OBJECTIVE: To compare the performance of a power wheelchair with stair-climbing capability (TopChair) and a conventional power wheelchair (Storm3).
DESIGN: A single-center, open-label study.
SETTING: A physical medicine and rehabilitation hospital.
PARTICIPANTS: Patients (N=25) who required power wheelchairs because of severe impairments affecting the upper and lower limbs.
INTERVENTIONS: Indoor and outdoor driving trials with both devices. Curb-clearing and stair-climbing with TopChair.
MAIN OUTCOME MEASURES: Trial duration and Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) tool; number of failures during driving trials and ability to climb curbs and stairs.
RESULTS: All 25 participants successfully completed the outdoor and indoor trials with both wheelchairs. Although differences in times to trial completion were statistically significant, they were less than 10%. QUEST scores were significantly better with the Storm3 than the TopChair for weight (P=.001), dimension (P=.006), and effectiveness (P=.04). Of the 25 participants, 23 cleared a 20-cm curb without help, and 20 climbed up and down 6 steps. Most participants felt these specific capabilities of the TopChair--for example, curb clearing and stair climbing-were easy to use (22/25 for curb, 21/25 for stairs) and helpful (24/25 and 23/25). A few participants felt insecure (4/25 and 6/25, respectively).
CONCLUSIONS: The TopChair is a promising mobility device that enables stair and curb climbing and warrants further study.
BACKGROUND: Multiple sclerosis (MS) is a chronic neurological disease that is associated with physical inactivity. Understanding the factors that correlate with physical activity is important for developing effective physical activity promotion programs for this population. Thus, we conducted a cross-sectional study that examined the association between features of the built environment with self-reported and objectively measured physical activity behaviour in adults with MS.
METHODS: Participants with MS (n = 196) were sent a questionnaire packet that included self-report measures of the built environment and physical activity and a pedometer in the mail and were instructed to complete the questionnaires and wear the device for seven days. Participants returned the completed questionnaires in a pre-stamped, pre-addressed envelope. Bivariate correlation analysis was conducted for examining associations between items on the environmental questionnaire with the two measures of physical activity. Stepwise regression analysis was conducted for determining the independent contributions of the significant environmental correlates for explaining variation in physical activity.
RESULTS: Correlational analysis indicated that presence of shops, stores, markets or other places within walking distance (r = .20; rho = .18), presence of a transit stop within walking distance (r = .20; rho = .16), and accessibility of free or low-cost recreation facilities (r = .16; rho = .15) were related to pedometer, but not self-reported, measured physical activity. Regression analysis indicated that the presence of a transit stop within walking distance independently explained 4% of variance in pedometer measured physical activity.
CONCLUSION: Physical activity is an important behaviour to promote among individuals with MS. This study indicated that aspects of the built environment are related to this health promoting behaviour among those with MS. Further research should focus on the longitudinal relationships among aspects of the environment with physical activity so as to provide strong background for developing effective promotion programs for people with MS.
OBJECTIVES: To determine the functional measures that best correlate with the skill levels of people with disabilities who operate a Segway Personal Transporter, and-using a qualitative analysis-to explore subjects' experience with the Segway.
DESIGN: A prospective study encompassing 3 training sessions with the Segway to correlate subjects' functional ability (eg, cognition, balance, mobility, muscle strength) with their skill level on the device.
SETTING: A provincial adult rehabilitation center.
PARTICIPANTS: Twenty-three subjects (age range, 19-65y) with a wide range of disabilities (eg, multiple sclerosis, spinal cord injury, amputation) who could walk at least 6m with or without assistance.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Segway Task Assessment, Berg Balance Scale, and Timed Up & Go test.
RESULTS: No correlation was found because all participants successfully completed the final Segway Task Assessment, regardless of scores on functional assessments.
CONCLUSIONS: The Segway is a useful device for a broad range of populations with functional disabilities. Subjects found the Segway easy to use and were excited about its potential as an assistive device for use in their communities.
Although psychological distress and cognitive dysfunction are well documented in adults with multiple sclerosis (MS), they are poorly understood in children with the disease. Psychosocial difficulty experienced by children and adolescents with MS involves factors common to all chronic illnesses in children, as well as MS-specific factors. The psychosocial manifestations of the disease may affect the patient's self-image, role functioning, mood, and cognition to adversely affect schooling, interpersonal relationships, and treatment compliance. Furthermore, the impact of having a family member with MS may affect overall family functioning. Assessment and interventions for psychosocial and cognitive problems in pediatric MS should be multidisciplinary in nature and address the child's functioning at home, school, and among peers, as well as the effect on the family.
The purpose of this study was to identify factors associated with increased likelihood of reporting fear of falling (FoF) among people with multiple sclerosis (MS) and factors associated with activity curtailment among the subset of individuals reporting FoF. Cross-sectional data from telephone interviews with 1064 individuals with MS, aged 45-90 years living in the Midwestern United States were used. Logistic regression models examined factors associated with FoF and with activity curtailment among individuals reporting FoF. Of the participants, 63.5% reported FoF. Increased likelihood of reporting FoF was associated with being female, experiencing greater MS symptom interference during everyday activities, history of a fall in the past 6 months, and using a walking aid. Among participants reporting FoF, 82.6% reported curtailing activity. Increased likelihood of activity curtailment among people reporting FoF was associated with using a walking aid, needing moderate or maximum assistance with instrumental activities of daily living, and having less than excellent self-reported mental health. We concluded that FoF and associated activity curtailment are common among people aged 45-90 with MS. While FoF and associated activity curtailment may be appropriate responses to fall risk, the findings suggest that factors beyond realistic appraisal of fall risk may be operating.
