Preserving Community Mobility in Wheelchair Users
An estimated 1.5 million people in the United States use a manual wheelchair (Kaye et al. 2002). Of those aged 65 years and under, spinal cord injury (SCI) is the most common diagnosis in manual wheelchair users (Kaye et al. 2002). Both improved life expectancy and increasing age at injury have resulted in a population that is increasingly experiencing the impact of aging with a disability (Kemp and Thompson 2002). One of the most common secondary complaints in the SCI population is shoulder joint pain which has been attributed to the high demand on the upper limbs during manual wheelchair use, transfers and raises (Nichols et al. 1979; Wing and Tredwell 1983; Bayley et al. 1987; Dalyan et al. 1999). In particular, the most strenuous activities and those that provoke the highest pain responses for manual wheelchair users are entering/leaving a car (Fliess-Douer et al. 2012), ascending ramps, heavy lifting with arms and outdoor wheeling (Janssen et al. 1994). While this clinical problem has been documented extensively in the spinal cord injury population, individuals with other primary diagnoses that preclude function of the lower extremities (e.g., lower extremity amputation, poliomyelitis, myelomeningocele, multiple sclerosis) experience a similar course of shoulder pain with prolonged wheelchair use (Curtis
et al. 1995; Curtis et al. 1999).
The rehabilitation problem that we will address in this project is chronic shoulder pain. The population served will include individuals aging with a disability who use a manual wheelchair for community mobility independent of diagnostic group, including but not limited to those with SCI, lower extremity amputation, poliomyelitis, myelomeningocele, and multiple sclerosis. The design of this project includes two activities: one primarily research and one predominantly development. The first activity will be to perform a research study to document the demands of transitioning in and out of the car including both the self-transfer and the loading of the wheelchair (Shoulder Preserving Transfer).
The second activity – with support from the Project 2 (Virtual Reality (VR) and Gaming for Home-Based Motor Assessment & Training) group – will develop a virtual reality (VR)-based game of a home exercise program (HEP) for preserving shoulder (rotator cuff) function (D3: VR-Home Exercise Program (HEP) for Shoulder Complex).