FIM-L).Methods: A subcommittee of international experts evaluated each instrument for test construct, administration, population applicability, reliability, sensitivity to change, and validity. Evaluations for each outcome measure were compiled, distributed to the whole committee, and then further reviewed with addition of comments and recommendations for consensus. An audience of experts voted on the validity and usefulness of each measure. Results: WISCI II and 10MWT were found to be the most valid and clinically useful tests to measure improvement in gait for patients with SCI. FIM-L had little utility and validity for research in SCI. 6MWT and 50FTWT were found to be useful but in need of further validation or changes for the SCI population. Conclusion: A combination of the 10MWT and WISCI II would provide the most valid measure of improvement in gait and ambulation in as much as objective changes of speed, and functional capacity allow for interval measurement. To provide the most comprehensive battery, however, it will be important to include a measure of endurance such as the 6MWT. Further validation and study should be devoted to WISCI II, 10MWT, and 6MWT as primary outcome measures for gait in SCI.
This document, approved by the Rehabilitation Engineering & Assistive Technology Society of North America (RESNA) Board of Directors on April 23, 2008, describes typical clinical applications and provides evidence from the literature supporting the application of tilt, recline, and elevating legrests for wheelchairs.
Objectives
To determine the efficacy of skin protection wheelchair seat cushions in preventing pressure ulcers in the elderly, nursing home population
Design
Clinical trial with participants assigned at random to either a skin protection or segmented foam cushion. Two hundred thirty two participants were recruited between June 2004 and May 2008 and followed for 6 months or until pressure ulcer incidence.
Setting
Twelve nursing homes
Participants
Nursing home residents’ age ≥ 65, using wheelchairs ≥6 hours/day, Braden score ≤ 18, and combined Braden activity and mobility score ≤ 5. Participants were recruited from a referred sample.
Intervention
All participants were provided a fitted wheelchair and randomized into skin protection (SPC) or segmented foam (SFC) cushion groups. The SPC group received an air, viscous fluid/foam, or gel/foam cushion. The SFC group received a 7.6 cm crosscut foam cushion.
Measurements
Pressure ulcer incidence over 6 months for wounds near the ischial tuberosities (IT ulcers) were measured. Secondary analysis was performed on combined IT and sacral/coccyx ulcers.
Results
One hundred eighty participants reached a study endpoint and 42 were lost to follow-up. Ten did not receive the intervention. There were 8/119 (6.7%) IT ulcers in the SFC group and 1/113 (0.9%) in the SPC group (p<0.04). In the group of combined IT and sacral/coccyx ulcers, there were 21/119 pressure ulcers (17.6%) in the SFC group and 12/113 (10.6%) in the SPC group (p=0.14).
Conclusion
Skin protection cushions used with fitted wheelchairs lower pressure ulcer incidence for elderly, nursing home residents and should be used to help prevent pressure ulcers.
Wheeled mobility and seating assessments for individuals with mobility impairments living in rural or distant locations are problematic due to the lack of expertise and available resources. The objective of this study was to measure satisfaction based on one's evaluation and prescription as well as comfort level when being evaluated by telerehabilitation (TR). Patient satisfaction data from real-time interactive TR clinical consultations between an expert practitioner located at least 125 miles away and four remote wheelchair clinics set up by the research team were collected and evaluated. The results revealed that there was a statistically significant difference between participants' pre- and postevaluation scores, t(39) = -13.92, p< .05, as well as pre- and postprescription scores, t(39) = -13.15, p < .05. In addition, all mean scores were significantly higher than the scale midpoint of3.5 on a TR survey. The study's findings are consistent with those of previous telemedicine satisfaction studies. Overall, the results indicate a high level of patient satisfaction using TR.
Results indicate that the FMA was a reliable and stable tool for assessing the functional performance of individuals who use or need WMS interventions.
Results suggest that the transition to a PMD enhances occupational performance, competence, adaptability, and self-esteem for persons with severe mobility impairments.
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