Decisions and Dilemmas in Everyday Life: Daily Use of Wheelchairs by Individuals with Spinal Cord Injury and the Impact on Pressure Ulcer Risk

Fogelberg, Donald; Atkins, Michal; Blanche, Erna Imperatore; Carlson, Michael; Clark, Florence

doi:10.1310/sci1502-16

Cited by 21 publications

(13 citation statements)

References 12 publications

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“…2009; Hansen, Tresse & Gunnarson 2004; WHO 2008). As people’s health, activity level and environment may change over time, a different type of wheelchair or adjustments to the current one may be needed (Di Marco et al .…”

Section: Resultsmentioning

confidence: 99%

Policy implementation in wheelchair service delivery in a rural South African setting

Visagie

Scheffler²,

Schneider

2013

Afr. j. disabil.

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BackgroundWheelchairs allow users to realise basic human rights and improved quality of life. South African and international documents guide rehabilitation service delivery and thus the provision of wheelchairs. Evidence indicates that rehabilitation policy implementation gaps exist in rural South Africa.ObjectivesThe aim of this article was to explore the extent to which wheelchair service delivery in a rural, remote area of South Africa was aligned with the South African National Guidelines on Provision of Assistive Devices, The United Nations Convention on the Rights of Persons with Disabilities and The World Health Organization Guidelines on Provision of Wheelchairs in Less-Resourced Settings.MethodQualitative methods were used. Data were collected through semi-structured interviews with 22 participants who were identified through purposive sampling. Content analysis of data was preformed around the construct of wheelchair service delivery.ResultsStudy findings identified gaps between the guiding documents and wheelchair service delivery. Areas where gaps were identified included service aspects such as referral, assessment, prescription, user and provider training, follow up, maintenance and repair as well as management aspects such as staff support, budget and monitoring. Positive findings related to individual assessments, enthusiastic and caring staff and the provision of wheelchairs at no cost.ConclusionThe gaps in policy implementation can have a negative impact on users and the service provider. Inappropriate or no wheelchairs limit user function, participation and quality of life. In addition, an inappropriate wheelchair will have a shorter lifespan, requiring frequent repairs and replacements with cost implications for the service provider.

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Section: Resultsmentioning

confidence: 99%

Policy implementation in wheelchair service delivery in a rural South African setting

Visagie

Scheffler²,

Schneider

2013

Afr. j. disabil.

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“…Through in-depth interviews and participant observations, detailed information was gathered on the everyday life circumstances that contribute to the formation of pressure ulcers in adults with SCI (Clark et al, 2006; Jackson et al, 2010). In addition to generating academic publications (Clark et al, 2006; Fogelberg, Atkins, Blanche, Carlson, & Clark, 2009; Jackson et al, 2010; Seip, Carlson, Jackson, & Clark, 2010), this qualitative study yielded several intervention-related products, including a, Stage I intervention manual (USC-RLANRC PUPP, 2005), a manual for rehabilitation professionals (USC-RLANRC PUPP, 2006a), and an on-line consumer manual (USC-RLANRC PUPP, 2006b). …”

Section: The Process Of Manualizing the Lifestyle Redesign® Interventmentioning

confidence: 99%

Manualization of Occupational Therapy Interventions: Illustrations From the Pressure Ulcer Prevention Research Program

Blanche

Fogelberg

Díaz

et al. 2011

The American Journal of Occupational Therapy

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The manualization of a complex occupational therapy intervention is a crucial step in ensuring treatment fidelity for both clinical application and research purposes. Towards this latter end, intervention manuals are essential for assuring trustworthiness and replicability of randomized controlled trials (RCT’s) that aim to provide evidence of the effectiveness of occupational therapy. In this paper, literature on the process of intervention manualization is reviewed. The prescribed steps are then illustrated through our experience in implementing the University of Southern California/Rancho Los Amigos National Rehabilitation Center’s collaborative Pressure Ulcer Prevention Project (PUPP). In this research program, qualitative research provided the initial foundation for manualization of a multifaceted occupational therapy intervention designed to reduce incidence of medically serious pressure ulcers in people with SCI.

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“…The National Health and Nutrition Examination Survey (NHANES) revealed that increased sitting time was significantly associated with adverse cardiometabolic risk factors [ 35 ]; those individuals who had a self-reported time sitting for more than 6 hours per day, were more likely to have adverse FPI, HDL-C concentrations, and HOMA-IR and HOMA % B scores [ 36 ], and, thus, a greater inferred CVD risk. As a consequence of paralysis and the inability to assume upright standing and ambulation, time spent sitting in a wheelchair in those with SCI has been self-reported to be, on average, 9.2 hours per day [ 37 ], and, in the anecdotal experience of the authors, it is not uncommon for these individuals to spend in excess of 12–15 hours sitting in their wheelchair on a daily basis, with the remaining balance of non-sleeping time during the day spent in a seated or non-weight bearing position (i.e., seated on surface other than wheelchair). Our SCI cohort has lived with their immobilizing injury from 6 months to 47 years.…”

Section: Discussionmentioning

confidence: 99%

Lipoprotein heterogeneity in persons with Spinal Cord Injury: a model of prolonged sitting and restricted physical activity

et al. 2015

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BackgroundPersons with spinal cord injury (SCI) often have low levels of physical activity, which predispose to increased adiposity and decreased high density lipoprotein cholesterol (HDL-C) concentrations, and, generally, normal low density lipoprotein cholesterol (LDL-C) concentrations. In spite of the mixed lipoprotein profile, the SCI population has been reported to have an elevated risk of cardiovascular-related morbidity and mortality. Nuclear magnetic resonance spectroscopy may permit a more precise quantification of lipoprotein particle (P) species, enabling a more accurate inference of risk for cardiovascular disease (CVD) in the SCI population.MethodsFasting blood samples were obtained on 83 persons with chronic SCI and 62 able-bodied (AB) subjects. Fasting plasma insulin (FPI), triglycerides (TG), and P number and size of VLDL (very low density lipoprotein), LDL, and HDL subclasses were determined. AB and SCI subjects were stratified based on HDL-C (i.e., Low <40 and Normal ≥40 mg/dl): AB-Normal (n = 48), AB-Low (n = 14), SCI-Normal (n = 49), and SCI-Low (n = 34). Factorial analyses of variance were performed to identify group differences in lipoprotein measurements. Pearson correlations were performed between the number of P by lipoprotein subclass, size, FPI, and TG.ResultsThe SCI-Normal group was not significantly different from the AB-Normal group for body composition, FPI, TG or LP-IR and had negligible differences in the lipoprotein P profile, except for fewer number and smaller size of HDL-P. The SCI-Low group had a similar lipoprotein profile to that of the AB-Low group, but with a lipid P composition associated with a heightened atherogenic risk and greater tendency toward insulin resistance by the Lipoprotein-Insulin Resistance (LP-IR) score. In the SCI-Low group, the decreased number and reduced size of lipoprotein P were more prevalent and may be associated with increased waist circumference (i.e., abdominal adiposity), relatively elevated TG values (compared to the other subgroups), and an underlying subclinical state of insulin resistance.ConclusionsProlonged sitting and restricted physical activity in individuals with SCI had the most profound effect on the HDL-C and its lipoprotein P subclasses, but not on LDL-C, however its P subclasses were also unfavorably affected but not to the same degree. The quantification of lipoprotein P characteristics may be a potent tool for the determination of risk for CVD in persons with SCI.

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Decisions and Dilemmas in Everyday Life: Daily Use of Wheelchairs by Individuals with Spinal Cord Injury and the Impact on Pressure Ulcer Risk

Cited by 21 publications

References 12 publications

Policy implementation in wheelchair service delivery in a rural South African setting

Policy implementation in wheelchair service delivery in a rural South African setting

Manualization of Occupational Therapy Interventions: Illustrations From the Pressure Ulcer Prevention Research Program

Lipoprotein heterogeneity in persons with Spinal Cord Injury: a model of prolonged sitting and restricted physical activity

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