Demographic and socioeconomic factors associated with disparity in wheelchair customizability among people with traumatic spinal cord injury

Hunt, Peter Cody; Boninger, Michael L.; Cooper, Rory A.; Zafonte, Ross; Fitzgerald, Shirley G.; Schmeler, Mark R.

doi:10.1016/j.apmr.2004.07.347

Cited by 60 publications

(60 citation statements)

References 16 publications

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“…Studies that have compared types of wheelchairs have focused on durability [12][13][14][15] rather than on provision. Only one other study was found that examined the provision of wheelchairs by type [16]. That population included 412 individuals with SCI who were receiving services from the SCI Model Systems.…”

Section: Discussionmentioning

confidence: 99%

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Distribution and cost of wheelchairs and scooters provided by Veterans Health Administration

Hubbard¹,

Fitzgerald²,

Vogel³

et al. 2007

JRRD

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Abstract-During fiscal years 2000 and 2001, the VeteransHealth Administration provided veterans with more than 131,000 wheelchairs and scooters at a cost of $109 million. This national study is the first to investigate Veterans Health Administration costs in providing wheelchairs and scooters and to compare regional prescription patterns. With a retrospective design, we used descriptive methods to analyze fiscal years 2000 and 2001 National Prosthetics Patient Database data (cleaned data set of 113,724 records). Wheelchairs were categorized by function, weight, and adjustability options for meeting individual needs (e.g., axle position, camber, position of wheels, tilt, and recline options). Results displayed a cost distribution that was negatively skewed by low-cost accessories coded as wheelchairs. Of the standard manual wheelchairs, 3.5% could be considered beyond the customary cost. Regionally, 71% to 86% of all wheelchairs provided were manual wheelchairs, 5% to 11% were power wheelchairs, and 5% to 20% were scooters. The considerable variation found in the types of wheelchairs and scooters provided across Veterans Integrated Service Networks may indicate a need for evidencebased prescription guidelines and clinician training in wheeledmobility technologies.

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Section: Discussionmentioning

confidence: 99%

“…Of the power wheelchair users, 46 percent used a standard chair with programmable controls (K0011) and 54 percent used customized power wheelchairs (K0014). No participants used a standard power wheelchair (K0010) [16]. This study, however, did not consider cost or geographic variation and was limited to individuals with SCI.…”

Section: Discussionmentioning

confidence: 99%

Distribution and cost of wheelchairs and scooters provided by Veterans Health Administration

Hubbard¹,

Fitzgerald²,

Vogel³

et al. 2007

JRRD

Self Cite

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show abstract

“…In addition, the type of insurance available to veterans is different than that available to the general population. A previous study has shown that individuals who have public insurance, such as Medicare and Medicaid, receive a lower quality wheelchair compared with individuals who have private insurance [25]. Veterans likely receive a higher overall quality wheelchair than individuals with public insurance because of the increased purchase flexibility of the VA.…”

Section: Discussionmentioning

confidence: 99%

“…This difference is not present when the type of wheelchairs issued to individuals from the VA or a Model SCI System are compared. According to Hunt et al, within a Model SCI System, 97 percent of all the manual wheelchairs issued were ultralightweight [25]. Therefore, specialty of the prescriber likely plays a role in the type of wheelchair issued.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of mobility device delivery within Department of Veterans Affairs for individuals with multiple sclerosis versus spinal cord injury

Ambrosio¹,

Boninger²,

Fitzgerald³

et al. 2007

JRRD

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Abstract-Individuals with multiple sclerosis (MS) report decreased satisfaction with their mobility devices compared with individuals with spinal cord injuries (SCIs). This study (1) investigated the demographic differences between veterans with MS (V-MS) and veterans with SCI (V-SCI) who were issued a wheelchair by the Veterans Health Administration (VHA) and (2) described differences in mobility device prescription. We merged two VHA databases to obtain demographic and wheelchair information for all V-MS and V-SCI in 2000 and 2001. Descriptive information for issued wheelchairs was available for 2,154 V-MS and V-SCI. We found that V-MS were significantly less likely to receive higher quality wheelchairs (manual or power) compared with V-SCI (p < 0.001). The disparity in VHA wheelchair prescription between these two groups indicates a need for further research regarding the assistive device prescription process in these populations.

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Functional reorganization of upper-body movement after spinal cord injury

et al. 2010

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Survivors of spinal cord injury need to reorganize their residual body movements for interacting with assistive devices and performing activities that used to be easy and natural. To investigate movement reorganization, we asked subjects with high-level spinal cord injury (SCI) and unimpaired subjects to control a cursor on a screen by performing upper-body motions. While this task would be normally accomplished by operating a computer mouse, here shoulder motions were mapped into the cursor position. Both the control and the SCI subjects were rapidly able to reorganize their movements and to successfully control the cursor. The majority of the subjects in both groups were successful in reducing the movements that were not effective at producing cursor motions. This is inconsistent with the hypothesis that the control system is merely concerned with the accurate acquisition of the targets and is unconcerned with motions that are not relevant to this goal. In contrast, our findings suggest that subjects can learn to reorganize coordination so as to increase the correspondence between the subspace of their upper-body motions with the plane in which the controlled cursor moves. This is effectively equivalent to constructing an inverse internal model of the map from body motions to cursor motions, established by the experiment. These results are relevant to the development of interfaces for assistive devices that optimize the use of residual voluntary control and enhance the learning process in disabled users, searching for an easily learnable map between their body motor space and control space of the device.

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Demographic and socioeconomic factors associated with disparity in wheelchair customizability among people with traumatic spinal cord injury

Cited by 60 publications

References 16 publications

Distribution and cost of wheelchairs and scooters provided by Veterans Health Administration

Distribution and cost of wheelchairs and scooters provided by Veterans Health Administration

Comparison of mobility device delivery within Department of Veterans Affairs for individuals with multiple sclerosis versus spinal cord injury

Functional reorganization of upper-body movement after spinal cord injury

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