Motor Learning Approach for Manual Wheelchair Users

NCT03781609 | Completed

• 1 other identifier: 201804133
• Study Type: interventional
• Target: 14
• Locations: 1 country
• Sites: 1

Brief 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).

Conditions

Spinal Cord Injuries

Keywords

manual wheelchair; wheelchair propulsion; occupational therapy; motor learning

Outcome Measures

Primary Outcomes (5)

• Video Motion Capture-Hand Axle relationship Change

  Kinematic data will be collected using a 3D infrared VMC system (VICON, Centennial, CO).106 The VMC system consists of 14 Vero 2.2 digital cameras to detect the location of reflective markers, which will be attached to the participant's third metacarpal and to the wheel axle of the participant's MWC. As the participant propels through the capture volume, the VMC will record the motion of the participant's third metacarpal in relation to the wheelchair axle. Hand-axle relationship will be measured in centimeters and compared across the three testing sessions. This variable corresponds to the recommendations outlined in the CPG (bringing the hand down toward the axle during recovery \[hand-axle relationship\].

  Baseline, Up to 4 weeks post intervention and 3-month post intervention

• Video Motion Capture-Push Angle Change

  Kinematic data will be collected using a 3D infrared VMC system (VICON, Centennial, CO).106 The VMC system consists of 14 Vero 2.2 digital cameras to detect the location of reflective markers, which will be attached to the participant's third metacarpal and to the wheel axle of the participant's MWC. As the participant propels through the capture volume, the VMC will record the motion of the participant's third metacarpal in relation to the wheelchair axle. Push angle will be compared across the three testing sessions. This variable corresponds to the recommendations outlined in the CPG (use longer push strokes \[push angle\].

  Baseline, Up to 4 weeks post intervention and 3-month post intervention

• Wheelchair Propulsion Test (WPT)-Number of pushes Change

  The WPT assesses wheelchair mobility and performance of MWUs. The WPT requires MWUs to propel using a self-selected natural velocity across 10 meters of a smooth, flat surface from a static start. The number of pushes needed to complete the 10 meters,will all noted. The WPT has excellent test-retest reliability (r = .72-.96), interrater reliability (r = .80-.96), and construct validity (p \< .04).14 The data collected from the WPT will assist in identifying changes of propulsion performance pre- and post-intervention and how those changes relate to the Clinical Practice Guidelines for the Preservation of upper Limb function Following Spinal Cord Injury (CPG) recommendation for minimizing the frequency of pushes while retaining the same speed.

  Baseline, Up to 4 weeks post intervention and 3-month post intervention

• Wheelchair Propulsion Test (WPT)-time to complete 10 meter push Change

  The WPT assesses wheelchair mobility and performance of MWUs. The WPT requires MWUs to propel using a self-selected natural velocity across 10 meters of a smooth, flat surface from a static start. Observation of the participant's propulsion pattern as well as whether their hands make contact with the pushrims, recovery, time to complete the 10 meters will be collected. The WPT has excellent test-retest reliability (r = .72-.96), interrater reliability (r = .80-.96), and construct validity (p \< .04).14 The data collected from the WPT will assist in identifying changes of propulsion performance pre- and post-intervention and how those changes relate to the Clinical Practice Guidelines for the Preservation of upper Limb function Following Spinal Cord Injury (CPG) recommendation for minimizing the frequency of pushes while retaining the same speed.

  Baseline, Up to 4 weeks post intervention and 3-month post intervention

• Wheelchair Propulsion Test (WPT)-type of propulsion pattern comparison between time points

  The WPT assesses wheelchair mobility and performance of MWUs. The WPT requires MWUs to propel using a self-selected natural velocity across 10 meters of a smooth, flat surface from a static start. The participant's dominant propulsion pattern will be noted. The WPT has excellent test-retest reliability (r = .72-.96), interrater reliability (r = .80-.96), and construct validity (p \< .04).14 The data collected from the WPT will assist in identifying changes of propulsion performance pre- and post-intervention and how those changes relate to the Clinical Practice Guidelines for the Preservation of upper Limb function Following Spinal Cord Injury (CPG) recommendation for minimizing the frequency of pushes while retaining the same speed.

  Baseline, Up to 4 weeks post intervention and 3-month post intervention

Secondary Outcomes (4)

• Outdoor Propulsion Test-Total push count

  Baseline, Up to 4 weeks post intervention and 3-month post intervention

• Outdoor Propulsion Test-# of pushes meeting clinical guidelines

  Baseline, Up to 4 weeks post intervention and 3-month post intervention

• Outdoor Propulsion Test-Type of propulsion pattern

  Baseline, Up to 4 weeks post intervention and 3-month post intervention

• Outdoor Propulsion Test-Time to complete route

  Baseline, Up to 4 weeks post intervention and 3-month post intervention

Other Outcomes (1)

• Wheelchair User's Shoulder Pain Index (WUSPI)

  Baseline, Up to 4 weeks post intervention and 3-month post intervention

Study Arms (3)

Roller system group (RG)

ACTIVE COMPARATOR

A group performing motor learning manual wheelchair propulsion repetitions on a roller system.

Behavioral: Roller system group (RG)

Overground group (OG)

ACTIVE COMPARATOR

A group performing motor learning manual wheelchair propulsion repetitions overground.

Behavioral: Overground group (OG)

Placebo - Wheelchair skills group (WSG)

PLACEBO COMPARATOR

A group receiving conventional manual wheelchair skills training.

Behavioral: Placebo - Wheelchair skills group (WSG)

Interventions

Roller system group (RG) BEHAVIORAL

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.

Roller system group (RG)

Overground group (OG) BEHAVIORAL

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.

Overground group (OG)

Placebo - Wheelchair skills group (WSG) BEHAVIORAL

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.

Placebo - Wheelchair skills group (WSG)

Eligibility Criteria

• Age: 18 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Participants must be 18 to 60 years of age
• Have a mobility limitation due to SCI, which requires the use of a manual wheelchair (MWC)
• Be able to self-propel a MWC bilaterally with their upper extremities
• Plan to use a MWC for at least 75% of activities throughout the day
• Live in the community
• Understand English at a sixth-grade level or higher
• Be able to follow multi-step instructions
• Participants must be able to provide informed consent independently
• Be able to tolerate propelling their wheelchair independently for 10 meters
• Be willing to participate in three assessments and up to 13 training sessions at the Enabling Mobility in the Community Laboratory (EMC Lab).

You may not qualify if:

• People will be excluded if they maneuver their MWC with their lower extremities or with only one upper extremity.
• Individuals who display the proper MWC propulsion techniques during the screening process, who already follow the CPG, or whose MWC position inhibits them from following the CPG will be excluded.
• Potential participants also will be excluded if they have bilateral incoordination due to strength inequality or neurological involvement that impairs propulsion in a steady, straight line. Specifically, if a person demonstrates upper extremity strength inequalities resulting in a 12-inch deviation from a marked pathway, he or she will be excluded.
• Potential participants will also be excluded if upper extremity or overall bodily pain is rated 8/10 or higher per the Wong-Baker FACES Numeric Pain Scale (FACES). -In addition, potential participants will be excluded if they are currently receiving medical treatment for an acute upper extremity injury, have a Stage IV pressure injury, or are currently hospitalized.

Sponsors & Collaborators

• Washington University School of Medicine: lead
• The Craig H. Neilsen Foundation: collaborator

Study Sites (1)

Washington University School of Medicine

St Louis, Missouri, 63108, United States

Location

Related Publications (125)

• National Spinal Cord Injury Statistical Center. (2016). Facts and Figures at a Glance. Birmingham, AL: University of Alabama at Birmingham.

  BACKGROUND

• Cott CA. Client-centred rehabilitation: client perspectives. Disabil Rehabil. 2004 Dec 16;26(24):1411-22. doi: 10.1080/09638280400000237.

  PMID: 15764361 BACKGROUND

• Morgan KA, Engsberg JR, Gray DB. Important wheelchair skills for new manual wheelchair users: health care professional and wheelchair user perspectives. Disabil Rehabil Assist Technol. 2017 Jan;12(1):28-38. doi: 10.3109/17483107.2015.1063015. Epub 2015 Jul 3.

  PMID: 26138222 BACKGROUND

• Cox RJ, Amsters DI, Pershouse KJ. The need for a multidisciplinary outreach service for people with spinal cord injury living in the community. Clin Rehabil. 2001 Dec;15(6):600-6. doi: 10.1191/0269215501cr453oa.

  PMID: 11777090 BACKGROUND

• Estores IM. The consumer's perspective and the professional literature: what do persons with spinal cord injury want? J Rehabil Res Dev. 2003 Jul-Aug;40(4 Suppl 1):93-8. doi: 10.1682/jrrd.2003.08.0093.

  PMID: 15077653 BACKGROUND

• National Spinal Cord Injury Statistical Center. (2015). Annual Statistical Report-Complete Public Version. Birmingham, AL: University of Alabama at Birmingham.

  BACKGROUND

• Kaye, H. S., Kang, T., & LaPlante, M. P. (2002). Wheelchair use in the United States [abstract]. Disability Statistics Abstract, 23, 1-4.

  BACKGROUND

• LaPlante MP, Kaye HS. Demographics and trends in wheeled mobility equipment use and accessibility in the community. Assist Technol. 2010 Spring;22(1):3-17; quiz 19. doi: 10.1080/10400430903501413.

  PMID: 20402043 BACKGROUND

• Kilkens OJ, Dallmeijer AJ, De Witte LP, Van Der Woude LH, Post MW. The Wheelchair Circuit: Construct validity and responsiveness of a test to assess manual wheelchair mobility in persons with spinal cord injury. Arch Phys Med Rehabil. 2004 Mar;85(3):424-31. doi: 10.1016/j.apmr.2003.05.006.

  PMID: 15031828 BACKGROUND

• Kilkens OJ, Post MW, Dallmeijer AJ, van Asbeck FW, van der Woude LH. Relationship between manual wheelchair skill performance and participation of persons with spinal cord injuries 1 year after discharge from inpatient rehabilitation. J Rehabil Res Dev. 2005 May-Jun;42(3 Suppl 1):65-73. doi: 10.1682/jrrd.2004.08.0093.

  PMID: 16195964 BACKGROUND

• Ozturk A, Ucsular FD. Effectiveness of a wheelchair skills training programme for community-living users of manual wheelchairs in Turkey: a randomized controlled trial. Clin Rehabil. 2011 May;25(5):416-24. doi: 10.1177/0269215510386979. Epub 2010 Nov 8.

  PMID: 21059666 BACKGROUND

• Bernard, B. P., Cohen, A. L., Fine, L. J., Gjessing, C. C., & McGlothlin, J. D. (1997). Elements of ergonomics programs: A primer based on workplace evaluations of musculoskeletal disorders. US Department of Health and Human Services publication, (97-117).

  BACKGROUND

• Kohn, J. P. (1998). Ergonomics Process Management: A Blueprint for Quality and Compliance. Boca Raton, FL: CRC Press.

  BACKGROUND

• Boninger ML, Cooper RA, Robertson RN, Rudy TE. Wrist biomechanics during two speeds of wheelchair propulsion: an analysis using a local coordinate system. Arch Phys Med Rehabil. 1997 Apr;78(4):364-72. doi: 10.1016/s0003-9993(97)90227-6.

  PMID: 9111455 BACKGROUND

• Hoover, A. E., Cooper, R. A., Dan, D., Dvorsnak, M., Cooper, R., Fitzgerald, S. G., & Boninger, M. L. (2003). Comparing driving habits of wheelchair users: Manual versus power. In Proceedings of the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) 26th International Conference on Technology & Disability: Research, Design, Practice, and Policy, (pp. 19-23).

  BACKGROUND

• Koontz AM, Yang Y, Boninger DS, Kanaly J, Cooper RA, Boninger ML, Dieruf K, Ewer L. Investigation of the performance of an ergonomic handrim as a pain-relieving intervention for manual wheelchair users. Assist Technol. 2006 Fall;18(2):123-43; quiz 145. doi: 10.1080/10400435.2006.10131912.

  PMID: 17236472 BACKGROUND

• Akbar M, Balean G, Brunner M, Seyler TM, Bruckner T, Munzinger J, Grieser T, Gerner HJ, Loew M. Prevalence of rotator cuff tear in paraplegic patients compared with controls. J Bone Joint Surg Am. 2010 Jan;92(1):23-30. doi: 10.2106/JBJS.H.01373.

  PMID: 20048092 BACKGROUND

• Boninger ML, Baldwin M, Cooper RA, Koontz A, Chan L. Manual wheelchair pushrim biomechanics and axle position. Arch Phys Med Rehabil. 2000 May;81(5):608-13. doi: 10.1016/s0003-9993(00)90043-1.

  PMID: 10807100 BACKGROUND

• Collinger JL, Impink BG, Ozawa H, Boninger ML. Effect of an intense wheelchair propulsion task on quantitative ultrasound of shoulder tendons. PM R. 2010 Oct;2(10):920-5. doi: 10.1016/j.pmrj.2010.06.007.

  PMID: 20970761 BACKGROUND

• Davidoff G, Werner R, Waring W. Compressive mononeuropathies of the upper extremity in chronic paraplegia. Paraplegia. 1991 Jan;29(1):17-24. doi: 10.1038/sc.1991.3.

  PMID: 2023767 BACKGROUND

• Finley MA, Rasch EK, Keyser RE, Rodgers MM. The biomechanics of wheelchair propulsion in individuals with and without upper-limb impairment. J Rehabil Res Dev. 2004 May;41(3B):385-95. doi: 10.1682/jrrd.2004.03.0385.

  PMID: 15543456 BACKGROUND

• Gellman H, Chandler DR, Petrasek J, Sie I, Adkins R, Waters RL. Carpal tunnel syndrome in paraplegic patients. J Bone Joint Surg Am. 1988 Apr;70(4):517-9.

  PMID: 3356717 BACKGROUND

• Koontz AM, Cooper RA, Boninger ML, Yang Y, Impink BG, van der Woude LH. A kinetic analysis of manual wheelchair propulsion during start-up on select indoor and outdoor surfaces. J Rehabil Res Dev. 2005 Jul-Aug;42(4):447-58. doi: 10.1682/jrrd.2004.08.0106.

  PMID: 16320141 BACKGROUND

• Mercer JL, Boninger M, Koontz A, Ren D, Dyson-Hudson T, Cooper R. Shoulder joint kinetics and pathology in manual wheelchair users. Clin Biomech (Bristol). 2006 Oct;21(8):781-9. doi: 10.1016/j.clinbiomech.2006.04.010. Epub 2006 Jun 30.

  PMID: 16808992 BACKGROUND

• Richter WM, Axelson PW. Low-impact wheelchair propulsion: achievable and acceptable. J Rehabil Res Dev. 2005 May-Jun;42(3 Suppl 1):21-33. doi: 10.1682/jrrd.2004.06.0074.

  PMID: 16195960 BACKGROUND

• Robertson RN, Boninger ML, Cooper RA, Shimada SD. Pushrim forces and joint kinetics during wheelchair propulsion. Arch Phys Med Rehabil. 1996 Sep;77(9):856-64. doi: 10.1016/s0003-9993(96)90270-1.

  PMID: 8822674 BACKGROUND

• Collinger JL, Boninger ML, Koontz AM, Price R, Sisto SA, Tolerico ML, Cooper RA. Shoulder biomechanics during the push phase of wheelchair propulsion: a multisite study of persons with paraplegia. Arch Phys Med Rehabil. 2008 Apr;89(4):667-76. doi: 10.1016/j.apmr.2007.09.052.

  PMID: 18373997 BACKGROUND

• Dalyan M, Cardenas DD, Gerard B. Upper extremity pain after spinal cord injury. Spinal Cord. 1999 Mar;37(3):191-5. doi: 10.1038/sj.sc.3100802.

  PMID: 10213328 BACKGROUND

• Nichols PJ, Norman PA, Ennis JR. Wheelchair user's shoulder? Shoulder pain in patients with spinal cord lesions. Scand J Rehabil Med. 1979;11(1):29-32.

  PMID: 419395 BACKGROUND

• Sie IH, Waters RL, Adkins RH, Gellman H. Upper extremity pain in the postrehabilitation spinal cord injured patient. Arch Phys Med Rehabil. 1992 Jan;73(1):44-8.

  PMID: 1729973 BACKGROUND

• Boninger ML, Cooper RA, Baldwin MA, Shimada SD, Koontz A. Wheelchair pushrim kinetics: body weight and median nerve function. Arch Phys Med Rehabil. 1999 Aug;80(8):910-5. doi: 10.1016/s0003-9993(99)90082-5.

  PMID: 10453767 BACKGROUND

• Boninger ML, Koontz AM, Sisto SA, Dyson-Hudson TA, Chang M, Price R, Cooper RA. Pushrim biomechanics and injury prevention in spinal cord injury: recommendations based on CULP-SCI investigations. J Rehabil Res Dev. 2005 May-Jun;42(3 Suppl 1):9-19. doi: 10.1682/jrrd.2004.08.0103.

  PMID: 16195959 BACKGROUND

• Fay BT, Boninger ML, Fitzgerald SG, Souza AL, Cooper RA, Koontz AM. Manual wheelchair pushrim dynamics in people with multiple sclerosis. Arch Phys Med Rehabil. 2004 Jun;85(6):935-42. doi: 10.1016/j.apmr.2003.08.093.

  PMID: 15179647 BACKGROUND

• Morgan KA, Tucker SM, Klaesner JW, Engsberg JR. A motor learning approach to training wheelchair propulsion biomechanics for new manual wheelchair users: A pilot study. J Spinal Cord Med. 2017 May;40(3):304-315. doi: 10.1080/10790268.2015.1120408. Epub 2015 Dec 16.

  PMID: 26674751 BACKGROUND

• Paralyzed Veterans of America Consortium for Spinal Cord Medicine. Preservation of upper limb function following spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med. 2005;28(5):434-70. doi: 10.1080/10790268.2005.11753844. No abstract available.

  PMID: 16869091 BACKGROUND

• Sawatzky B, DiGiovine C, Berner T, Roesler T, Katte L. The need for updated clinical practice guidelines for preservation of upper extremities in manual wheelchair users: a position paper. Am J Phys Med Rehabil. 2015 Apr;94(4):313-24. doi: 10.1097/PHM.0000000000000203.

  PMID: 25299526 BACKGROUND

• Boninger ML, Souza AL, Cooper RA, Fitzgerald SG, Koontz AM, Fay BT. Propulsion patterns and pushrim biomechanics in manual wheelchair propulsion. Arch Phys Med Rehabil. 2002 May;83(5):718-23. doi: 10.1053/apmr.2002.32455.

  PMID: 11994814 BACKGROUND

• Askari S, Kirby RL, Parker K, Thompson K, O'Neill J. Wheelchair propulsion test: development and measurement properties of a new test for manual wheelchair users. Arch Phys Med Rehabil. 2013 Sep;94(9):1690-8. doi: 10.1016/j.apmr.2013.03.002. Epub 2013 Mar 14.

  PMID: 23499781 BACKGROUND

• MacPhee AH, Kirby RL, Coolen AL, Smith C, MacLeod DA, Dupuis DJ. Wheelchair skills training program: A randomized clinical trial of wheelchair users undergoing initial rehabilitation. Arch Phys Med Rehabil. 2004 Jan;85(1):41-50. doi: 10.1016/s0003-9993(03)00364-2.

  PMID: 14970966 BACKGROUND

• Kendall MB, Ungerer G, Dorsett P. Bridging the gap: transitional rehabilitation services for people with spinal cord injury. Disabil Rehabil. 2003 Sep 2;25(17):1008-15. doi: 10.1080/0963828031000122285.

  PMID: 12851090 BACKGROUND

• Best KL, Miller WC, Routhier F. A description of manual wheelchair skills training curriculum in entry-to-practice occupational and physical therapy programs in Canada. Disabil Rehabil Assist Technol. 2015;10(5):401-6. doi: 10.3109/17483107.2014.907368. Epub 2014 Apr 7.

  PMID: 24702609 BACKGROUND

• Fliess-Douer O, Vanlandewijck YC, Lubel Manor G, Van Der Woude LH. A systematic review of wheelchair skills tests for manual wheelchair users with a spinal cord injury: towards a standardized outcome measure. Clin Rehabil. 2010 Oct;24(10):867-86. doi: 10.1177/0269215510367981. Epub 2010 Jun 16.

  PMID: 20554638 BACKGROUND

• McNevin NH, Wulf G, Carlson C. Effects of attentional focus, self-control, and dyad training on motor learning: implications for physical rehabilitation. Phys Ther. 2000 Apr;80(4):373-85. doi: 10.1093/ptj/80.4.373.

  PMID: 10758522 BACKGROUND

• Axelson, P., Chesney, D. Y., Minkel, J., & Perr, A. (1996). The manual wheelchair training guide. Santa Cruz, CA: Pax Press.

  BACKGROUND

• Kirby RL, Dupuis DJ, Macphee AH, Coolen AL, Smith C, Best KL, Newton AM, Mountain AD, Macleod DA, Bonaparte JP. The wheelchair skills test (version 2.4): measurement properties. Arch Phys Med Rehabil. 2004 May;85(5):794-804. doi: 10.1016/j.apmr.2003.07.007.

  PMID: 15129405 BACKGROUND

• Isaacson, M. (2011). Best practices by occupational and physical therapists performing seating and mobility evaluations. Assistive Technology, 23(1), 13-21.

  BACKGROUND

• Mitchell, M., Jin, B. T., Kim, A. J., Giesbrecht, E. M., Miller, W. C. (2014). METTA: A tablet-based platform for monitored at-home training as demonstrated through the EPIC Wheels Wheelchair Skills Training Program. In Proceedings of the Rehabilitation Engineering and Assistive Technology Society of North America Conference. Vancouver: University of British Columbia.

  BACKGROUND

• Baddeley, A. D. & Longman, D. J. A. (1978). The influence of length and frequency of training session on the rate of learning to type. Ergonomics, 21(8), 627-635.

  BACKGROUND

• Karni A. The acquisition of perceptual and motor skills: a memory system in the adult human cortex. Brain Res Cogn Brain Res. 1996 Dec;5(1-2):39-48. doi: 10.1016/s0926-6410(96)00039-0. No abstract available.

  PMID: 9049069 BACKGROUND

• Kitago T, Krakauer JW. Motor learning principles for neurorehabilitation. Handb Clin Neurol. 2013;110:93-103. doi: 10.1016/B978-0-444-52901-5.00008-3.

  PMID: 23312633 BACKGROUND

• Korman M, Raz N, Flash T, Karni A. Multiple shifts in the representation of a motor sequence during the acquisition of skilled performance. Proc Natl Acad Sci U S A. 2003 Oct 14;100(21):12492-7. doi: 10.1073/pnas.2035019100. Epub 2003 Oct 6.

  PMID: 14530407 BACKGROUND

• Rice I, Gagnon D, Gallagher J, Boninger M. Hand rim wheelchair propulsion training using biomechanical real-time visual feedback based on motor learning theory principles. J Spinal Cord Med. 2010;33(1):33-42. doi: 10.1080/10790268.2010.11689672.

  PMID: 20397442 BACKGROUND

• Rice IM, Pohlig RT, Gallagher JD, Boninger ML. Handrim wheelchair propulsion training effect on overground propulsion using biomechanical real-time visual feedback. Arch Phys Med Rehabil. 2013 Feb;94(2):256-63. doi: 10.1016/j.apmr.2012.09.014. Epub 2012 Sep 26.

  PMID: 23022092 BACKGROUND

• Boudreau SA, Farina D, Falla D. The role of motor learning and neuroplasticity in designing rehabilitation approaches for musculoskeletal pain disorders. Man Ther. 2010 Oct;15(5):410-4. doi: 10.1016/j.math.2010.05.008. Epub 2010 Jul 7.

  PMID: 20615749 BACKGROUND

• Dayan E, Cohen LG. Neuroplasticity subserving motor skill learning. Neuron. 2011 Nov 3;72(3):443-54. doi: 10.1016/j.neuron.2011.10.008.

  PMID: 22078504 BACKGROUND

• Lang CE, Macdonald JR, Reisman DS, Boyd L, Jacobson Kimberley T, Schindler-Ivens SM, Hornby TG, Ross SA, Scheets PL. Observation of amounts of movement practice provided during stroke rehabilitation. Arch Phys Med Rehabil. 2009 Oct;90(10):1692-8. doi: 10.1016/j.apmr.2009.04.005.

  PMID: 19801058 BACKGROUND

• Nudo RJ. Mechanisms for recovery of motor function following cortical damage. Curr Opin Neurobiol. 2006 Dec;16(6):638-44. doi: 10.1016/j.conb.2006.10.004. Epub 2006 Nov 3.

  PMID: 17084614 BACKGROUND

• Karni A, Meyer G, Rey-Hipolito C, Jezzard P, Adams MM, Turner R, Ungerleider LG. The acquisition of skilled motor performance: fast and slow experience-driven changes in primary motor cortex. Proc Natl Acad Sci U S A. 1998 Feb 3;95(3):861-8. doi: 10.1073/pnas.95.3.861.

  PMID: 9448252 BACKGROUND

• Lang CE, MacDonald JR, Gnip C. Counting repetitions: an observational study of outpatient therapy for people with hemiparesis post-stroke. J Neurol Phys Ther. 2007 Mar;31(1):3-10. doi: 10.1097/01.npt.0000260568.31746.34.

  PMID: 17419883 BACKGROUND

• Krebs HI, Hogan N, Hening W, Adamovich SV, Poizner H. Procedural motor learning in Parkinson's disease. Exp Brain Res. 2001 Dec;141(4):425-37. doi: 10.1007/s002210100871. Epub 2001 Oct 18.

  PMID: 11810137 BACKGROUND

• Mak MK, Hui-Chan CW. Cued task-specific training is better than exercise in improving sit-to-stand in patients with Parkinson's disease: A randomized controlled trial. Mov Disord. 2008 Mar 15;23(4):501-9. doi: 10.1002/mds.21509.

  PMID: 18074365 BACKGROUND

• Birkenmeier RL, Prager EM, Lang CE. Translating animal doses of task-specific training to people with chronic stroke in 1-hour therapy sessions: a proof-of-concept study. Neurorehabil Neural Repair. 2010 Sep;24(7):620-35. doi: 10.1177/1545968310361957. Epub 2010 Apr 27.

  PMID: 20424192 BACKGROUND

• Kimberley TJ, Samargia S, Moore LG, Shakya JK, Lang CE. Comparison of amounts and types of practice during rehabilitation for traumatic brain injury and stroke. J Rehabil Res Dev. 2010;47(9):851-62. doi: 10.1682/jrrd.2010.02.0019.

  PMID: 21174250 BACKGROUND

• de Groot S, Veeger HE, Hollander AP, van der Woude LH. Influence of task complexity on mechanical efficiency and propulsion technique during learning of hand rim wheelchair propulsion. Med Eng Phys. 2005 Jan;27(1):41-9. doi: 10.1016/j.medengphy.2004.08.007.

  PMID: 15604003 BACKGROUND

• DeGroot KK, Hollingsworth HH, Morgan KA, Morris CL, Gray DB. The influence of verbal training and visual feedback on manual wheelchair propulsion. Disabil Rehabil Assist Technol. 2009 Mar;4(2):86-94. doi: 10.1080/17483100802613685.

  PMID: 19253097 BACKGROUND

• Rice LA, Smith I, Kelleher AR, Greenwald K, Boninger ML. Impact of a wheelchair education protocol based on practice guidelines for preservation of upper-limb function: a randomized trial. Arch Phys Med Rehabil. 2014 Jan;95(1):10-19.e11. doi: 10.1016/j.apmr.2013.06.028. Epub 2013 Jul 13.

  PMID: 23856151 BACKGROUND

• Zwinkels M, Verschuren O, Janssen TW, Ketelaar M, Takken T; Sport-2-Stay-Fit study group; Sport-2-Stay-Fit study group. Exercise training programs to improve hand rim wheelchair propulsion capacity: a systematic review. Clin Rehabil. 2014 Sep;28(9):847-61. doi: 10.1177/0269215514525181. Epub 2014 Mar 10.

  PMID: 24615862 BACKGROUND

• Rodgers MM, Keyser RE, Rasch EK, Gorman PH, Russell PJ. Influence of training on biomechanics of wheelchair propulsion. J Rehabil Res Dev. 2001 Sep-Oct;38(5):505-11.

  PMID: 11732828 BACKGROUND

• de Groot S, de Bruin M, Noomen SP, van der Woude LH. Mechanical efficiency and propulsion technique after 7 weeks of low-intensity wheelchair training. Clin Biomech (Bristol). 2008 May;23(4):434-41. doi: 10.1016/j.clinbiomech.2007.11.001. Epub 2008 Feb 20.

  PMID: 18077065 BACKGROUND

• Kotajarvi BR, Basford JR, An KN, Morrow DA, Kaufman KR. The effect of visual biofeedback on the propulsion effectiveness of experienced wheelchair users. Arch Phys Med Rehabil. 2006 Apr;87(4):510-5. doi: 10.1016/j.apmr.2005.12.033.

  PMID: 16571390 BACKGROUND

• Klaesner J, Morgan KA, Gray DB. The development of an instrumented wheelchair propulsion testing and training device. Assist Technol. 2014 Spring;26(1):24-32. doi: 10.1080/10400435.2013.792020.

  PMID: 24800451 BACKGROUND

• Kwarciak AM, Turner JT, Guo L, Richter WM. Comparing handrim biomechanics for treadmill and overground wheelchair propulsion. Spinal Cord. 2011 Mar;49(3):457-62. doi: 10.1038/sc.2010.149. Epub 2010 Nov 2.

  PMID: 21042332 BACKGROUND

• Stephens CL, Engsberg JR. Comparison of overground and treadmill propulsion patterns of manual wheelchair users with tetraplegia. Disabil Rehabil Assist Technol. 2010;5(6):420-7. doi: 10.3109/17483101003793420.

  PMID: 20441443 BACKGROUND

• DiGiovine CP, Cooper RA, Boninger ML. Dynamic calibration of a wheelchair dynamometer. J Rehabil Res Dev. 2001 Jan-Feb;38(1):41-55.

  PMID: 11322470 BACKGROUND

• Best KL, Routhier F, Miller WC. A description of manual wheelchair skills training: current practices in Canadian rehabilitation centers. Disabil Rehabil Assist Technol. 2015;10(5):393-400. doi: 10.3109/17483107.2014.907367. Epub 2014 Apr 7.

  PMID: 24702608 BACKGROUND

• Kilkens OJ, Post MW, Dallmeijer AJ, Seelen HA, van der Woude LH. Wheelchair skills tests: a systematic review. Clin Rehabil. 2003 Jul;17(4):418-30. doi: 10.1191/0269215503cr633oa.

  PMID: 12785251 BACKGROUND

• Belmont PJ, Owens BD, Schoenfeld AJ. Musculoskeletal Injuries in Iraq and Afghanistan: Epidemiology and Outcomes Following a Decade of War. J Am Acad Orthop Surg. 2016 Jun;24(6):341-8. doi: 10.5435/JAAOS-D-15-00123.

  PMID: 27115793 BACKGROUND

• Blair JA, Patzkowski JC, Schoenfeld AJ, Cross Rivera JD, Grenier ES, Lehman RA Jr, Hsu JR; Skeletal Trauma Research Consortium (STReC). Spinal column injuries among Americans in the global war on terrorism. J Bone Joint Surg Am. 2012 Sep 19;94(18):e135(1-9). doi: 10.2106/JBJS.K.00502.

  PMID: 22992883 BACKGROUND

• Blackbourne LH. Combat damage control surgery. Crit Care Med. 2008 Jul;36(7 Suppl):S304-10. doi: 10.1097/CCM.0b013e31817e2854.

  PMID: 18594257 BACKGROUND

• Ma VY, Chan L, Carruthers KJ. Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the United States: stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pain. Arch Phys Med Rehabil. 2014 May;95(5):986-995.e1. doi: 10.1016/j.apmr.2013.10.032. Epub 2014 Jan 21.

  PMID: 24462839 BACKGROUND

• National Spinal Cord Injury Statistical Center. (2016). Spinal Cord Injury Data Sheet. Birmingham: University of Alabama at Birmingham.

  BACKGROUND

• Finley MA, Rodgers MM. Prevalence and identification of shoulder pathology in athletic and nonathletic wheelchair users with shoulder pain: A pilot study. J Rehabil Res Dev. 2004 May;41(3B):395-402. doi: 10.1682/jrrd.2003.02.0022.

  PMID: 15543457 BACKGROUND

• Fritz HA, Lysack C, Luborsky MR, Messinger SD. Long-term community reintegration: concepts, outcomes and dilemmas in the case of a military service member with a spinal cord injury. Disabil Rehabil. 2015;37(16):1501-7. doi: 10.3109/09638288.2014.967415. Epub 2014 Oct 1.

  PMID: 25270306 BACKGROUND

• Krahn GL, Suzuki R, Horner-Johnson W. Self-rated health in persons with spinal cord injury: relationship of secondary conditions, function and health status. Qual Life Res. 2009 Jun;18(5):575-84. doi: 10.1007/s11136-009-9477-z. Epub 2009 Apr 19.

  PMID: 19381872 BACKGROUND

• Plach HL, Sells CH. Occupational performance needs of young veterans. Am J Occup Ther. 2013 Jan-Feb;67(1):73-81. doi: 10.5014/ajot.2013.003871.

  PMID: 23245785 BACKGROUND

• Walker KA, Morgan KA, Morris CL, DeGroot KK, Hollingsworth HH, Gray DB. Development of a community mobility skills course for people who use mobility devices. Am J Occup Ther. 2010 Jul-Aug;64(4):547-54. doi: 10.5014/ajot.2010.08117.

  PMID: 20825125 BACKGROUND

• Goins AM, Morgan K, Stephens CL, Engsberg JR. Elbow kinematics during overground manual wheelchair propulsion in individuals with tetraplegia. Disabil Rehabil Assist Technol. 2011;6(4):312-9. doi: 10.3109/17483107.2010.528143. Epub 2010 Oct 20.

  PMID: 20961219 BACKGROUND

• Julien MC, Morgan K, Stephens CL, Standeven J, Engsberg J. Trunk and neck kinematics during overground manual wheelchair propulsion in persons with tetraplegia. Disabil Rehabil Assist Technol. 2014 May;9(3):213-8. doi: 10.3109/17483107.2013.775362. Epub 2013 Apr 2.

  PMID: 23548111 BACKGROUND

• Will, K., Engsberg, J. R., Foreman, M., Klaesner, J., Birkenmeier, R., & Morgan, K. A. (2015). Repetition based training for efficient propulsion in new manual wheelchair users. Journal of Physical Medicine, Rehabilitation & Disabilities, 1(001), 1-9.

  BACKGROUND

• Flaherty E. Using pain-rating scales with older adults. Am J Nurs. 2008 Jun;108(6):40-7; quiz 48. doi: 10.1097/01.NAJ.0000324375.02027.9f. No abstract available.

  PMID: 18535445 BACKGROUND

• SAS Institute Inc., Cary, NC, USA.

  BACKGROUND

• Gray DB, Hollingsworth HH, Stark SL, Morgan KA. Participation survey/mobility: psychometric properties of a measure of participation for people with mobility impairments and limitations. Arch Phys Med Rehabil. 2006 Feb;87(2):189-97. doi: 10.1016/j.apmr.2005.09.014.

  PMID: 16442971 BACKGROUND

• Curtis KA, Roach KE, Applegate EB, Amar T, Benbow CS, Genecco TD, Gualano J. Development of the Wheelchair User's Shoulder Pain Index (WUSPI). Paraplegia. 1995 May;33(5):290-3. doi: 10.1038/sc.1995.65.

  PMID: 7630657 BACKGROUND

• Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005 Apr;53(4):695-9. doi: 10.1111/j.1532-5415.2005.53221.x.

  PMID: 15817019 BACKGROUND

• Toglia J, Fitzgerald KA, O'Dell MW, Mastrogiovanni AR, Lin CD. The Mini-Mental State Examination and Montreal Cognitive Assessment in persons with mild subacute stroke: relationship to functional outcome. Arch Phys Med Rehabil. 2011 May;92(5):792-8. doi: 10.1016/j.apmr.2010.12.034.

  PMID: 21530727 BACKGROUND

• Rushton PW, Kirby RL, Miller WC. Manual wheelchair skills: objective testing versus subjective questionnaire. Arch Phys Med Rehabil. 2012 Dec;93(12):2313-8. doi: 10.1016/j.apmr.2012.06.007. Epub 2012 Jun 21.

  PMID: 22728701 BACKGROUND

• Lindquist NJ, Loudon PE, Magis TF, Rispin JE, Kirby RL, Manns PJ. Reliability of the performance and safety scores of the wheelchair skills test version 4.1 for manual wheelchair users. Arch Phys Med Rehabil. 2010 Nov;91(11):1752-7. doi: 10.1016/j.apmr.2010.07.226.

  PMID: 21044722 BACKGROUND

• Mountain AD, Kirby RL, Smith C. The wheelchair skills test, version 2.4: Validity of an algorithm-based questionnaire version. Arch Phys Med Rehabil. 2004 Mar;85(3):416-23. doi: 10.1016/s0003-9993(03)00427-1.

  PMID: 15031827 BACKGROUND

• Heinemann AW, Lai JS, Magasi S, Hammel J, Corrigan JD, Bogner JA, Whiteneck GG. Measuring participation enfranchisement. Arch Phys Med Rehabil. 2011 Apr;92(4):564-71. doi: 10.1016/j.apmr.2010.07.220. Epub 2011 Mar 2.

  PMID: 21367395 BACKGROUND

• Stinson JN, Kavanagh T, Yamada J, Gill N, Stevens B. Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents. Pain. 2006 Nov;125(1-2):143-57. doi: 10.1016/j.pain.2006.05.006. Epub 2006 Jun 13.

  PMID: 16777328 BACKGROUND

• Gagnon DH, Roy A, Verrier MC, Duclos C, Craven BC, Nadeau S. Do Performance-Based Wheelchair Propulsion Tests Detect Changes Among Manual Wheelchair Users With Spinal Cord Injury During Inpatient Rehabilitation in Quebec? Arch Phys Med Rehabil. 2016 Jul;97(7):1214-8. doi: 10.1016/j.apmr.2016.02.018. Epub 2016 Mar 15.

  PMID: 26987621 BACKGROUND

• Pradon D, Pinsault N, Zory R, Routhier F. Could mobilty performance measures be used to evaluate wheelchair skills? J Rehabil Med. 2012 Mar;44(3):276-9. doi: 10.2340/16501977-0919.

  PMID: 22278048 BACKGROUND

• Sawatzky B, Hers N, MacGillivray MK. Relationships between wheeling parameters and wheelchair skills in adults and children with SCI. Spinal Cord. 2015 Jul;53(7):561-4. doi: 10.1038/sc.2015.29. Epub 2015 Feb 17.

  PMID: 25687512 BACKGROUND

• Motion Analysis Corporation. HiRes Motion Analysis Corporation System. Santa Rosa, CA.

  BACKGROUND

• Cowan RE, Nash MS, Collinger JL, Koontz AM, Boninger ML. Impact of surface type, wheelchair weight, and axle position on wheelchair propulsion by novice older adults. Arch Phys Med Rehabil. 2009 Jul;90(7):1076-83. doi: 10.1016/j.apmr.2008.10.034.

  PMID: 19577019 BACKGROUND

• Three Rivers Holdings, LLC. SmartWheel. Mesa, AZ.

  BACKGROUND

• Asato KT, Cooper RA, Robertson RN, Ster JF. SMARTWheels: development and testing of a system for measuring manual wheelchair propulsion dynamics. IEEE Trans Biomed Eng. 1993 Dec;40(12):1320-4. doi: 10.1109/10.250587.

  PMID: 8125507 BACKGROUND

• Cooper RA. SMARTWheel: From concept to clinical practice. Prosthet Orthot Int. 2009 Sep;33(3):198-209. doi: 10.1080/03093640903082126.

  PMID: 19658010 BACKGROUND

• Lui J, MacGillivray MK, Sawatzky BJ. Test-retest reliability and minimal detectable change of the SmartWheel clinical protocol. Arch Phys Med Rehabil. 2012 Dec;93(12):2367-72. doi: 10.1016/j.apmr.2012.07.008. Epub 2012 Jul 25.

  PMID: 22842483 BACKGROUND

• ActiGraph, LLC. GT9X Activity Monitors. Pensacola, FL.

  BACKGROUND

• Bailey RR, Klaesner JW, Lang CE. An accelerometry-based methodology for assessment of real-world bilateral upper extremity activity. PLoS One. 2014 Jul 28;9(7):e103135. doi: 10.1371/journal.pone.0103135. eCollection 2014.

  PMID: 25068258 BACKGROUND

• Garcia-Masso X, Serra-Ano P, Garcia-Raffi LM, Sanchez-Perez EA, Lopez-Pascual J, Gonzalez LM. Validation of the use of Actigraph GT3X accelerometers to estimate energy expenditure in full time manual wheelchair users with spinal cord injury. Spinal Cord. 2013 Dec;51(12):898-903. doi: 10.1038/sc.2013.85. Epub 2013 Sep 3.

  PMID: 23999111 BACKGROUND

• Nyland J, Quigley P, Huang C, Lloyd J, Harrow J, Nelson A. Preserving transfer independence among individuals with spinal cord injury. Spinal Cord. 2000 Nov;38(11):649-57. doi: 10.1038/sj.sc.3101070.

  PMID: 11114770 BACKGROUND

• Wulf G, McNevin N, Shea CH. The automaticity of complex motor skill learning as a function of attentional focus. Q J Exp Psychol A. 2001 Nov;54(4):1143-54. doi: 10.1080/713756012.

  PMID: 11765737 BACKGROUND

• Wulf G, Shea C, Lewthwaite R. Motor skill learning and performance: a review of influential factors. Med Educ. 2010 Jan;44(1):75-84. doi: 10.1111/j.1365-2923.2009.03421.x.

  PMID: 20078758 BACKGROUND

• Shea, J. B. & Morgan, R. L. (1979). Contextual interference effects on the acquisition, retention, and transfer of a motor skill. Journal of Experimental Psychology: Human Learning and Memory, 5, 179-187.

  BACKGROUND

• Del Rey P, Wughalter EH, Whitehurst M. The effects of contextual interference on females with varied experience in open sport skills. Res Q Exerc Sport. 1982 Jun;53(2):108-15. doi: 10.1080/02701367.1982.10605236. No abstract available.

  PMID: 7111849 BACKGROUND

• Hall KG, Domingues DA, Cavazos R. Contextual interference effects with skilled baseball players. Percept Mot Skills. 1994 Jun;78(3 Pt 1):835-41. doi: 10.1177/003151259407800331.

  PMID: 8084699 BACKGROUND

• Schmidt RA, Young DE, Swinnen S, Shapiro DC. Summary knowledge of results for skill acquisition: support for the guidance hypothesis. J Exp Psychol Learn Mem Cogn. 1989 Mar;15(2):352-9. doi: 10.1037//0278-7393.15.2.352.

  PMID: 2522520 BACKGROUND

• Gevins A, Smith ME, Leong H, McEvoy L, Whitfield S, Du R, Rush G. Monitoring working memory load during computer-based tasks with EEG pattern recognition methods. Hum Factors. 1998 Mar;40(1):79-91. doi: 10.1518/001872098779480578.

  PMID: 9579105 BACKGROUND

• Schmidt RA, Wulf G. Continuous concurrent feedback degrades skill learning: implications for training and simulation. Hum Factors. 1997 Dec;39(4):509-25. doi: 10.1518/001872097778667979.

  PMID: 9473972 BACKGROUND

• Goodwin JE, Eckerson JM, Voll CA Jr. Testing specificity and guidance hypotheses by manipulating relative frequency of KR scheduling in motor skill acquisition. Percept Mot Skills. 2001 Dec;93(3):819-24. doi: 10.2466/pms.2001.93.3.819.

  PMID: 11806606 BACKGROUND

• MATLAB version 7.10.0. (2010). Natick, Massachusetts: The MathWorks Inc.

  BACKGROUND

• SPSS Inc. (2012). SPSS Statistics Version 21. Chicago, IL: IBM.

  BACKGROUND

• Chisholm D, Toto P, Raina K, Holm M, Rogers J. Evaluating capacity to live independently and safely in the community: Performance Assessment of Self-care Skills. Br J Occup Ther. 2014 Feb;77(2):59-63. doi: 10.4276/030802214X13916969447038.

  PMID: 25298616 BACKGROUND

MeSH Terms

Conditions

Spinal Cord Injuries

Condition Hierarchy (Ancestors)

Spinal Cord Diseases; Central Nervous System Diseases; Nervous System Diseases; Trauma, Nervous System; Wounds and Injuries

Study Officials

• Kerri A Morgan, PhD

  Washington University School of Medicine

  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: SPONSOR

Study Record Dates

• First Submitted: November 21, 2018
• First Posted: December 20, 2018
• Study Start: November 5, 2018
• Primary Completion: July 30, 2021
• Study Completion: July 30, 2021
• Last Updated: October 6, 2021

Record last verified: 2021-10

Locations

US (1)