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Immediate Biomechanical Implications of Transfer Component Skills Training on Independent Wheelchair Transfers

  • Chung-Ying Tsai
    Affiliations
    Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

    Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
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  • Michael L. Boninger
    Affiliations
    Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

    Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA

    Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA

    Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
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  • Jennifer Hastings
    Affiliations
    Department of Physical Therapy, University of Puget Sound, Tacoma, WA
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  • Rory A. Cooper
    Affiliations
    Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

    Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA

    Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA

    Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
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  • Laura Rice
    Affiliations
    Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois, Champaign, IL
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  • Alicia M. Koontz
    Correspondence
    Corresponding author Alicia M. Koontz, PhD, VA Pittsburgh Healthcare System, 6425 Penn Ave, Ste 400, Pittsburgh, PA 15206.
    Affiliations
    Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

    Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
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Published:April 12, 2016DOI:https://doi.org/10.1016/j.apmr.2016.03.009

      Abstract

      Objective

      To evaluate the immediate effects of transfer training based on the Transfer Assessment Instrument (TAI) on the upper limb biomechanics during transfers.

      Design

      Pre-post intervention.

      Setting

      Biomechanics laboratory.

      Participants

      Full-time manual wheelchair users (N=24) performed 5 transfers to a level height bench, while their natural transfer skills were scored using the TAI, and their biomechanical data were recorded.

      Intervention

      Participants with 2 or more component skill deficits were invited to return to receive personalized transfer training.

      Main Outcome Measures

      TAI part 1 summary scores and biomechanical variables calculated at the shoulder, elbow, and wrist joints were compared before and immediately after transfer training.

      Results

      Sixteen of the 24 manual wheelchair users met the criteria for training, and 11 manual wheelchair users came back for the revisit. Their TAI part 1 summary scores improved from 6.31±.98 to 9.92±.25. They had significantly smaller elbow range of motion, shoulder resultant moment, and rates of rise of elbow and wrist resultant forces on their trailing side during transfers after training (P<.05). On the leading side, shoulder maximum internal rotation and elevation angles, and shoulder resultant moments and rates of rise of shoulder resultant force and moment decreased after training (P<.04).

      Conclusions

      The TAI-based training showed short-term beneficial biomechanical effects on wheelchair users' upper limbs, such as better shoulder positioning and lower joint loadings. If the skills are practiced longer-term, they may help protect the upper limbs from developing pain and injuries.

      Keywords

      List of abbreviations:

      ROM (range of motion), TAI (Transfer Assessment Instrument)
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