: influence of dynamic wheelchair locomotion compared with static seated measurements. Arch Phys Med Rehabil 1998; 79(3): 313-6.
11. Hughes CJ, Weimar WH, Sheth PN, et al. Biomechanics of wheelchair propulsion as a function of seat position and user-to-chair interface. Arch Phys Med Rehabil 1992; 73(3): 263-9.
12. van der Woude LH, Veeger DJ, Rozendal RH, et al. Seat height in handrim wheelchair propulsion. J Rehabil Res Dev 1989; 26(4): 31-50.
13. Boninger ML, Baldwin M, Cooper RA, et al. Manual wheelchair pushrim biomechanics and axle position. Arch Phys Med Rehabil 2000; 81(5): 608-13.
14. Kirby RL, Ashton BD, Ackroyd-Stolarz SA, et al. Adding loads to occupied wheelchairs: effect on static rear and forward stability. Arch Phys Med Rehabil 1996; 77(2): 183-6.
15. Hastings JD, Fanucchi ER, Burns SP. Wheelchair configuration and postural alignment in persons with spinal cord injury. Arch Phys Med Rehabil 2003; 84(4): 528-34.
16. Presperin Pedersen J, Smith C, Dahlin M, et al. Wheelchair backs that support the spinal curves: Assessing postural and functional changes. J Spinal Cord Med 2020: 1-10.
17. May LA, Butt C, Kolbinson K, et al. Wheelchair back-support options: functional outcomes for persons with recent spinal cord injury. Arch Phys Med Rehabil 2004; 85(7): 1146-50.
18. Giesbrecht EM, Ethans KD, Staley D. Measuring the effect of incremental angles of wheelchair tilt on interface pressure among individuals with spinal cord injury. Spinal Cord 2011; 49(7): 827-31.
19. Lung CW, Yang TD, Liau BY, et al. Dynamic changes in seating pressure gradient in wheelchair users with spinal cord injury. Assist Technol 2020; 32(5): 277-86.
20. Jan YK, Crane BA. Wheelchair tilt-in-space and recline does not reduce sacral skin perfusion as changing from the upright to the tilted and reclined position in people with spinal cord injury. Arch Phys Med Rehabil 2013; 94(6): 1207-10.
21. Jan YK, Liao F, Jones MA, et al. Effect of durations of wheelchair tilt-in-space and recline on skin perfusion over the ischial tuberosity in people with spinal cord injury. Arch Phys Med Rehabil 2013; 94(4): 667-72.
22. Janssen-Potten YJ, Seelen HA, Drukker J, et al. The effect of footrests on sitting balance in paraplegic subjects. Arch Phys Med Rehabil 2002; 83(5): 642-8.
23. Yuen HK, Garrett D. Comparison of three wheelchair cushions for effectiveness of pressure relief. Am J Occup Ther 2001; 55(4): 470-5.
24. Mendes PVB, Gradim LCC, Silva NS, et al. Pressure distribution analysis in three wheelchairs cushions of subjects with spinal cord injury. Disabil Rehabil Assist Technol 2019; 14(6): 555-60.
25. Sonenblum SE, Vonk TE, Janssen TW, et al. Effects of wheelchair cushions and pressure relief maneuvers on ischial interface pressure and blood flow in people with spinal cord injury. Arch Phys Med Rehabil 2014; 95(7): 1350-7.
26. Brienza D, Vallely J, Karg P, et al. An MRI investigation of the effects of user anatomy and wheelchair cushion type on tissue deformation. J Tissue Viability 2018; 27(1): 42-53.
27. Burns SP, Betz KL. Seating pressures with conventional and dynamic wheelchair cushions in tetraplegia. Arch Phys Med Rehabil 1999; 80(5): 566-71.
28. Garber SL. Wheelchair cushions for spinal cord-injured individuals. Am J Occup Ther 1985; 39(11): 722-5.
29. Vilchis-Aranguren R, Gayol-Mérida D, Quinzaños-Fresnedo J, et al. A prospective, longitudinal, descriptive study of the effect of a customized wheelchair cushion on clinical variables, satisfaction, and functionality among patients with spinal cord injury. Ostomy Wound Manage 2015; 61(2): 26-36.
30. Liu HY, Pearlman J, Cooper R, et al. Evaluation of aluminum ultralight rigid wheelchairs versus other ultralight wheelchairs using ANSI/RESNA standards. J Rehabil Res Dev 2010; 47(5): 441-55.
31. Vorrink SN, Van der Woude LH, Messenberg A, et al. Comparison of wheelchair wheels in terms of vibration and spasticity in people with spinal cord injury. J Rehabil Res Dev 2008; 45(9): 1269-79.
32. Dieruf K, Ewer L, Boninger D. The natural-fit handrim: factors related to improvement in symptoms and function in wheelchair users. J Spinal Cord Med 2008; 31(5): 578-85.
33. Majaess GG, Kirby RL, Ackroyd-Stolarz SA, et al. Influence of seat position on the static and dynamic forward and rear stability of occupied wheelchairs. Arch Phys Med Rehabil 1993; 74(9): 977-82.
34. Requejo PS, Kerdanyan G, Minkel J, et al. Effect of rear suspension and speed on seat forces and head accelerations experienced by manual wheelchair riders with spinal cord injury. J Rehabil Res Dev 2008; 45(7): 985-96.
35. de Groot S, Post MW, Bongers-Janssen HM, et al. Is manual wheelchair satisfaction related to active lifestyle and participation in people with a spinal cord injury? Spinal Cord 2011; 49(4): 560-5.
36. Rushton PW, Miller WC, Mortenson WB, et al. Satisfaction with participation using a manual wheelchair among individuals with spinal cord injury. Spinal Cord 2010; 48(9): 691-6.
37. Toro ML, Worobey L, Boninger ML, et al. Type and Frequency of Reported Wheelchair Repairs and Related Adverse Consequences Among People With Spinal Cord Injury. Arch Phys Med Rehabil 2016; 97(10): 1753-60.
38. Nitz JC, Bullock MI. Wheelchair design for people with neuromuscular disability. Aust J Physiother 1983; 29(2): 43-7.
39. Flemmer CL, Flemmer RC. A review of manual wheelchairs. Disabil Rehabil Assist Technol 2016; 11(3): 177-87.
40. Deems-Dluhy SL, Jayaraman C, Green S, et al. Evaluating the Functionality and Usability of Two Novel Wheelchair Anti-Rollback Devices for Ramp Ascent in Manual Wheelchair Users With Spinal Cord Injury. PM R 2017; 9(5): 483-93.
41. Simpson RC, LoPresti EF, Cooper RA. How many people would benefit from a smart wheelchair? J Rehabil Res Dev 2008; 45(1): 53-71.
42. Newsam CJ, Mulroy SJ, Gronley JK, et al. Temporal-spatial characteristics of wheelchair propulsion. Effects of level of spinal cord injury, terrain, and propulsion rate. Am J Phys Med Rehabil 1996; 75(4): 292-9.
43. Cooper RA, Fitzgerald SG, Boninger ML, et al. Evaluation of a pushrim-activated, power-assisted wheelchair. Arch Phys Med Rehabil 2001; 82(5): 702-8.
44. Beekman CE, Miller-Porter L, Schoneberger M. Energy cost of propulsion in standard and ultralight wheelchairs in people with spinal cord injuries. Phys Ther 1999; 79(2): 146-58.
45. Chen Y, Wang J, Lung CW, et al. Effect of tilt and recline on ischial and coccygeal interface pressures in people with spinal cord injury. Am J Phys Med Rehabil 2014; 93(12): 1019-30.
46. Worobey L, Oyster M, Pearlman J, et al. Differences between manufacturers in reported power wheelchair repairs and adverse consequences among people with spinal cord injury. Arch Phys Med Rehabil 2014; 95(4): 597-603.
47. Worobey L, Oyster M, Nemunaitis G, et al. Increases in wheelchair breakdowns, repairs, and adverse consequences for people with traumatic spinal cord injury. Am J Phys Med Rehabil 2012; 91(6): 463-9.
48. Jan YK, Jones MA, Rabadi MH, et al. Effect of wheelchair tilt-in-space and recline angles on skin perfusion over the ischial tuberosity in people with spinal cord injury. Arch Phys Med Rehabil 2010; 91(11): 1758-64.
49. Brubaker CE. Wheelchair prescription: an analysis of factors that affect mobility and performance. J Rehabil Res Dev 1986; 23(4): 19-26.
50. Marszalek J PhD PT, Kosmol AP, Mroz AP, et al. Physiological parameters depending on two different types of manual wheelchair propulsion. Assist Technol 2018: 1-7.
51. Tsai IH, Graves DE, Lai CH. The association of assistive mobility devices and social participation in people with spinal cord injuries. Spinal Cord 2014; 52(3): 209-15.
52. Preservation of upper limb function following spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med 2005; 28(5): 434-70.
53. Bolin I, Bodin P, Kreuter M. Sitting position - posture and performance in C5 - C6 tetraplegia. Spinal Cord 2000; 38(7): 425-34.
2. Scherer S. Wheels in motion. A history of the wheelchair. Contemp Longterm Care 2003; 26(11): 26.
3. Woods B, Watson N. A short history of powered wheelchairs. Assist Technol 2003; 15(2): 164-80.
4. You JS, Kim YL, Lee SM. Effects of a standard transfer exercise program on transfer quality and activities of daily living for transfer-dependent spinal cord injury patients. J Phys Ther Sci 2017; 29(3): 478-83.
5. Tsai CY, Hogaboom NS, Boninger ML, et al. The relationship between independent transfer skills and upper limb kinetics in wheelchair users. Biomed Res Int 2014; 2014: 984526.
6. Ekiz T, Ozbudak Demir S, Ozgirgin N. Wheelchair appropriateness in patients with spinal cord injury: a Turkish experience. Spinal Cord 2014; 52(12): 901-4.
7. Sprigle S, Wootten M, Sawacha Z, et al. Relationships among cushion type, backrest height, seated posture, and reach of wheelchair users with spinal cord injury. J Spinal Cord Med 2003; 26(3): 236-43.
8. Bayley MT, Kirby RL, Farahani F, et al. Development of Wheeled Mobility indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project. J Spinal Cord Med 2019; 42(sup1): 130-40.
9. Ferguson JE, Wittig BL, Payette M, et al. Pilot study of strap-based custom wheelchair seating system in persons with spinal cord injury. J Rehabil Res Dev 2014; 51(8): 1255-64.
10. Kernozek TW, Lewin JE. Seat interface pressures of individuals with paraplegia: influence of dynamic wheelchair locomotion compared with static seated measurements. Arch Phys Med Rehabil 1998; 79(3): 313-6.
11. Hughes CJ, Weimar WH, Sheth PN, et al. Biomechanics of wheelchair propulsion as a function of seat position and user-to-chair interface. Arch Phys Med Rehabil 1992; 73(3): 263-9.
12. van der Woude LH, Veeger DJ, Rozendal RH, et al. Seat height in handrim wheelchair propulsion. J Rehabil Res Dev 1989; 26(4): 31-50.
13. Boninger ML, Baldwin M, Cooper RA, et al. Manual wheelchair pushrim biomechanics and axle position. Arch Phys Med Rehabil 2000; 81(5): 608-13.
14. Kirby RL, Ashton BD, Ackroyd-Stolarz SA, et al. Adding loads to occupied wheelchairs: effect on static rear and forward stability. Arch Phys Med Rehabil 1996; 77(2): 183-6.
15. Hastings JD, Fanucchi ER, Burns SP. Wheelchair configuration and postural alignment in persons with spinal cord injury. Arch Phys Med Rehabil 2003; 84(4): 528-34.
16. Presperin Pedersen J, Smith C, Dahlin M, et al. Wheelchair backs that support the spinal curves: Assessing postural and functional changes. J Spinal Cord Med 2020: 1-10.
17. May LA, Butt C, Kolbinson K, et al. Wheelchair back-support options: functional outcomes for persons with recent spinal cord injury. Arch Phys Med Rehabil 2004; 85(7): 1146-50.
18. Giesbrecht EM, Ethans KD, Staley D. Measuring the effect of incremental angles of wheelchair tilt on interface pressure among individuals with spinal cord injury. Spinal Cord 2011; 49(7): 827-31.
19. Lung CW, Yang TD, Liau BY, et al. Dynamic changes in seating pressure gradient in wheelchair users with spinal cord injury. Assist Technol 2020; 32(5): 277-86.
20. Jan YK, Crane BA. Wheelchair tilt-in-space and recline does not reduce sacral skin perfusion as changing from the upright to the tilted and reclined position in people with spinal cord injury. Arch Phys Med Rehabil 2013; 94(6): 1207-10.
21. Jan YK, Liao F, Jones MA, et al. Effect of durations of wheelchair tilt-in-space and recline on skin perfusion over the ischial tuberosity in people with spinal cord injury. Arch Phys Med Rehabil 2013; 94(4): 667-72.
22. Janssen-Potten YJ, Seelen HA, Drukker J, et al. The effect of footrests on sitting balance in paraplegic subjects. Arch Phys Med Rehabil 2002; 83(5): 642-8.
23. Yuen HK, Garrett D. Comparison of three wheelchair cushions for effectiveness of pressure relief. Am J Occup Ther 2001; 55(4): 470-5.
24. Mendes PVB, Gradim LCC, Silva NS, et al. Pressure distribution analysis in three wheelchairs cushions of subjects with spinal cord injury. Disabil Rehabil Assist Technol 2019; 14(6): 555-60.
25. Sonenblum SE, Vonk TE, Janssen TW, et al. Effects of wheelchair cushions and pressure relief maneuvers on ischial interface pressure and blood flow in people with spinal cord injury. Arch Phys Med Rehabil 2014; 95(7): 1350-7.
26. Brienza D, Vallely J, Karg P, et al. An MRI investigation of the effects of user anatomy and wheelchair cushion type on tissue deformation. J Tissue Viability 2018; 27(1): 42-53.
27. Burns SP, Betz KL. Seating pressures with conventional and dynamic wheelchair cushions in tetraplegia. Arch Phys Med Rehabil 1999; 80(5): 566-71.
28. Garber SL. Wheelchair cushions for spinal cord-injured individuals. Am J Occup Ther 1985; 39(11): 722-5.
29. Vilchis-Aranguren R, Gayol-Mérida D, Quinzaños-Fresnedo J, et al. A prospective, longitudinal, descriptive study of the effect of a customized wheelchair cushion on clinical variables, satisfaction, and functionality among patients with spinal cord injury. Ostomy Wound Manage 2015; 61(2): 26-36.
30. Liu HY, Pearlman J, Cooper R, et al. Evaluation of aluminum ultralight rigid wheelchairs versus other ultralight wheelchairs using ANSI/RESNA standards. J Rehabil Res Dev 2010; 47(5): 441-55.
31. Vorrink SN, Van der Woude LH, Messenberg A, et al. Comparison of wheelchair wheels in terms of vibration and spasticity in people with spinal cord injury. J Rehabil Res Dev 2008; 45(9): 1269-79.
32. Dieruf K, Ewer L, Boninger D. The natural-fit handrim: factors related to improvement in symptoms and function in wheelchair users. J Spinal Cord Med 2008; 31(5): 578-85.
33. Majaess GG, Kirby RL, Ackroyd-Stolarz SA, et al. Influence of seat position on the static and dynamic forward and rear stability of occupied wheelchairs. Arch Phys Med Rehabil 1993; 74(9): 977-82.
34. Requejo PS, Kerdanyan G, Minkel J, et al. Effect of rear suspension and speed on seat forces and head accelerations experienced by manual wheelchair riders with spinal cord injury. J Rehabil Res Dev 2008; 45(7): 985-96.
35. de Groot S, Post MW, Bongers-Janssen HM, et al. Is manual wheelchair satisfaction related to active lifestyle and participation in people with a spinal cord injury? Spinal Cord 2011; 49(4): 560-5.
36. Rushton PW, Miller WC, Mortenson WB, et al. Satisfaction with participation using a manual wheelchair among individuals with spinal cord injury. Spinal Cord 2010; 48(9): 691-6.
37. Toro ML, Worobey L, Boninger ML, et al. Type and Frequency of Reported Wheelchair Repairs and Related Adverse Consequences Among People With Spinal Cord Injury. Arch Phys Med Rehabil 2016; 97(10): 1753-60.
38. Nitz JC, Bullock MI. Wheelchair design for people with neuromuscular disability. Aust J Physiother 1983; 29(2): 43-7.
39. Flemmer CL, Flemmer RC. A review of manual wheelchairs. Disabil Rehabil Assist Technol 2016; 11(3): 177-87.
40. Deems-Dluhy SL, Jayaraman C, Green S, et al. Evaluating the Functionality and Usability of Two Novel Wheelchair Anti-Rollback Devices for Ramp Ascent in Manual Wheelchair Users With Spinal Cord Injury. PM R 2017; 9(5): 483-93.
41. Simpson RC, LoPresti EF, Cooper RA. How many people would benefit from a smart wheelchair? J Rehabil Res Dev 2008; 45(1): 53-71.
42. Newsam CJ, Mulroy SJ, Gronley JK, et al. Temporal-spatial characteristics of wheelchair propulsion. Effects of level of spinal cord injury, terrain, and propulsion rate. Am J Phys Med Rehabil 1996; 75(4): 292-9.
43. Cooper RA, Fitzgerald SG, Boninger ML, et al. Evaluation of a pushrim-activated, power-assisted wheelchair. Arch Phys Med Rehabil 2001; 82(5): 702-8.
44. Beekman CE, Miller-Porter L, Schoneberger M. Energy cost of propulsion in standard and ultralight wheelchairs in people with spinal cord injuries. Phys Ther 1999; 79(2): 146-58.
45. Chen Y, Wang J, Lung CW, et al. Effect of tilt and recline on ischial and coccygeal interface pressures in people with spinal cord injury. Am J Phys Med Rehabil 2014; 93(12): 1019-30.
46. Worobey L, Oyster M, Pearlman J, et al. Differences between manufacturers in reported power wheelchair repairs and adverse consequences among people with spinal cord injury. Arch Phys Med Rehabil 2014; 95(4): 597-603.
47. Worobey L, Oyster M, Nemunaitis G, et al. Increases in wheelchair breakdowns, repairs, and adverse consequences for people with traumatic spinal cord injury. Am J Phys Med Rehabil 2012; 91(6): 463-9.
48. Jan YK, Jones MA, Rabadi MH, et al. Effect of wheelchair tilt-in-space and recline angles on skin perfusion over the ischial tuberosity in people with spinal cord injury. Arch Phys Med Rehabil 2010; 91(11): 1758-64.
49. Brubaker CE. Wheelchair prescription: an analysis of factors that affect mobility and performance. J Rehabil Res Dev 1986; 23(4): 19-26.
50. Marszalek J PhD PT, Kosmol AP, Mroz AP, et al. Physiological parameters depending on two different types of manual wheelchair propulsion. Assist Technol 2018: 1-7.
51. Tsai IH, Graves DE, Lai CH. The association of assistive mobility devices and social participation in people with spinal cord injuries. Spinal Cord 2014; 52(3): 209-15.
52. Preservation of upper limb function following spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med 2005; 28(5): 434-70.
53. Bolin I, Bodin P, Kreuter M. Sitting position - posture and performance in C5 - C6 tetraplegia. Spinal Cord 2000; 38(7): 425-34.
Published
2022-09-28
Section
Young Scientists Pages
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