Impact of Pushrim Activated Power Assist Wheelchairs on Mobility Among People With Tetraplegia
Condition: Wheelchair Users
MeSH terms: Quadriplegia
Study type: Interventional

Summary: 
      The purpose of this three phase study is to evaluate a Pushrim Activated Power Assist
      Wheelchair (PAPAW). Phase I will examine whether the steady-state, metabolic energy
      efficiency for propelling a manual wheelchair with and without the device will be
      significantly different. In Phase II, wheelchair users will evaluate the PAPAW over
      activities of daily living course to determine its usability and acceptability and to
      identify areas for future development. Finally, in phase III, comparison of activities of
      daily living in the community will be made between the subjects when using their personal
      wheelchair and a PAPAW.
    

Detailed description: 
      Objectives:

      The purpose of this three phase study is to evaluate a Pushrim Activated Power Assist
      Wheelchair (PAPAW). Phase I will examine whether the steady-state, metabolic energy
      efficiency for propelling a manual wheelchair with and without the device will be
      significantly different. In Phase II, wheelchair users will evaluate the PAPAW over
      activities of daily living course to determine its usability and acceptability and to
      identify areas for future development. Finally, in phase III, comparison of activities of
      daily living in the community will be made between the subjects when using their personal
      wheelchair and a PAPAW.

      Research Design:

      This is a repeated measures design type study, conducted in different locations for each
      phase: a biomechanics laboratory, an ADL driving course, and the participants' home
      environment. Analyzed variables include: metabolic energy expenditures, stroke frequency,
      upper extremity joint range of motion, participant responses to a visual analog survey,
      average speed, and actual daily driving time spent in either wheelchair, and daily distance
      traveled. Subjects will act as their own controls.

      Methodology:

      Full-time wheelchair users with tetraplegia between the ages of 18 and 65 will be recruited
      for the study. They will be free of pressure sores, free from any shoulder pain that would
      prevent them from propelling a manual wheelchair, and have no history of cardiopulmonary
      disease. A maximum of 50 subjects (fifteen for Phase I and II, and 15 or Phase III, and five
      for subject drop-out) will be recruited. In Phase I, participants will be asked to propel a
      PAPAW and their own wheelchair, attached to a wheelchair roller system through three
      resistance conditions. In Phase II, participants will be asked to propel both wheelchairs
      over activities of daily living. Finally, Phase III consists of a four-week trial including a
      two-week test with subjects' own wheelchairs (i.e. own chair trial) and a two-week test where
      they were provided with the PAPAW (i.e. PAPAW trial). The order of the own chair trial and
      the PAPAW trial will be randomized.

      Clinical Relationship:

      For individuals with tetraplegia, PAPAWs reduce energy demands, stroke frequency, and overall
      joint range of motion when compared to traditional manual wheelchair propulsion. In addition,
      PAPAWs have the potential to improve the functional capabilities during certain activities of
      daily living as well as community participation of individuals with tetraplegia. Use of this
      device could help maintain overall physical capacity while reducing the risk for pain and
      injuries to the upper extremities.
    

Intervention name(s): Pushrim Activated Power Assist
Intervention type(s): Device
Intervention description(s): The PAPAW is an electrically-powered add-on unit for common manual wheelchairs. The unit automatically supplements the users manual pushrim input with additional rear-wheel torque for up to six kilometers/hour traveling velocity. The amount of added torque is provided proportional to the user input to the pushrims. Movement and braking assistance is provided for both forward and rearward travel. Several types and sizes are available based on users operating strength, needs and anthropometry. The PAPAWs to be tested during this study will be the JWII (Yamaha Motor Corporation).
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: wheelchair; spinal cord injury; rehabilitation