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A Wheelchair Propulsion Training Program (HS)

Primary Purpose

Spinal Cord Injuries, Multiple Sclerosis, Amputation

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
In-person wheelchair propulsion training program
30-minute education session
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Spinal Cord Injuries focused on measuring manual wheelchair, wheelchair propulsion, motor learning

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • 18-65 years of age
  • have a mobility limitation requiring the use of a manual wheelchair (MWC)
  • be able to self-propel a MWC bilaterally with their upper extremities
  • plan to use a MWC for at least 75% of their activities throughout the day
  • live in the community
  • understand English at a sixth-grade level or higher
  • can follow multi-step instructions
  • able to provide informed consent independently
  • able to tolerate propelling their wheelchair independently for 10m
  • be willing to participate in three assessments and six training sessions at the Enabling Mobility in the Community Laboratory (EMC Lab).

Exclusion Criteria:

  • maneuver their MWC with their lower extremities or with only one upper extremity
  • display the proper wheelchair propulsion techniques during the screening process
  • MWC position inhibits them from following the CPGs
  • bilateral incoordination
  • upper extremity strength inequalities resulting in a 12-inch deviation from a marked pathway
  • surgeries compromising the integrity of the upper extremities
  • cardiovascular complications within the past year
  • upper extremity or overall bodily pain is rated 8/10 or higher per the Wong-Baker FACES Numeric Pain Scale (FACES)
  • currently receiving medical treatment for an acute upper extremity injury
  • have a Stage IV pressure injury or are currently hospitalized

Sites / Locations

  • Washington University School of Medicine

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Training group

Control group

Arm Description

Training group will first receive 30 minutes of education about biomechanically efficient propulsion techniques. They will be tested on this knowledge to make sure participants understand the material. The participant then will be asked to come into the lab for 6 sessions of training, two times per week for three weeks. The training is an hour of the proper wheelchair propulsion techniques broken into 5 parts, 7 minutes each with breaks. Based on the motor learning principles, we gradually increase the components of the training by focusing either hand reaching toward the back of the wheel or hands reaching down toward the axle.

Control group will first receive 30 minutes of education about the biomechanically efficient propulsion. They will be tested on this knowledge to make sure participants understand the material. No further training will be implemented with this group.

Outcomes

Primary Outcome Measures

Motion capture - changes in push angle
Push angle during the push phase of propulsion is assessed with video motion capture (VMC). The VMC system consists of 14 Vero 2.2 digital cameras to detect the location of the reflective markers, specifically on the shoulder, elbow, and wrist. The 3D infrared coordinates will be recorded while participants propel their wheelchair over the ground and on a dynamic roller system. Push angle will be calculated by finding the inner product of the vectors formed by the elbow-shoulder and elbow-wrist. The push angles will be compared across the three testing sessions. This variable corresponds to the recommendations outlined in the clinical practice guidelines. We hypothesize that the increase of push angle will be greater in the training group than the control group.
Motion capture - changes in hand-axle distance
Hand-axle distance during the recovery phase of propulsion assessed with video motion capture (VMC). The VMC system consists of 14 Vero 2.2 digital cameras to detect the location of the reflective markers, specifically on the axle and the third metacarpal joint. The 3D infrared coordinates will be recorded while participants propel their wheelchair over the ground and on a dynamic roller system. Hand-axle distance will be calculated by the magnitude of the vector formed by the third metacarpal joint and the axle. The hand-axle will be compared across the three testing sessions. This variable corresponds to the recommendations outlined in the clinical practice guidelines. We hypothesize that the increase of hand-axle distance will be greater in the training group than the control group.
Wheelchair Propulsion Test (WPT) - changes in effectiveness
The WPT assesses wheelchair mobility and performance of manual wheelchair users (MWU). The WPT requires MWU to propel using a self-selected natural velocity across 10 meters of a smooth flat surface from a static start. The number of pushes and the time will be recorded. The effectiveness of the propulsion is the displacement per push and will be calculated by the 10 meters divided by the number of pushes. We hypothesize that the increase in the effectiveness of propulsion will be greater in the training group than the control group.
Wheelchair Propulsion Test (WPT) - changes in cadence
The WPT assesses wheelchair mobility and performance of manual wheelchair users (MWU). The WPT requires MWU to propel using a self-selected natural velocity across 10 meters of a smooth flat surface from a static start. The number of pushes and the time will be recorded. The cadence of the propulsion is the number of push per second and will be calculated by the number of push divided by the time spent finishing the 10-meters line. We hypothesize that the decrease of cadence will be greater in the training group than the control group.
Wheelchair Propulsion Test (WPT) - changes in propulsion pattern
The WPT assesses wheelchair mobility and performance of manual wheelchair users (MWU). The WPT requires MWU to propel using a self-selected natural velocity across 10 meters of a smooth flat surface from a static start. The number of pushes and the time will be recorded. Clinicians will also record whether"during the contact phases, did the subject generally begin the contact between the hands and the hand-rims behind the top dead center of the rear wheel?", and " during the recovery phases, did the subject generally use a path of the hands that was predominantly beneath the handrims?" The clinician will provide his/her evaluation by answering the two questions. It is expected that after the training, the subject will change his/her pattern from both "no" to both "yes". These two questions are based on the clinical practice guidelines (CPG) and only when both answers are "yes", then the participant will be considered following CPG.
Outdoor propulsion - ratio of efficient propulsion pattern
During the outdoor propulsion session, participants will push their wheelchair in an outdoor, asphalt surface parking lot with no ceiling for approximately three to five minutes across approximately 200 meters. The parking lot consists of 5°-10°slopes, a flat surface with small potholes, and two small bumps/thresholds. Participants will be told to propel their wheelchair at their regular speed in the parking lot. An experimenter will follow the participant with a body harnessed action camera to record participant's left side propulsion. A video coder will be viewing the recording then judge whether each push with the two questions mentioned in WPT form. The changes in propulsion patterns will be calculated by the amount of CPG-based propulsion divided by the total amount of propulsion. We hypothesize that the ratio increases of the CPG-based propulsion will be greater in the training group than controls.

Secondary Outcome Measures

Full Information

First Posted
July 1, 2019
Last Updated
April 7, 2020
Sponsor
Washington University School of Medicine
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1. Study Identification

Unique Protocol Identification Number
NCT04009187
Brief Title
A Wheelchair Propulsion Training Program
Acronym
HS
Official Title
Efficacy of a Wheelchair Propulsion Training Program for Manual Wheelchair Users: a Pilot Study
Study Type
Interventional

2. Study Status

Record Verification Date
April 2020
Overall Recruitment Status
Completed
Study Start Date
March 27, 2018 (Actual)
Primary Completion Date
October 22, 2019 (Actual)
Study Completion Date
October 22, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Washington University School of Medicine

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The overall purpose of this project is to test the feasibility of a manual wheelchair propulsion program which aims to reduce the chance of development of upper limbs pain and injury.
Detailed Description
The purpose of this project is to develop a feasible wheelchair propulsion training that can fit into an in-patient rehabilitation schedule, and determine the effectiveness of the training protocol. This project consists of a randomized control trial (RCT) for manual wheelchair users (MWUs) that examines the number of manual wheelchair propulsion repetitions required to produce change. For the RCT, we will recruit twenty individuals who use manual wheelchairs as their primary means of mobility and who do not follow the recommended clinical guidelines for propulsion. Participants will be randomized into two independent groups: motor learning repetitions overground (Training Group; n =10), and general education on recommended propulsion techniques (Education Group; n =10). Demographics, cognition, shoulder strength, participation, and wheelchair seating may only be assessed at baseline. Participants then may be assessed from the kinematics of their wheelchair performance overground and on a motorized treadmill. Participants may be tested on their wheelchair propulsion techniques in and outside of the lab, upper extremity pain at baseline, post-intervention, and three-week follow-up; participants may also be asked qualitative questions regarding the intervention experience, the experience with the equipment and the laboratory research, the monitoring setting, and the general experience with the research study. The primary research question is that will repetition of proper propulsion technique practiced overground result in improved manual wheelchair propulsion biomechanics?

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Spinal Cord Injuries, Multiple Sclerosis, Amputation, Spina Bifida
Keywords
manual wheelchair, wheelchair propulsion, motor learning

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
20 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Training group
Arm Type
Active Comparator
Arm Description
Training group will first receive 30 minutes of education about biomechanically efficient propulsion techniques. They will be tested on this knowledge to make sure participants understand the material. The participant then will be asked to come into the lab for 6 sessions of training, two times per week for three weeks. The training is an hour of the proper wheelchair propulsion techniques broken into 5 parts, 7 minutes each with breaks. Based on the motor learning principles, we gradually increase the components of the training by focusing either hand reaching toward the back of the wheel or hands reaching down toward the axle.
Arm Title
Control group
Arm Type
Active Comparator
Arm Description
Control group will first receive 30 minutes of education about the biomechanically efficient propulsion. They will be tested on this knowledge to make sure participants understand the material. No further training will be implemented with this group.
Intervention Type
Behavioral
Intervention Name(s)
In-person wheelchair propulsion training program
Intervention Description
The wheelchair propulsion (WP) intervention is based on our previous pilot work and the best available evidence on WP training. The CPGs recommend minimizing the force and frequency of pushes while using long strokes during propulsion. Each training session will include massed practice with repetitions overground. Each session is organized to limit the number of variables (i.e., long push strokes and dropping the hands down below axle) presented to the participant at one time. Propulsion Set A will focus on using longer push strokes. Propulsion Set B will focus on dropping the hand down toward the axle. Propulsion Set C will focus on both A and B.
Intervention Type
Behavioral
Intervention Name(s)
30-minute education session
Intervention Description
Both groups will receive a 30-minute education session regarding the CPGs. This education session will follow the instructions provided in Rice and colleagues. (L. A. Rice et al., 2014). It consists of the importance of practicing biomechanical efficient propulsion. The material lists out the consequences and the impact of upper limb pain and injury. It provides a detailed step by step on how to propel properly. They will view the video that shows the biomechanics of efficient and inefficient propulsion.
Primary Outcome Measure Information:
Title
Motion capture - changes in push angle
Description
Push angle during the push phase of propulsion is assessed with video motion capture (VMC). The VMC system consists of 14 Vero 2.2 digital cameras to detect the location of the reflective markers, specifically on the shoulder, elbow, and wrist. The 3D infrared coordinates will be recorded while participants propel their wheelchair over the ground and on a dynamic roller system. Push angle will be calculated by finding the inner product of the vectors formed by the elbow-shoulder and elbow-wrist. The push angles will be compared across the three testing sessions. This variable corresponds to the recommendations outlined in the clinical practice guidelines. We hypothesize that the increase of push angle will be greater in the training group than the control group.
Time Frame
Baseline, 3-week after baseline for the control group/immediate after training group intervention, 3-weeks after second assessment
Title
Motion capture - changes in hand-axle distance
Description
Hand-axle distance during the recovery phase of propulsion assessed with video motion capture (VMC). The VMC system consists of 14 Vero 2.2 digital cameras to detect the location of the reflective markers, specifically on the axle and the third metacarpal joint. The 3D infrared coordinates will be recorded while participants propel their wheelchair over the ground and on a dynamic roller system. Hand-axle distance will be calculated by the magnitude of the vector formed by the third metacarpal joint and the axle. The hand-axle will be compared across the three testing sessions. This variable corresponds to the recommendations outlined in the clinical practice guidelines. We hypothesize that the increase of hand-axle distance will be greater in the training group than the control group.
Time Frame
Baseline, 3-week after baseline for the control group/immediate after training group intervention, 3-weeks after second assessment
Title
Wheelchair Propulsion Test (WPT) - changes in effectiveness
Description
The WPT assesses wheelchair mobility and performance of manual wheelchair users (MWU). The WPT requires MWU to propel using a self-selected natural velocity across 10 meters of a smooth flat surface from a static start. The number of pushes and the time will be recorded. The effectiveness of the propulsion is the displacement per push and will be calculated by the 10 meters divided by the number of pushes. We hypothesize that the increase in the effectiveness of propulsion will be greater in the training group than the control group.
Time Frame
Baseline, 3-week after baseline for the control group/immediate after training group intervention, 3-weeks after second assessment
Title
Wheelchair Propulsion Test (WPT) - changes in cadence
Description
The WPT assesses wheelchair mobility and performance of manual wheelchair users (MWU). The WPT requires MWU to propel using a self-selected natural velocity across 10 meters of a smooth flat surface from a static start. The number of pushes and the time will be recorded. The cadence of the propulsion is the number of push per second and will be calculated by the number of push divided by the time spent finishing the 10-meters line. We hypothesize that the decrease of cadence will be greater in the training group than the control group.
Time Frame
Baseline, 3-week after baseline for the control group/immediate after training group intervention, 3-weeks after second assessment
Title
Wheelchair Propulsion Test (WPT) - changes in propulsion pattern
Description
The WPT assesses wheelchair mobility and performance of manual wheelchair users (MWU). The WPT requires MWU to propel using a self-selected natural velocity across 10 meters of a smooth flat surface from a static start. The number of pushes and the time will be recorded. Clinicians will also record whether"during the contact phases, did the subject generally begin the contact between the hands and the hand-rims behind the top dead center of the rear wheel?", and " during the recovery phases, did the subject generally use a path of the hands that was predominantly beneath the handrims?" The clinician will provide his/her evaluation by answering the two questions. It is expected that after the training, the subject will change his/her pattern from both "no" to both "yes". These two questions are based on the clinical practice guidelines (CPG) and only when both answers are "yes", then the participant will be considered following CPG.
Time Frame
Baseline, 3-week after baseline for the control group/immediate after training group intervention, 3-weeks after second assessment
Title
Outdoor propulsion - ratio of efficient propulsion pattern
Description
During the outdoor propulsion session, participants will push their wheelchair in an outdoor, asphalt surface parking lot with no ceiling for approximately three to five minutes across approximately 200 meters. The parking lot consists of 5°-10°slopes, a flat surface with small potholes, and two small bumps/thresholds. Participants will be told to propel their wheelchair at their regular speed in the parking lot. An experimenter will follow the participant with a body harnessed action camera to record participant's left side propulsion. A video coder will be viewing the recording then judge whether each push with the two questions mentioned in WPT form. The changes in propulsion patterns will be calculated by the amount of CPG-based propulsion divided by the total amount of propulsion. We hypothesize that the ratio increases of the CPG-based propulsion will be greater in the training group than controls.
Time Frame
Baseline, 3-week after baseline for the control group/immediate after training group intervention, 3-weeks after second assessment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: 18-65 years of age have a mobility limitation requiring the use of a manual wheelchair (MWC) be able to self-propel a MWC bilaterally with their upper extremities plan to use a MWC for at least 75% of their activities throughout the day live in the community understand English at a sixth-grade level or higher can follow multi-step instructions able to provide informed consent independently able to tolerate propelling their wheelchair independently for 10m be willing to participate in three assessments and six training sessions at the Enabling Mobility in the Community Laboratory (EMC Lab). Exclusion Criteria: maneuver their MWC with their lower extremities or with only one upper extremity display the proper wheelchair propulsion techniques during the screening process MWC position inhibits them from following the CPGs bilateral incoordination upper extremity strength inequalities resulting in a 12-inch deviation from a marked pathway surgeries compromising the integrity of the upper extremities cardiovascular complications within the past year upper extremity or overall bodily pain is rated 8/10 or higher per the Wong-Baker FACES Numeric Pain Scale (FACES) currently receiving medical treatment for an acute upper extremity injury have a Stage IV pressure injury or are currently hospitalized
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kerri Morgan, PhD
Organizational Affiliation
Washington University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Washington University School of Medicine
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63108
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
11994814
Citation
Boninger ML, Souza AL, Cooper RA, Fitzgerald SG, Koontz AM, Fay BT. Propulsion patterns and pushrim biomechanics in manual wheelchair propulsion. Arch Phys Med Rehabil. 2002 May;83(5):718-23. doi: 10.1053/apmr.2002.32455.
Results Reference
background
PubMed Identifier
26674751
Citation
Morgan KA, Tucker SM, Klaesner JW, Engsberg JR. A motor learning approach to training wheelchair propulsion biomechanics for new manual wheelchair users: A pilot study. J Spinal Cord Med. 2017 May;40(3):304-315. doi: 10.1080/10790268.2015.1120408. Epub 2015 Dec 16.
Results Reference
background
Citation
Will, K., Engsberg, J. R., Foreman, M., Klaesner, J., Birkenmeier, R., & Morgan, K. A. (2015). Repetition based training for efficient propulsion in new manual wheelchair users. Journal of Physical Medicine, Rehabilitation & Disabilities, 1(001), 1-9.
Results Reference
background
PubMed Identifier
26138222
Citation
Morgan KA, Engsberg JR, Gray DB. Important wheelchair skills for new manual wheelchair users: health care professional and wheelchair user perspectives. Disabil Rehabil Assist Technol. 2017 Jan;12(1):28-38. doi: 10.3109/17483107.2015.1063015. Epub 2015 Jul 3.
Results Reference
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PubMed Identifier
16869091
Citation
Paralyzed Veterans of America Consortium for Spinal Cord Medicine. Preservation of upper limb function following spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med. 2005;28(5):434-70. doi: 10.1080/10790268.2005.11753844. No abstract available.
Results Reference
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PubMed Identifier
25299526
Citation
Sawatzky B, DiGiovine C, Berner T, Roesler T, Katte L. The need for updated clinical practice guidelines for preservation of upper extremities in manual wheelchair users: a position paper. Am J Phys Med Rehabil. 2015 Apr;94(4):313-24. doi: 10.1097/PHM.0000000000000203.
Results Reference
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PubMed Identifier
23499781
Citation
Askari S, Kirby RL, Parker K, Thompson K, O'Neill J. Wheelchair propulsion test: development and measurement properties of a new test for manual wheelchair users. Arch Phys Med Rehabil. 2013 Sep;94(9):1690-8. doi: 10.1016/j.apmr.2013.03.002. Epub 2013 Mar 14.
Results Reference
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PubMed Identifier
14970966
Citation
MacPhee AH, Kirby RL, Coolen AL, Smith C, MacLeod DA, Dupuis DJ. Wheelchair skills training program: A randomized clinical trial of wheelchair users undergoing initial rehabilitation. Arch Phys Med Rehabil. 2004 Jan;85(1):41-50. doi: 10.1016/s0003-9993(03)00364-2.
Results Reference
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Citation
Axelson, P., Chesney, D. Y., Minkel, J., & Perr, A. (1996). The manual wheelchair training guide. Santa Cruz, CA: Pax Press,1996.
Results Reference
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PubMed Identifier
15129405
Citation
Kirby RL, Dupuis DJ, Macphee AH, Coolen AL, Smith C, Best KL, Newton AM, Mountain AD, Macleod DA, Bonaparte JP. The wheelchair skills test (version 2.4): measurement properties. Arch Phys Med Rehabil. 2004 May;85(5):794-804. doi: 10.1016/j.apmr.2003.07.007.
Results Reference
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PubMed Identifier
23022092
Citation
Rice IM, Pohlig RT, Gallagher JD, Boninger ML. Handrim wheelchair propulsion training effect on overground propulsion using biomechanical real-time visual feedback. Arch Phys Med Rehabil. 2013 Feb;94(2):256-63. doi: 10.1016/j.apmr.2012.09.014. Epub 2012 Sep 26.
Results Reference
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PubMed Identifier
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Citation
DeGroot KK, Hollingsworth HH, Morgan KA, Morris CL, Gray DB. The influence of verbal training and visual feedback on manual wheelchair propulsion. Disabil Rehabil Assist Technol. 2009 Mar;4(2):86-94. doi: 10.1080/17483100802613685.
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PubMed Identifier
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Citation
Rice LA, Smith I, Kelleher AR, Greenwald K, Boninger ML. Impact of a wheelchair education protocol based on practice guidelines for preservation of upper-limb function: a randomized trial. Arch Phys Med Rehabil. 2014 Jan;95(1):10-19.e11. doi: 10.1016/j.apmr.2013.06.028. Epub 2013 Jul 13.
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PubMed Identifier
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Citation
Klaesner J, Morgan KA, Gray DB. The development of an instrumented wheelchair propulsion testing and training device. Assist Technol. 2014 Spring;26(1):24-32. doi: 10.1080/10400435.2013.792020.
Results Reference
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A Wheelchair Propulsion Training Program

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