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Rice I.M.,University of Illinois at Urbana - Champaign | Pohlig R.T.,University of Pittsburgh | Gallagher J.D.,University of Pittsburgh | Boninger M.L.,Human Engineering Research Laboratories | Boninger M.L.,University of Pittsburgh
Archives of Physical Medicine and Rehabilitation | Year: 2013

Objective: To compare the effects of 2 manual wheelchair propulsion training programs on handrim kinetics, contact angle, and stroke frequency collected during overground propulsion. Design: Randomized controlled trial comparing handrim kinetics between 3 groups: a control group that received no training, an instruction-only group that reviewed a multimedia presentation, and a feedback group that reviewed the multimedia presentation and real-time visual feedback. Setting: Research laboratory. Participants: Full-time manual wheelchair users (N=27) with spinal cord injury living in the Pittsburgh area. Interventions: Propulsion training was given 3 times over 3 weeks, and data were collected at baseline, immediately after training, and at 3 months. Main Outcome Measures: Contact angle, stroke frequency, peak resultant force, and peak rate of rise of resultant force. Results: Both feedback and instruction-only groups improved their propulsion biomechanics across all surfaces (carpet, tile, and ramp) at both target and self-selected speeds compared with the control group. While controlling for velocity, both intervention groups showed long-term reductions in the peak rate or rise of resultant force, stroke frequency, and increased contact angle. Conclusions: Long-term wheelchair users in both intervention groups significantly improved many aspects of their propulsion technique immediately after training and 3 months from baseline. Furthermore, training with a low-cost instructional video and slide presentation was an effective training tool alone. © 2013 American Congress of Rehabilitation Medicine.


Yang Y.-S.,Kaohsiung Medical University | Koontz A.M.,Human Engineering Research Laboratories | Koontz A.M.,University of Pittsburgh | Yeh S.-J.,Chung Ho Memorial Hospital | Chang J.-J.,Kaohsiung Medical University
Archives of Physical Medicine and Rehabilitation | Year: 2012

Effect of backrest height on wheelchair propulsion biomechanics for level and uphill conditions. Objective: To evaluate the effect of backrest height on wheelchair propulsion kinematics and kinetics. Design: An intervention study with repeated measures. Setting: University laboratory. Participants: Convenience sample included manual wheelchair users (N=36; 26 men and 10 women) with spinal cord injuries ranging from T8 to L2. Intervention: Participants propelled on a motor-driven treadmill for 2 conditions (level and slope of 3°) at a constant speed of 0.9m/s while using in turn a sling backrest fixed at 40.6cm (16in) high (high backrest) and a lower height set at 50% trunk length (low backrest). Main Outcome Measures: Cadence, stroke angle, peak shoulder extension angle, shoulder flexion/extension range of motion, and mechanical effective force. Results: Pushing with the low backrest height enabled greater range of shoulder motion (P<.01), increased stroke angle (P<.01), push time (P<.01), and reduced cadence (P=.01) regardless of whether the treadmill was level or sloped. Conclusions: A lower cadence can be achieved when pushing with a lower backrest, which decreases the risk of developing upper-limb overuse related injuries. However, postural support, comfort, and other activities of daily living must also be considered when selecting a backrest height for active, long-term wheelchair users. The improvements found when using the low backrest were found regardless of slope type. Pushing uphill demanded significantly higher resultant and tangential force, torque, mechanical effective force, and cadence. © 2012 by the American Congress of Rehabilitation Medicine.


Ding D.,University of Pittsburgh | Ding D.,Human Engineering Research Laboratories | Cooper R.A.,University of Pittsburgh | Cooper R.A.,Human Engineering Research Laboratories | And 2 more authors.
Maturitas | Year: 2011

A smart home is a residence equipped with technology that observes the residents and provides proactive services. Most recently, it has been introduced as a potential solution to support independent living of people with disabilities and older adults, as well as to relieve the workload from family caregivers and health providers. One of the key supporting features of a smart home is its ability to monitor the activities of daily living and safety of residents, and in detecting changes in their daily routines. With the availability of inexpensive low-power sensors, radios, and embedded processors, current smart homes are typically equipped with a large amount of networked sensors which collaboratively process and make deductions from the acquired data on the state of the home as well as the activities and behaviors of its residents. This article reviews sensor technology used in smart homes with a focus on direct environment sensing and infrastructure mediated sensing. The article also points out the strengths and limitations of different sensor technologies, as well as discusses challenges and opportunities from clinical, technical, and ethical perspectives. It is recommended that sensor technologies for smart homes address actual needs of all stake holders including end users, their family members and caregivers, and their doctors and therapists. More evidence on the appropriateness, usefulness, and cost benefits analysis of sensor technologies for smart homes is necessary before these sensors should be widely deployed into real-world residential settings and successfully integrated into everyday life and health care services. © 2011 Elsevier Ireland Ltd. All rights reserved.


Hiremath S.V.,Human Engineering Research Laboratories | Ding D.,University of Pittsburgh
Journal of Spinal Cord Medicine | Year: 2011

Objective: The aim of this study was to evaluate the performance of SenseWear® (SW) and RT3 activity monitors (AMs) in estimating energy expenditure (EE) in manual wheelchair users (MWUs) with paraplegia for a variety of physical activities. Methods: Twenty-four subjects completed four activities including resting, wheelchair propulsion, arm-ergometry exercise, and deskwork. The criterion EE was measured by a K4b2 portable metabolic cart. The EE estimated by the SW and RT3 were compared with the criterion EE by the absolute differences and absolute percentage errors. Intraclass correlations and the Bland and Altman plots were also used to assess the agreements between the two AMs and the metabolic cart. Correlations between the criterion EE and the estimated EE and sensors data from the AMs were evaluated. Results: The EE estimation errors for the AMs varied from 24.4 to 125.8% for the SW and from 22.0 to 52.8% for the RT3. The intraclass correlation coefficients (ICCs) between the criterion EE and the EE estimated by the two AMs for each activity and all activities as a whole were considered poor with all the ICCs smaller than 0.75. Except for deskwork, the EE from the SW was more correlated to the criterion EE than the EE from the RT3. Conclusion: The results indicate that neither of the AMs is an appropriate tool for quantifying physical activity in MWUs with paraplegia. However, the accuracy of EE estimation could be potentially improved by building new regression models based on wheelchair-related activities. © The Academy for Spinal Cord Injury Professionals, Inc. 2011.


De Luigi A.J.,Georgetown University | Cooper R.A.,Human Engineering Research Laboratories
PM and R | Year: 2014

With the technologic advances in medicine and an emphasis on maintaining physical fitness, the population of athletes with impairments is growing. It is incumbent upon health care practitioners to make every effort to inform these individuals of growing and diverse opportunities and to encourage safe exercise and athletic participation through counseling and education. Given the opportunities for participation in sports for persons with a limb deficiency, the demand for new, innovative prosthetic designs is challenging the clinical and technical expertise of the physician and prosthetist. When generating a prosthetic prescription, physicians and prosthetists should consider the needs and preferences of the athlete with limb deficiency, as well as the functional demands of the chosen sporting activity. The intent of this article is to provide information regarding the current advancements in the adaptive sports technology and biomechanics in the field of prosthetics, and to assist clinicians and their patients in facilitating participation in sporting activities. © 2014 American Academy of Physical Medicine and Rehabilitation.


Cooper R.A.,Human Engineering Research Laboratories | De Luigi A.J.,Georgetown University
PM and R | Year: 2014

Wheelchair sports are an important tool in the rehabilitation of people with severe chronic disabilities and have been a driving force for innovation in technology and practice. In this paper, we will present an overview of the adaptive technology used in Paralympic sports with a special focus on wheeled technology and the impact of design on performance (defined as achieving the greatest level of athletic ability and minimizing the risk of injury). Many advances in manual wheelchairs trace their origins to wheelchair sports. Features of wheelchairs that were used for racing and basketball 25 or more years ago have become integral to the manual wheelchairs that people now use every day; moreover, the current components used on ultralight wheelchairs also have benefitted from technological advances developed for sports wheelchairs. For example, the wheels now used on chairs for daily mobility incorporate many of the components first developed for sports chairs. Also, advances in manufacturing and the availability of aerospace materials have driven current wheelchair design and manufacture. Basic principles of sports wheelchair design are universal across sports and include fit; minimizing weight while maintaining high stiffness; minimizing rolling resistance; and optimizing the sports-specific design of the chair. However, a well-designed and fitted wheelchair is not sufficient for optimal sports performance: the athlete must be well trained, skilled, and use effective biomechanics because wheelchair athletes face some unique biomechanical challenges. © 2014 American Academy of Physical Medicine and Rehabilitation.


Collinger J.L.,Human Engineering Research Laboratories
PM & R : the journal of injury, function, and rehabilitation | Year: 2011

Rehabilitation engineers apply engineering principles to improve function or to solve challenges faced by persons with disabilities. It is critical to integrate the knowledge of biologics into the process of rehabilitation engineering to advance the field and maximize potential benefits to patients. Some applications in particular demonstrate the value of a symbiotic relationship between biologics and rehabilitation engineering. In this review we illustrate how researchers working with neural interfaces and integrated prosthetics, assistive technology, and biologics data collection are currently integrating these 2 fields. We also discuss the potential for further integration of biologics and rehabilitation engineering to deliver the best technologies and treatments to patients. Engineers and clinicians must work together to develop technologies that meet clinical needs and are accessible to the intended patient population. Copyright © 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.


Laferrier J.Z.,Human Engineering Research Laboratories | Laferrier J.Z.,University of Pittsburgh | Gailey R.,Functional Outcomes Research and Evaluation Center | Gailey R.,University of Miami
Physical Medicine and Rehabilitation Clinics of North America | Year: 2010

The boundaries once faced by individuals with amputations are quickly being overcome through biotechnology. Although there are currently no prosthetics capable of replicating anatomic function, there have been radical advancements in prosthetic technology, medical science, and rehabilitation in the past 30 years, vastly improving functional mobility and quality of life for individuals with lower-limb amputations. What once seemed impossible is rapidly becoming reality. The future seems limitless, and the replication of anatomic function now seems possible.


Hosseini S.M.,University of Pittsburgh | Oyster M.L.,University of Pittsburgh | Oyster M.L.,Human Engineering Research Laboratories | Kirby R.L.,Dalhousie University | And 3 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2012

Hosseini SM, Oyster ML, Kirby RL, Harrington AL, Boninger ML. Manual wheelchair skills capacity predicts quality of life and community integration in persons with spinal cord injury. Objectives: To determine wheelchair (WC) skills success rates for manual WC users with spinal cord injury (SCI), to determine subject characteristics associated with the lowest success rates of WC skills, and to characterize the relationship between WC skills and measures of community integration and quality of life (QOL). Design: Cross-sectional multisite study. Setting: Six Spinal Cord Injury Model Systems (SCIMS) centers. Participants: Individuals with SCI (N=214) who were at least 11 months postinjury, treated at an SCIMS center, and who used a manual WC as their primary means of mobility. Intervention: Not applicable. Main Outcome Measures: Wheelchair Skills Test (WST) and questionnaires of demographics and characteristics, QOL, and community participation. Results: Of the 31 skills in the WST assessed, success rates ranged from 19.6% to 100%. Eight skills had success rates of ≤75%: folding/unfolding the WC (71.5%), ascending (19.6%) and descending (47.2%) a 15-cm curb, ascending (23.2%) and descending (26.5%) stairs, transferring from ground to WC (40.6%), turning 180° in wheelie position (55.2%), and holding a 30-second stationary wheelie (59.9%). Male sex, paraplegia, employed status, lower education, younger age at injury, and white race were among the participant characteristics bivariately associated with higher success rates of several WC skills. After controlling for covariates, higher success rates of several WC skills and a higher total WST score predicted better self-perceived health, higher life satisfaction, and more community participation. Conclusions: For people with SCI who use a manual WC as their primary means of mobility, their ability to perform manual WC skills is associated with higher community participation and life satisfaction. Factors contributing to low success rates need to be investigated, and interventions to improve these rates are needed. © 2012 American Congress of Rehabilitation Medicine.


Crytzer T.M.,Human Engineering Research Laboratories | Crytzer T.M.,University of Pittsburgh | Dicianno B.E.,Human Engineering Research Laboratories | Dicianno B.E.,University of Pittsburgh | Kapoor R.,Indian Spinal Injuries Center
PM and R | Year: 2013

Spina bifida (SB) is the most common birth defect in United States that results in permanent lifelong disability according to the Spina Bifida Association. Advancements in medical care have led to a longer life span and an increase in the risk of secondary conditions, for example, obesity, with age. The need to maintain a healthy and active lifestyle is even stronger in adults with SB than the general population. Our objective was to fill a gap in the literature by highlighting the current state of the literature on health-related measures of fitness, exercise, and physical activity (PA) in adults with SB. PubMed and Ovid were searched for articles by using the terms "spina bifida or myelomeningocele and exercise," published between January 1, 1988 and May 10, 2012. Results of studies showed that adults with SB had an inactive lifestyle, lower aerobic capacity, decreased level of daily PA, higher prevalence of obesity, and lower health-related quality of life compared with reference groups. Therapeutic interventions reduced pain, increased biomechanical efficiency during wheelchair propulsion, and improved PA and balance. Overall, the quality of the evidence on PA, exercise, and health-related measures of fitness is low in SB. Given misdistribution of adipose tissue, short stature, scoliosis, and joint contractures, future research should be conducted to determine the most reliable and low-cost methods of measuring body composition and to establish norms. Other reference standards, for example, aerobic capacity, require further development. Studies are needed to investigate lifestyle interventions that facilitate PA and exercise, and to determine the amount of exercise required to reduce secondary conditions as people with SB age. © 2013 American Academy of Physical Medicine and Rehabilitation.

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