Zoekresultaten

Determinants of physical activity in wheelchair users with spinal cord injury or lower limb amputation

ABSTRACT Purpose: To gain insight into determinants of physical activity in wheelchair users with spinal cord injury or lower limb amputation, from the perspective of both wheelchair users and rehabilitation professionals. Methods: Seven focus groups were conducted: five with wheelchair users (n=25) and two with rehabilitation professionals (n¼11). The transcripts were analysed using a sequential coding strategy, in which the reported determinants of physical activity were categorized using the Physical Activity for people with a Disability (PAD) model. Results: Reported personal determinants of physical activity were age, general health status, stage of life, demotivation due to difficulty burning calories, available time and energy, balance in daily life, attitude, and history of a physically active lifestyle. Reported environmental determinants were professional guidance, inconvenient exercise times, accessibility of facilities, costs, transportation difficulties, equipment difficulties, and social support. Conclusions: Important, changeable determinants of physical activity that might be influenced in future lifestyle interventions for wheelchair users are: balance in daily life leading to more time and energy to exercise, attitude towards physical activity, professional guidance, accessibility of facilities (providing information on how and where to find accessible facilities), and social support (learning how to get this)

Real-Life Wheelchair Mobility Metrics from IMUs

Daily wheelchair ambulation is seen as a risk factor for shoulder problems, which are prevalent in manual wheelchair users. To examine the long-term effect of shoulder load from daily wheelchair ambulation on shoulder problems, quantification is required in real-life settings. In this study, we describe and validate a comprehensive and unobtrusive methodology to derive clinically relevant wheelchair mobility metrics (WCMMs) from inertial measurement systems (IMUs) placed on the wheelchair frame and wheel in real-life settings. The set of WCMMs includes distance covered by the wheelchair, linear velocity of the wheelchair, number and duration of pushes, number and magnitude of turns and inclination of the wheelchair when on a slope. Data are collected from ten able-bodied participants, trained in wheelchair-related activities, who followed a 40 min course over the campus. The IMU-derived WCMMs are validated against accepted reference methods such as Smartwheel and video analysis. Intraclass correlation (ICC) is applied to test the reliability of the IMU method. IMU-derived push duration appeared to be less comparable with Smartwheel estimates, as it measures the effect of all energy applied to the wheelchair (including thorax and upper extremity movements), whereas the Smartwheel only measures forces and torques applied by the hand at the rim. All other WCMMs can be reliably estimated from real-life IMU data, with small errors and high ICCs, which opens the way to further examine real-life behavior in wheelchair ambulation with respect to shoulder loading. Moreover, WCMMs can be applied to other applications, including health tracking for individual interest or in therapy settings.

Recreational N2O use

Patient outcomes before and after implementation of a selective pre-hospital spinal immobilization protocol

Background: A new selective preventive spinal immobilization (PSI) protocol was introduced in the Netherlands. This may have led to an increase in non-immobilized spinal fractures (NISFs) and consequently adverse patient outcomes. Aim: A pilot study was conducted to describe the adverse patient outcomes in NISF of the PSI protocol change and assess the feasibility of a larger effect study. Methods: Retrospective comparative cohort pilot study including records of trauma patients with a presumed spinal injury who were presented at the emergency department of a level 2 trauma center by the emergency medical service (EMS). The pre-period 2013-2014 (strict PSI protocol), was compared to the post-period 2017-2018 (selective PSI protocol). Primary outcomes were the percentage of records with a NISF who had an adverse patient outcome such as neurological injuries and mortality before and after the protocol change. Secondary outcomes were the sample size calculation for a larger study and the feasibility of data collection. Results: 1,147 records were included; 442 pre-period, and 705 post-period. The NISF-prevalence was 10% (95% CI 7-16, n = 19) and 8% (95% CI 6-11, n = 33), respectively. In both periods, no neurological injuries or mortality due to NISF were found, by which calculating a sample size is impossible. Data collection showed to be feasible. Conclusions: No neurological injuries or mortality due to NISF were found in a strict and a selective PSI protocol. Therefore, a larger study is discouraged. Future studies should focus on which patients really profit from PSI and which patients do not.

Validity and Reliability of Skill-Related Fitness Tests for Wheelchair-Using Youth with Spina Bifida

Objective: To determine content validity of the Muscle Power Sprint Test (MPST) and construct validity and reliability of the MPST, 10x5 Meter Sprint Test (10x5MST), slalom test and one stroke push test (1SPT) in wheelchair-using youth with spina bifida (SB). Design: Clinimetric study Setting: Rehabilitation centers, SB outpatient services, private practices Participants: A convenience sample of 53 children (5-19 years, 32 boys / 21 girls) with SB who use a manual wheelchair. Participants were recruited in the Netherlands through rehabilitation centers, SB outpatient services, pediatric physical therapists and the BOSK (Association of and by parents of children, adolescents and adults with a disability). Interventions: Not applicable. Main Outcome Measures: Construct validity of the the MPST was determined by comparing results with the arm-cranking Wingate Anaerobic test (WAnT) using paired t-tests and Pearson Correlation Coefficients, while content validity was assessed using time based criteria for anaerobic testing . Construct validity of the 10x5MST, slalom test and 1SPT was analyzed by hypothesis testing using Pearson Correlation Coefficients and Multiple Regression. For reliability, Intra Class Correlation coefficients (ICC) and smallest detectable changes (SDC) were calculated. Results: For the MPST, mean exercise time of four sprints was 28.1 sec. (±6.6 sec.). Correlations between the MPST and WAnT were high (r>0.72, p<0.01). Excellent correlations were found between the 10x5MST and slalom test (r=0.93, p<0.01), while correlations between the10x5MST or slalom test and MPST and 1SPT were moderate (r=-0.56- -0.70; r=0.56, p<0.01). The 1SPT was explained for 38% by wheelchair mass (Beta -0.489) and total upper muscle strength (Beta 0.420). All ICCs were excellent (ICC>0.95) but the SDCs varied widely. Conclusions: The MPST, 10x5MST and slalom test are valid and reliable tests in wheelchair-using youth with SB for measuring respectively anaerobic performance or agility. For the 1SPT, both validity and reliability are questionable.

Increasing recreational nitrous oxide use: Should we worry?

Background: Since 2000, the prevalence of recreational nitrous oxide (N 2O) use has increased in the Western world. Although N 2O is a relatively safe drug, the overall increase in the use of N 2O has concomitantly also initiated a modest but important increase in the number of young excessive users. The recent introduction of large 2 kg N 2O tanks, allowing high and prolonged dosing, has facilitated this excessive use. This is of concern, because repeated exposure to high doses of N 2O for a prolonged time is known to induce neurological damage, such as (irreversible) neuropathy and paralysis due to N 2O-induced vitamin B 12 deficiency. The increasing trend of recreational users with N 2O-induced neurological damage at emergency departments confirms the urgency of this development. Objective/Methods: This narrative review describes recent trends in N 2O use and misuse, the adverse health effects associated with excessive use and the risk factors of excessive use. Results: Considering the rising trend in N 2O use, particularly among young and other vulnerable people, we propose to take legislative action to limit the availability of N 2O, and also advocate for better and timely education of non-users, users and medical professionals about the serious side-effects associated with excessive N 2O use. Conclusion: It is concluded that the increase in excessive N 2O use is of serious concern.