Similar to The differences in self-efficacy, function, and participation between adults with C6-C7 motor tetraplegia who use power or manual wheelchairs
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Similar to The differences in self-efficacy, function, and participation between adults with C6-C7 motor tetraplegia who use power or manual wheelchairs (20)
![The differences in self-efficacy, function, and participation between adults with C6-C7 motor tetraplegia who use power or manual wheelchairs Yvette Griffiths SPT , Christina Hamilton SPT , Hillary Robins SPT , Jennifer Hastings PT, PhD, NCS University of Puget Sound Introduction The impact of spinal cord injury (SCI) on emotional, physical, and social health has been broadly investigated in the literature. However, the role of the wheelchair that is used by a person with low cervical level SCI, manual or power, has not previously been examined. There is no clear recommendation for wheelchair prescription for individuals with C6 or C7 level SCI. Individuals with this level of SCI are able to propel a manual wheelchair but significant loss of upper extremity function allows for the medical justification of power mobility for insurance. There are many growing concerns about the long-term physical effect of SCI on the remaining functional body systems and extremities. The incidence of shoulder pain is higher in people with SCI than in their able-bodied counterparts and results in an even greater loss of functional independence. 1,2 Wheelchair propulsion has often been cited as a cause of shoulder pain, however shoulder pain is also correlated with sitting posture, postural control, relative rear axle position, increased body weight, age, and time since injury, all of which may impact shoulder joint forces throughout manual propulsion, performing transfers and overhead reaching. 3-6 For these reasons, changes in demand on the shoulder joint following SCI may affect both manual and power wheelchair users. Decreased physical activity and obesity are rising concerns for people with SCI that may be impacted by the type of wheelchair that they use. 7,8 This descriptive study investigated the influence of the type of wheelchair, manual or power, on measures of self-esteem, function, and participation in adults with C6 or C7 tetraplegia due to SCI. The University of Puget Sound institutional review board approved this study. Protocol PT 0708-004 Discussion Analysis of the three outcome measures in this sample revealed that manual wheelchair users demonstrate better physical function, mobility, and had a higher rate of employment than power wheelchair users. Manual wheelchair users were shown to have significantly higher levels of physical function and mobility. This may be explained by the fact that while they have the same body mass index manual wheelchair users may be more physically fit than their counterparts who use power wheelchairs because of the daily maintenance exercise resulting from manually propelling their wheelchair. Mobility scores may reflect greater independence with balance, transfers and functional mobility due to a higher degree of positive neuroplasticity and more immediate motor learning following injury. 9 Results A two-tailed independent t-test determined there were no significant differences between group demographics. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Conclusion The outcomes at a participation level are important when considering wheelchair selection. Participation is directly affected by body structure and function, activity, and environmental factors. Therefore, given the favorable outcomes found in this study at both the activity and body function and structure level, clinicians may want to carefully consider the selection of wheelchair for initial use after low cervical SCI. This study supports the use of manual wheelchairs when an individual’s lifestyle, home environment, community accessibility, personal preference, and functional needs are also met. * Denotes statistical significance at alpha level of 0.05 Presentation of this research study was supported by the Department of Physical Therapy and the University Enrichment Committee of the University of Puget Sound. Employment rate, as measured by the CHART occupation subscale, was found to be significantly higher in people who use manual wheelchairs as compared to those who use power wheelchairs. Although the CHART did not account for individuals who are full-time students or retired, employment is a valuable point to consider because research shows that employment is directly related to better life satisfaction and can be used as an indicator of social integration following SCI. 10 This study did not directly investigate the relationship between type of wheelchair and specific transportation capabilities; however, manual wheelchair users demonstrated higher levels of employment as well as greater autonomy with transportation. Data Collection Participants completed 3 questionnaires and a demographic sheet at a single data collection appointment. The Spinal Cord Independence Measure III (SCIM III), Craig Handicap Assessment and Reporting Technique (CHART), and Rosenberg Self Esteem Scale (RSES) were used to measure function, participation and self-esteem. For the purposes of this study the self-care and mobility subscales of the SCIM III were used, as they were the most applicable to the question. The demographics form included participants’ age, height, weight, time since injury, self-reported left and right triceps function, type of wheelchair, length of acute rehabilitation stay post SCI, date of SCI, driving post injury, highest level of education, incidence of pressure ulcers, and type and amount of consistent physical activity. Information obtained was used to determine if there were any significant differences between the study groups. The Statistical Package for the Social Sciences (SPSS) Windows version 14.0 was used for data analysis. A p-value of less than 0.05 was considered significant. Recruitment Power analysis based on a medium effect size of the SCIM II when used with tetraplegia suggested a sample size of 50. A convenience sample of 30 participants was recruited from the community in the Pacific Northwest region (18 manual and 12 power chair users). Participants Participants included adults with C6 or C7 motor level tetraplegia due to SCI who were over age 18 and at least one year post injury. Subjects were excluded from the study if they were unable to speak English, used power-assist manual chairs, or had other impairments that could influence the outcome measures. Cronbach’s alpha was calculated for SCIM III, RSES, and CHART scores, and was found to have a value of 0.7, demonstrating good internal consistency. Significant differences were found in the outcome measures between groups (Hotelling’s Trace: F = 2.677, p = 0.038). Multivariate analysis of variance (MANOVA) determined wheelchair type explained differences in the SCIM III (F=11.088, p = 0.003), CHART subcategories Physical (F=7.402, p = 0.011), Mobility (F=12.894, p = 0.001), and Occupation (F=5.174, p = 0.031). It is also important to note that manual wheelchair users can more easily maneuver in small spaces, they have more diverse options for transporting their wheelchair, and there is greater potential to overcome environmental barriers with some occasional assistance from friends, family, or caregivers. Every manual wheelchair participant in this study returned to driving after SCI, as compared to 75% of the power wheelchair users . Manual wheelchair participants were all primary drivers and 89% could transfer to the drivers seat, as compared to 67% and 42% of power wheelchair users respectively. Limitations of this study include sampling bias, limited statistical power, a ceiling effect of CHART scores, self-reported SCI level, and missing CHART data.](https://image.slidesharecdn.com/scicsm2010-100321200629-phpapp02/85/The-differences-in-self-efficacy-function-and-participation-between-adults-with-C6-C7-motor-tetraplegia-who-use-power-or-manual-wheelchairs-1-320.jpg)
