Motor Learning-based Wheelchair Propulsion Training for Older Adults

NCT02123043 | Completed

• 1 other identifier: H14-00253
• Study Type: interventional
• Target: 35
• Locations: 1 country
• Sites: 1

Brief Summary

Many older adults lack the skill of efficient wheelchair propulsion despite being the largest cohort of wheelchair users. Inefficient wheelchair propulsion can lead to fatigue and overuse injuries that can result in lost independent mobility. This study will evaluate the effectiveness of a new training strategy using a motor learning based approach to train efficient wheelchair propulsion. Participants will be randomly assigned to one of three groups: 1) No practice; 2) Motor learning-based training; or 3) Practice (time-matched to training). Potential improvements based on training will be explored for wheeling biomechanical variables and energy efficiency. Study Hypothesis: We expect that the Training intervention will be superior to the Practice intervention for improving the biomechanical and physiological efficiency of wheelchair propulsion. It is also hypothesized that both the Training and Practice interventions will be superior to no practice.

Conditions

Aging; Wheelchair Training

Keywords

rehabilitation; wheelchair; older adults; manual wheelchair; motor learning; biomechanics; gross mechanical efficiency

Outcome Measures

Primary Outcomes (3)

• Push Angle (biomechanical variable)

  Push angle will be collected using a force sensing push rim (SmartWheel).

  Change from baseline at 4 weeks, change from baseline at 6 weeks

• Cadence (biomechanical variable)

  Cadence will be collected using a force sensing push rim (SmartWheel).

  Change from baseline at 4 weeks, change from baseline at 6 weeks

• Force application (biomechanical variable)

  Force application will be collected using a force sensing push rim (SmartWheel).

  Change from baseline at 4 weeks, change from baseline at 6 weeks

Secondary Outcomes (5)

• Gross mechanical efficiency

  Change from baseline at 4 weeks, change from baseline at 6 weeks

• SmartWheel Clinical Protocol

  Change from baseline at 4 weeks, change from baseline at 6 weeks

• Wheelchair skills related to propulsion

  Change from baseline at 4 weeks, change from baseline at 6 weeks

• Wheelchair sprint test (peak power output)

  Change from baseline at 4 weeks, change from baseline at 6 weeks

• Wheeling pattern

  Change from baseline at 4 weeks, change from baseline at 6 weeks

Study Arms (3)

Control

NO INTERVENTION

The control group will not experience any wheelchair training or 'practice' with a manual wheelchair.

Motor learning-based training

EXPERIMENTAL

The motor learning-based training, like the 'practice' condition, will consist of six visits over three weeks. Each visit will involve two 5-minute wheeling trials with 10-minutes of rest between trials. The motor learning-based training will focus on variable practice and sporadic feedback.

Behavioral: Motor learning-based training

Practice wheeling

ACTIVE COMPARATOR

To provide a comparable amount of exposure to wheelchair propulsion, the practice group will participate in the same number of visits and wheeling time as the motor-learning based training group. This will allow us to determine whether the motor-learning based training is superior to exposure through practice. The practice group will come to the lab six times over three weeks and wheel for two 5-minute trials with a 10-minute rest break in between. Participants randomized to this group will receive no feedback.

Behavioral: Practice wheeling

Interventions

Motor learning-based training BEHAVIORAL

The motor learning-based training will focus on some of the core concepts in the field of motor learning. The key concepts will include variable practice with respect to speed, feedback (both intrinsic and extrinsic but focusing on extrinsic), feedback focusing on three main variables (wheeling pattern, speed of hand when contacting push rim, push angle), sequential learning (specifically relating to wheeling pattern), and mental imagery (during the rest breaks).

Motor learning-based training

Practice wheeling BEHAVIORAL

The practice wheeling will consist of the same amount of wheeling exposure compared to the motor learning-based training group, however no feedback regarding an individuals's wheeling will be provided. Participants randomized to this group will wheel for two 5-minute trials/ visit for 6 visits for a total of 60 minutes of wheeling exposure.

Practice wheeling

Eligibility Criteria

• Age: 50 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Able-bodied adults 50+ years of age
• Reside in the community
• Have no previous experience using a manual wheelchair
• Have the physical endurance to walk at a moderate intensity for 10 min
• Physical activity readiness questionnaire (PAR-Q+) approval for individuals up to 69 y and Physical activity readiness medical examination (PARMED X) approval for individuals over 69 y.
• Able to read, write and speak English

You may not qualify if:

• Unable to communicate in English
• Smoke or have respiratory illnesses (i.e. asthma)
• Have current upper extremity injury or pain
• Have a mini-mental state examination score of less than 23
• Have a mass of more than 113kg (upper limit for testing device)

Sponsors & Collaborators

• University of British Columbia: lead

Study Sites (1)

Blusson Spinal Cord Centre

Vancouver, British Columbia, V5Z 1M9, Canada

Location

Related Publications (1)

• MacGillivray MK, Eng JJ, Dean E, Sawatzky BJ. Effects of Motor Skill-Based Training on Wheelchair Propulsion Biomechanics in Older Adults: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2020 Jan;101(1):1-10. doi: 10.1016/j.apmr.2019.07.017. Epub 2019 Sep 4.

  PMID: 31493382 DERIVED

Study Officials

• Bonita J Sawatzky, PhD

  University of British Columbia

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: April 15, 2014
• First Posted: April 25, 2014
• Study Start: October 1, 2014
• Primary Completion: February 7, 2017
• Study Completion: July 31, 2017
• Last Updated: May 2, 2018

Record last verified: 2018-04

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)