Motor Learning Approach for Manual Wheelchair Users
Condition: Spinal Cord Injuries
MeSH terms: Spinal Cord Injuries
Study type: Interventional

Summary: 
      The overall purpose of this project is to pilot test a manual wheelchair (MWC) training
      program based on motor learning theory to improve wheelchair propulsion for manual wheelchair
      users (MWUs) with spinal cord injury (SCI).
    

Detailed description: 
      The project objective is to conduct a pilot randomized control trial (RCT) examining (1) the
      number of task-specific repetitions required to produce change in wheelchair propulsion
      techniques and (2) identifying the most conducive surface (overground or on a stationary
      device such as rollers) for implementing a repetition-based manual wheelchair propulsion
      training program. The long-term goals of this research are to minimize upper extremity pain
      and chronic overuse injury and to increase mobility efficiency in in persons with SCI who use
      MWCs for everyday mobility. The current project goal is to test the effects of a
      repetition-based manual wheelchair propulsion training program that emphasizes the
      recommended clinical practice guidelines (CPG). The expected outcome will be evidence to use
      in training MWUs with SCI in proper propulsion techniques in order to prevent or delay pain
      and chronic overuse injuries and maximize mobility through efficient wheelchair propulsion
      techniques. The long-term impact will be implementing evidence-based MWC propulsion training
      in appropriate amounts to facilitate a reduction in pain and dysfunction, a reduction in
      health costs, and prolonged participation in major life activities for MWUs with SCI.

      Our research aims are to:

        1. Compare wheelchair propulsion kinematics, kinetics, and wheelchair performance changes
           among three independent groups (Roller Group, Overground Group, Wheelchair Skills
           Group).

        2. Characterize the dose-response relationship of repetition-based propulsion practice.

        3. Evaluate the long-term impact of propulsion training on performance in the lived
           environment.

      A single-blind pilot RCT will be conducted. Forty-eight individuals with SCI who use MWCs and
      who do not follow the recommended clinical guidelines for propulsion will be recruited. Each
      participant will be randomized into one of three independent groups: motor learning
      repetitions on a roller system (RG), motor learning repetitions overground (OG), or the
      placebo-controlled group receiving conventional MWC skills training (WSG). The WSG will
      operate as a placebo by receiving basic MWC skills training-the current standard of
      rehabilitation care. Participants' kinematics (video motion analysis), kinetics (SmartWheel),
      and wheelchair performance overground (Wheelchair Propulsion Test) will be assessed
      pre-intervention (Baseline), immediately following intervention (Follow-up), and three
      months' post-intervention (3-Month Follow-up).
    

Intervention name(s): Roller system group (RG); Overground group (OG); Placebo - Wheelchair skills group (WSG)
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): They will first receive the standard of care that is often used in rehabilitation: a 30 minute educational session about recommended propulsion techniques with no motor learning principles implemented. In addition, they will execute 750-1250 wheelchair propulsion repetitions on the roller system per each 1 hour session (2-3 x per week for 4-6 weeks) until they reach approximately 10,000 repetitions (10 sessions). Each session will focus on minimizing the force and frequency of pushes while using longer push strokes during propulsion.; They will first receive the standard of care that is often used in rehabilitation: a 30 minute educational session about recommended propulsion techniques with no motor learning principles implemented. In addition, they will execute 750-1250 wheelchair propulsion repetitions overground per each 1 hour session (2-3 x per week for 4-6 weeks) until they reach approximately 10,000 repetitions (10 sessions). Each session will focus on minimizing the force and frequency of pushes while using longer push strokes during propulsion.; They will receive the standard of care that is often used in rehabilitation: a 30 minute educational session about recommended propulsion techniques with no motor learning principles implemented.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: manual wheelchair; wheelchair propulsion; occupational therapy; motor learning