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Purpose: Functional mobility is necessary to perform activities of daily living and for community participation for everyone, but especially important for persons with disabilities (PWD). Therefore, functional mobility requires reliable measurement of consumer satisfaction and functional changes. The functional mobility assessment (FMA) instrument is a self-report outcomes tool designed to measure effectiveness of wheeled mobility and seating (WMS) interventions for PWD. This study examined the test-retest reliability of the FMA, and the stability of self-reported performance items. Method: A repeated-measures cohort study was conducted at the Center for Assistive Technology, at the University of Pittsburgh Medical Center. Participants (n = 41) completed an initial FMA questionnaire, and were re-administered the questionnaire within 7-21 days of the first questionnaire completion. The study sample included 20 participants who were non-WMS users but in the process of being evaluated for a device and 21 participants who were existing WMS users. Intra-Class Correlation coefficients (ICC) were computed to determine agreement between the two scores. Results: Test-retest reliability scores for all items and participants were above the acceptable value for a clinical assessment tool (≥0.80). Responses on the FMA of Existing WMS users and non-WMS users did not differ significantly at test or retest. Conclusions: Results indicate that the FMA was a reliable and stable tool for assessing the functional performance of individuals who use or need WMS interventions. Implications for Rehabilitation The FMA is applicable to non-WMS and WMS users. The FMA fills a gap in mobility assessment tools because it is applicable to the total range of WMS devices. The FMA promotes collaboration between the consumer and the practitioner, yielding a better outcome for the consumer. © 2013 Informa UK, Ltd.

Surface characteristics of a cross slope can impact the ease with which a manual wheelchair (MWC) user propels across a surface. The purpose of this research was two-fold. Phase I of this research surveyed MWC users to identify cross slope scenarios that they reported to be more difficult to traverse compared to other common driving obstacles. Our survey results showed that, overall, cross slopes were harder to propel across than narrow and manual doors, and cross-slopes in inclement weather conditions were equal or more difficult than gravel and rough-surfaces. Cross slopes with severe angles and those with compound angles (slope with cross-slope) were the most difficult to traverse. Phase II focused on identifying the responses (e.g., avoid, explore alternative, experience a sense of insecurity, no effect) people had when viewing pictures of various cross-slopes scenarios (e.g., narrow space, compound angles, extreme weather) that wheelchair users encounter. These results showed that people reported that they would avoid or feel insecure on some cross-sloped surfaces, like the weather, that are not within our control, others, like compound angle and curb-cuts on slopes, that can be addressed in the construction of pathways or sidewalks. Copyright © 2012 RESNA.

This study determined the driving characteristics of wheelchair users during power wheelchair soccer games. Data for this study were collected at the 28th and 29th National Veterans Wheelchair Games. Nineteen veterans who were 18 years or older and power wheelchair soccer players completed a brief demographic survey and provided information about their power wheelchairs. A customized data-logging device was placed on each participant's wheelchair before power soccer game participation. The data logger was removed at the end of the final game for each participant. The average distance traveled during the games was 899.5 +/- 592.5 m, and the average maximum continuous distance traveled was 256.0 +/- 209.4 m. The average wheelchair speed was 0.8 +/- 0.2 m/s, and the average duration of driving time was 17.6 +/- 8.3 min. Average proportion of time spent at a speed >1 m/s was 30.7% +/- 33.8%, between 0.5 and 1 m/s was 16.2% +/- 34.4%, and <0.5 m/s was 21.4% +/- 24.3%. The information from this descriptive study provides insight for future research in the field of adapted sports for people with high levels of impairments who use power wheelchairs for their mobility.

Objective: To compare wheelchair driving performance in a driving simulator using a conventional joystick and an isometric joystick. Design: Randomized, cohort study. Setting: A research facility based in a hospital or in an independent living center. Participants: Participants (N=20; 12 men, 8 women; mean age ± SD, 30.62±10.91y) who were at least 1 year post-TBI. Interventions: Driving performance using an isometric joystick compared with a conventional movement joystick. Main Outcome Measures: Average trial completion time, and trajectory-specific measures measured orthogonal to the center of driving tasks: root mean squared error, movement offset, movement error, and number of significant changes in heading. Results: After statistically controlling for driving speed, participants were able to complete the driving tasks faster with an isometric joystick than while using a conventional movement joystick. Compared with the conventional joystick, an isometric joystick used for driving forward demonstrated fewer driving errors. During reverse driving the conventional joystick performed better. Conclusions: The customizable isometric joystick seems to be a promising interface for driving a powered wheelchair for individuals with TBI. © 2011 American Congress of Rehabilitation Medicine.

The purpose of this study was to determine whether the use of wheeled mobility devices differed with respect to age, gender, residential setting, and health-related factors among older adults. A total of 723 adults ageing 60 and older are representing three cohorts, from nursing homes, the Center for Assistive Technology, and the wheelchair registry from the Human Engineering Research Laboratories. Wheeled mobility devices were classified into three main groups: manual wheelchairs, power wheelchairs, and scooters. Our results found factors including age, gender, diagnosis, and living settings to be associated with differences in use of manual versus powered mobility devices. Differences in use were also noted for subtypes of manual (depot, standard, and customized) and powered (scooter, standard, and customized) mobility devices, on demographic, living arrangements, and health-related factors. Consideration of demographic, health-related, and environmental factors during the prescription process may help clinicians identify the most appropriate mobility device for the user. Copyright © 2011 Amol M. Karmarkar et al.

Salmonellosis is an internationally important disease of mammals and birds. Unique epidemics in New Zealand in the recent past include two Salmonella serovars: Salmonella enterica subsp. enterica serovar Typhimurium definitive type (DT) 160 (S. Typhimurium DT160) and S. Brandenburg. Although not a major threat internationally, in New Zealand S. Typhimurium DT160 has been the most common serovar isolated from humans, and continues to cause significant losses in wildlife. We have identified DNA differences between the first New Zealand isolate of S. Typhimurium DT160 and the genome-sequenced strain, S. Typhimurium LT2. All the differences could be accounted for in one cryptic phage ST64B, and one novel P22-like phage, ST160. The majority of the ST160 genome is almost identical to phage SE1 but has two regions not found in SE1 which are identical to the P22-like phage ST64T, suggesting that ST160 evolved from SE1 via two recombination events with ST64T. All of the New Zealand isolates of DT160 were identical indicating the clonal spread of this particular Salmonella. Some overseas isolates of S. Typhimurium DT160 differed from the New Zealand strain and contained SE1 phage rather than ST160. ST160 was also identified in New Zealand isolates of S. Typhimurium DT74 and S. Typhimurium RDNC-April06 and in S. Typhimurium DT160 isolates from the USA. The emergence of S. Typhimurium DT160 as a significant pathogen in New Zealand is postulated to have occurred due to the sensitivity of the Salmonella strains to the ST160 phage when S. Typhimurium DT160 first arrived. © 2010 Cambridge University Press.

Multiple sclerosis (MS) causes a wide variety of neurological deficits, with ambulatory impairment the most obvious cause of disability. Within 10 to 15 years of disease onset, 80% of persons with MS experience gait problems due to muscle weakness or spasticity, fatigue, and loss of balance. To facilitate mobility, persons with MS frequently use mobility assistive technology (MAT), such as canes, crutches, walkers, wheelchairs, and scooters. We systematically reviewed the published literature on MAT use among persons with MS. We used electronic reference lists such as Ovid MEDLINE and PubMed to search the literature. We located 50 articles that met the initial criteria of providing good evidence of the types of MAT devices and their benefits for individuals with MS. A limited number of articles with higher levels of evidence was found regarding benefits of MAT use specifically for persons with MS. Evidence-based literature provides the basis for the strongest method of measurable clinical performance; therefore, having a strong research study design is vital to the justification of MAT prescription and reimbursement decisions. However, a paucity of studies with higher levels of evidence-based practice exists.

Aim.Manual wheelchairs are commonly prescribed for older adults in nursing homes (NH). The extent of their utilisation being unknown may result in the prescription of standard wheelchairs. The purpose of this study was to quantify manual wheelchair use by nursing home residents. Methods.Seventy-two independent wheelchair users were recruited from four NH (two VA-affiliated and two private). A customised wheelchair data logger was attached to each participant's wheelchair for 1 month. Data were reduced and compared separately for VA- affiliated and private facilities by types of propulsion pattern (arms versus legs and the combination of arms and legs) using MANOVA. Results.Participants from the VA-affiliated facilities who used their arms were covering more distance (1451m versus 806m), with greater endurance (73m versus 60m) as compared to participants who used combination of arms and legs. However, no difference was observed between velocity of wheelchair propulsion between groups (0.48m/s versus 0.58m/s). For private facilities no notable difference was observed between the groups. Conclusion.Older adults who live in NH and use of wheelchairs represent a diverse cohort. The efficacy of using an objective assessment method to measure the extent of use of wheelchairs was demonstrated in this study. © 2010 Informa UK, Ltd.

Purpose. Older adults commonly use wheelchairs for mobility impairments regardless of their living situations. However, limited outcomes data are available to determine quality of the wheelchairs that older Americans are receiving, as well as their satisfaction with wheelchair service delivery programs. The purpose of this article was to analyze satisfaction data collected from three cohorts of older individuals living at nursing homes and in community settings. Ninety participants were residents in VA (n=60). Methods. One hundred thirty two older adults completed the standardized Quebec User Evaluation of Satisfaction with Assistive Technology. Ninety participants were residents in VA (n=30) or private nursing homes (n=30), and 42 were community dwelling participants. Those enrolled were either independent manual or power wheelchairs users. Results. The community dwelling group reported significantly higher levels of satisfaction with their manual wheelchairs and service delivery when compared with the private nursing home participants (4.3 versus 2.9, p=0.002). The satisfaction was also higher for VA nursing homes than private (3.9 versus 2.9, p=0.004). No significant differences were reported for satisfaction levels regarding powered wheelchairs use between three groups. Conclusion. Level of satisfaction should be incorporated as an outcomes measure for evaluating wheelchair prescriptions and service delivery programs. This study also supports the establishment of a re-evaluation process of wheelchair fit as the users' age, to aide in provision of the best quality wheelchairs and service delivery programs. © 2009 Informa UK Ltd All rights reserved.

We determined the demographic, health, functional, and satisfaction factors related to lower-limb prosthesis or wheelchair use among veterans with lower-limb amputation. Forty-two veterans were recruited from the 20th National Disabled Veterans Winter Sports Clinic and the 26th National Veterans Wheelchair Games. Participants were at least 18 years of age, had a lower-limb amputation, and were either prosthesis or wheelchair users. Level of amputation was the most significant health-related characteristic determining the veterans' use of a prosthesis versus a wheelchair (p = 0.02). Veterans who had a higher level of amputation and used a prosthesis reported significantly greater difficulty navigating a ramp (p = 0.03), getting in and out of cars and buses (p = 0.03), carrying 10 lb of groceries (p = 0.02), and participating in sports and leisure activities (p = 0.03). The parameter "satisfaction related to prosthesis" did not determine selection of mobility device type. The interaction of demographics, health-related characteristics, and mobility device characteristics affects functional performance and influences the use of prostheses, wheelchairs, or both in persons with lower-limb amputation. Long-term outcome assessments may help determine factors associated with either transition from one device to another or combined use of the devices over time.

OBJECTIVE: Many individuals with spina bifida have impairments that limit mobility and functional independence. Sedentary lifestyles and social isolation are very prevalent. This study evaluated the association between the use of mobility devices and degree of socialization. DESIGN: A retrospective chart review was performed on 208 adults with spina bifida attending a university-based clinic. Data collected included the Craig Handicap Assessment Reporting Technique-Short Form, Beck Depression Inventory, and data on wheelchair and other assistive technology use. We hypothesized that community and home mobility and social integration, as measured by the Craig Handicap Assessment Reporting Technique-Short Form, would be lower for manual and power wheelchair users than for ambulators, regardless of depression scores or shunt history. RESULTS: We found that individuals with spina bifida who used both manual and power wheelchairs do have lower daily home and community activity levels compared with ambulators, but that most individuals with spina bifida have low social integration and economic self-sufficiency scores, regardless of whether they can ambulate or use wheelchairs. These findings were not explained by wheelchair quality because most were prescribed high-quality devices. A high prevalence of depression was also found. CONCLUSIONS: Special considerations for wheelchair provision are discussed. Additional research is needed to identify other barriers to social integration. © 2009 Lippincott Williams & Wilkins, Inc.

A group of 158 service members who sustained major limb amputations during the global war on terrorism were surveyed on their satisfaction with the quality of care received from the Walter Reed Army Medical Center (WRAMC) Amputee Clinic from the time of their injury to their inpatient discharge. Of these participants, 96% were male, 77% were Caucasian, 89% were enlisted personnel, and 68% had sustained lower-limb amputations. WRAMC inpatient therapy, peer visitors, overall medical care, and pain management received particularly high satisfaction ratings. Age, race, rank, and level and side of amputation had little effect on overall satisfaction ratings. Significant differences, however, were found by location of injury (Iraq vs Afghanistan, Cuba, and Africa) regarding satisfaction with care received while in Europe and with the education process at WRAMC. Study findings strongly support the rehabilitation-based, integrative care approach designed by the U.S. military to care for service members with amputations.

Acute mountain sickness (AMS) is a frequent complication for military personnel, veterans, athletes, and travelers at high altitudes. Symptoms may occur in individuals with less cerebrospinal fluid volume and less ability to accommodate increased brain volume. No studies on AMS exist in individuals with neurological impairments. We studied 64 subjects, including active and sedentary controls and those with tetraplegia, paraplegia, multiple sclerosis, and traumatic brain injury at the 2007 National Veterans Winter Sports Clinic in Snowmass, Colorado. Subjects completed three Lake Louise Score surveys to quantify symptoms. We found a higher than expected occurrence of AMS overall (51.6%) but no differences among groups, and few participants sought treatment. Fatigue and weakness were common symptoms. High subject activity levels may explain these findings. More research is warranted on larger sample sizes and on preventative medications and treatments for AMS, especially since many military personnel with neurological impairments are returning to full active service.

This paper provides an overview of the development of a wheelchair users registry and subsequently describes a population of individuals who use wheelchairs. The characteristics of Americans who permanently use wheelchairs and scooters are currently unknown. As the result of developing a Registry of individuals who use wheeled mobility devices for systematic recruitment for research studies, this study provides a description of a nationwide sample of over 1000 individuals who used wheelchairs or scooters for their daily mobility. The Registry is predominantly Caucasian (83%), 63% male, with a mean age of 50 years. Some 54% used manual wheelchairs for an average of 16 years. When quality of wheelchairs was compared, results indicated those in more customizable manual wheelchairs were significantly more likely to be younger. Males were significantly more likely to receive more customizable, heavy duty power wheelchairs than females. The Wheelchair Users Registry provides an organized and systematic way to maintain contact with previous research participants. Expected to grow in size, the Registry may enable an even more diverse pool of subjects interested in participating in research studies. © 2007 Informa UK Ltd All rights reserved.

Wheelchair-related physical restraints, lap belts, and other alternatives are intended to provide safe and adequate seating and mobility for individuals using wheelchairs. Physical restraints and lap belts are also helpful for positioning people in their wheelchairs to reduce the risk of injury during wheelchair tips and falls. However, when used improperly or in ways other than intended, injury or even death can result. Although widely prescribed, little evidence is available to direct professionals on the appropriate use of these restraints and lap belts and for whom these restraints are indicated. The purpose of this study was to conduct a review of available literature from 1966–2006 to identify the risks and benefits associated with lap belts while seated in wheelchairs. Twenty-five studies that met the inclusion criteria were reviewed. Nine studies reported the frequency of asphyxial deaths caused by physical restraints, nine studies reported the long-term complication and indirect adverse effects of physical restraints and lap-belt use, and seven studies reported the benefits of physical restraints and lap belts with individuals using wheelchairs. Despite the weak evidence, the results suggest a considerable number of deaths from asphyxia caused by the use of physical restraints occurred each year in the U.S. The majority of the deaths occurred in nursing homes, followed by hospitals, and then the home of the person. Most deaths occurred while persons were restrained in wheelchairs or beds. Based on that, caution needs to be exercised when using restraints or positioning belts. In addition, other seating and environment alternatives should be explored prior to using restraints or positioning belts, such as power wheelchair seating options. Positioning belts may reduce risk of falls from wheelchairs and should be given careful consideration, but caution should be exercised if the individual cannot open the latch independently. Also, the duration of use of the

The literature on lower extremity prostheses from 1989 to 2006 has been reviewed in this article. New technologies, such as the microprocessor- controlled prosthetic knees and energy-storing/return prosthetic feet, are recent advances in the prosthetic field. Despite the extensive research to date in the areas of socket design and manufacturing, and alignment of prostheses for optimum gait analyses, problems persist in the field. Difficulties in obtaining a comfortable socket fit, prostheses weight and alignment guidelines, and the ability to rapidly manufacture a prosthetic socket that can accommodate the changing sizes of the residual limb persist. Furthermore, no prosthetic device can adjust to the typical movements of the human gait. These areas provide opportunities for further research and development. © 2006 by Begell House, Inc.

With about 2.2 million Americans currently using wheeled mobility devices, wheelchairs are frequently provided to people with impaired mobility to provide accessibility to the community. Individuals with spinal cord injuries, arthritis, balance disorders, and other conditions or diseases are typical users of wheelchairs. However, secondary injuries and wheelchair-related accidents are risks introduced by wheelchairs. Research is underway to advance wheelchair design to prevent or accommodate secondary injuries related to propulsion and transfer biomechanics, while improving safe, functional performance and accessibility to the community. This paper summarizes research and development underway aimed at enhancing safety and optimizing wheelchair design. © 2006 IEEE.

Purpose. This cross-sectional study examined whether partnering with service dogs influenced psychosocial well-being and community participation of adult individuals using wheelchairs or scooters. Method. One hundred and fifty-two people were recruited and group-matched, resulting in 76 participants with and 76 without service dogs. Standardized scale scores for affect, depressive symptoms, self-esteem, and loneliness were used to operationally define psychosocial well-being. Community participation was assessed with the Social Integration domain of the Craig Handicap Assessment and Reporting Technique. Results. Psychosocial characteristics did not differ significantly between those partnered with and without service dogs overall. However, of participants with progressive conditions, those with service dogs demonstrated significantly higher positive affect scores than comparison group participants. Among those with clinical depression, service dog partners scored significantly higher in positive affect. Finally, regardless of whether individuals had service dogs, fewer depressive symptoms and being female or married were predictors of greater community participation. Conclusion. Select individuals may experience psychosocial benefits from partnering with service dogs. However, it is unclear if these benefits might also be derived from companion dogs. Further research is needed to substantiate the findings of this study. © 2006 Informa UK Ltd All rights reserved.

In this pilot study, we assessed wheelchair durability and its effect on user satisfaction. Specifically, we examined the characteristics of the participants' wheelchairs, the types of maintenance and repairs completed, and whether the participants' satisfaction was affected by problems with their wheelchairs. A convenience sample of 130 participants who used wheelchairs as their primary means of mobility was recruited. Participants completed a questionnaire about their wheelchairs, the maintenance and repair history, and their satisfaction levels. Results showed that 26% of the participants had completed a wheelchair repair in the past 6 months, 16% had completed general maintenance, and 27% had completed tire repairs. Neither hours of wheelchair use nor wheelchair age affected repair or maintenance frequency. Participants were generally satisfied with their wheelchairs. Better understanding of wheelchair maintenance and repair issues will guide improvements in wheelchair design and enhance the community participation of individuals who use wheelchairs.

According to the International Standards Organization 2631-1 standard on human vibration, individuals in a seated position are at risk of injury due to whole-body vibrations when exposed for long periods of time. Wheelchair users fit this description perfectly; however, little research has been conducted to evaluate the amount of vibration transmitted to a wheelchair user. The vibration exposure produced by traversing nine surfaces was evaluated by having 10 individuals without disabilities propel over them in both a manual wheelchair at 1 m/s and a powered wheelchair at 1 and 2 m/s. Root-mean squared (RMS) vertical vibration was examined to determine if differences existed between surfaces. At 1 m/s for both the manual and the powered wheelchair the 8-mm bevel interlocking concrete surface produced significantly higher RMS vertical vibration than the other surfaces. At 2 m/s in the powered wheelchair, the poured concrete surface (control) produced the significantly highest RMS vertical vibration. Based on the manual and power wheelchair results of this study, use of selected ICPI pavers would be acceptable for any route traveled by individuals using wheelchair. Furthermore, a 90° herringbone pattern is preferred over the 45° pattern, and it is recommended that for safety reasons regarding vibration exposure a bevel of less than 6 mm should be used. © 2005 Taylor & Francis.