Two approaches to manual wheelchair configuration and effects on function for individuals with acquired brain injury.

OBJECTIVE

To determine whether manual wheelchair configuration impacts how well a person who has acquired brain injury (ABI) related hemiparesis performs functional tasks from his or her wheelchair.

DESIGN

Multi-treatment cross-over design.

SETTING

Inpatient rehabilitation hospital.

PARTICIPANTS

Nineteen patients with ABI resulting in hemiparesis undergoing inpatient rehabilitation (average of 75 days post-injury (± 29.2 days); age range, 21-64; 9 with mechanical brain injury, 10 with cerebral vascular accident).

INTERVENTIONS

Participants in the study were placed in two different wheelchair configurations (position one and position two) and were randomized as to which position they were placed in first. All outcome measures were taken twice on each individual within each wheelchair configuration during two consecutive days.

MAIN OUTCOME MEASURES

Timed Forward Wheeling (TFW), Modified Functional Reach test (MFR), Visual Analogue Scale for Comfort (VAS), transfer score from the Functional Independence Measure (FIM), measurement of popliteal fossa to front of cushion.

RESULTS

The position two seating group's TFW was significantly faster than the position one seating group at both time points. There were no significant differences in the MFR scores, VAS comfort scale scores, and FIM transfer score between the two groups.

CONCLUSION

A wheelchair configuration with no seat slope, solid backrest mounted at 95 degree (± 3 degrees) seat to back angle, and use of a solid seat insert with a flat foam cushion (position two) results in greater efficiency in foot propulsion for individuals with ABI than a wheelchair configuration with one inch of seat slope, solid backrest mounted at 105 degree (± 3 degrees) seat to back angle, and no solid seat insert with a gel/foam contoured cushion (position 1).