The influence of Belt Use on Reach and Push Function in Active Wheelchair Users

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Christiana Charles
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2/24/13 The influence of Belt Use on Reach and Push Function in Active Wheelchair Users 29th International Seating Symposium 8 March 2013 Study Question Why Do Active Wheelchair

1 2/24/13 The influence of Belt Use on Reach and Push Function in Active Wheelchair Users 29th International Seating Symposium 8 March 2013 Study Question Why Do Active Wheelchair Riders Use Belts In Wheelchair Sports But Not In Their Everyday Chair? Background It is a common clinical practice to provide a postural belt when delivering a manual or power wheelchair. 1

2 The most common exception to this is the lack of belt use by active wheelchair users. Background Controlling Pelvic Positioning Improved Stability and Function Wheelchairs Provide Two Types of Support Primary Supports: Include the Seat, Backrest, Arm and Foot Supports. 2

Belt is the Most Common Secondary Support Belts Should Do Three Things - Provide Safety

3 Wheelchairs Provide Two Types of Support Secondary Supports: Positioning Belts, Head Supports, Lateral Torso Supports Lower Extremity Positioning Equipment The Positioning Belt is the Most Common Secondary Support Belts Should Do Three Things - Provide Safety and Security - Control Unwanted Movement (Positioning) - Allow Beneficial Movement (Function) 3

Torso and Pelvic Movement Normal Reaching Patterns Include Pelvis and Upper Body Movement. Restricting Available Movement of Any Body Segment Decreases Function.

4 Torso and Pelvic Movement Normal Reaching Patterns Include Pelvis and Upper Body Movement. Restricting Available Movement of Any Body Segment Decreases Function. Torso Movement Forward Leaning of the Torso helps: Deliver power to each push Increase Push Strength Increase Range of Push Stroke Pelvis Control Points ASIS PSIS Trochanter Trochanteric shelf Ischial Tuberosities 4

5 Torso Movement Forward Leaning of the Torso helps Increase Access for Improved Function in Daily Tasks Torso Movement in Wheelchair Images courtesy of Dr. Mark Richter Pelvis Movement If the Pelvis is Allowed to Rotate to Anterior Tilt, Forward Reach Distance is Increased 5

6 Anterior Pelvic Supports The Mounting Angle of The Postural Belt Has a Significant Effect on Posture, Mobility and Function Typical 45 Lap Belt 6

7 Typical 45 Lap Belt Lap Belt Lap Belt 7

8 90 Lap Belt 90 Lap Belt 90 4-point Lap Belt 8

9 90 4-point Lap Belt 90 4-point Lap Belt Provides Good Pressure Relief Clinical Study 10 Subjects SCI Manual Wheelchair Users No Belt Use in Everyday Chair May Use Belts in Sports Activities Tested For Reach And Function In Their Chair With And Without Belts. 9

10 Subjects 10 Active Wheelchair Riders all with SCI (2 lumbar, 3 thoracic and 5 cervical) 8 Male, 2 Female Average age 42 years Average height 177 cm Average weight 71 kg. Average Wheelchair experience - 14 years Study Design Tests Forward, Lateral and Downward Reach Timed Push (time to travel 5 meters) Distance Pushed (single push up standard ADA 1:12 ramp) All Tests Were Repeated 3 Times. Results Were Averaged Study Design Equipment All Test Subjects Used Their Personal Everyday Wheelchair. Belts were attached at 70 to 80 The Order Of Testing With (A) No Pelvic Positioning Support, (B) A Web Pelvic Belt, And (C) And Pelvic Stabilizer Was Randomized. 10

11 Forward Reach Lateral Reach Downward Reach 11

12 Pushing Tests Time / Distance: Time to complete 5-meters Pushing Tests Distance in a Single Push Up an ADA 1:12 Ramp Results Forward Reach All 10 Subjects Reached Farther In Both The Left And Right Forward Reach Test With Belt Use. 12

Results Lateral Reach All 10 Subjects Reached Farther In The

Results: Downward Reach Nine Out Of 10 Subjects Reached Farther

Left Side Downward Reach Test Using A Belt.

13 Results Lateral Reach All 10 Subjects Reached Farther In The Lateral Reach Test Using A Belt. Results: Downward Reach Nine Out Of 10 Subjects Reached Farther On The Right Side And All 10 Subjects Reached Farther In The Left Side Downward Reach Test Using A Belt. Results: Time / Distance Seven Out Of 10 Subjects Were Faster During The 5-meter Distance Test When Using A Belt. 13

Results: Single Push up Ramp Results Were Inconclusive.

14 Results: Single Push up Ramp Only 4 Out Of 10 Subjects Had A Greater Distance Traveled Up A Ramp With A Single Push Using Either The Pelvic Stabilizer Or Webbing Belt Than When Using No Pelvic Support. Results: Single Push up Ramp Results Were Inconclusive. Examination Of Test Results Indicate That A Multiple Push Test Would Have Been More Appropriate. Results: Single Push up Ramp Adapted Push Strategy for Single Push 14

15 STUDY CONCLUSIONS Anterior Pelvic Support Devices Fitted At A 70 To 80 Mounting Angle Can Increase Functional Performance For Forward, Lateral, And Downward Reach For People That Use Manual Wheelchairs. STUDY CONCLUSIONS Anterior Pelvic Support Devices Fitted At A 70 To 80 Mounting Angle May Increase Pushing Speed For People That Use Manual Wheelchairs. Testing Over Longer Distances May Provide More Significant Results. STUDY CONCLUSIONS While There Is A Potential For Improvements In Manual Wheelchair Mobility, The Pushing Tests Conducted In This Study Were Not Able To Provide Data To Prove Or Disprove This Hypothesis. The Test Should Be Changed To Include Multiple Pushes Up The Ramp. 15

16 2/24/13 Results Post Test Interview 9 of 10 Subjects said they would buy a pelvic stabilizer 3 of 10 would use it daily 5 of 10 would use it for specific tasks Over 50% cited stability and security as a reason for using. Allen Siekman Consulting allen@ebold.com Santa Cruz. CA 16

A wheelchair is a body orthosis on wheels. Understanding basic principles of seating. Seating REQUIREMENTS OF SEATING

Understanding basic principles of seating A wheelchair is a body orthosis on wheels. Bengt Engström Orthosis = splint FUNCTIONS OF AN ORTHOSIS Maintaining alignment Protecting weak muscles Protecting joints