Many persons with spinal cord injuries and disorders (SCI/D) use a wheelchair for mobility, which keeps them in a seated position for long periods of time. A major complication of wheelchair use is the development of pressure ulcers due to prolonged sitting. Most maneuvers intended to offload sitting surface tissues (e.g. wheelchair pushups, tilts or leans) take the person away from their normal activities and may require longer periods of time than previously thought to provide any benefit. Currently available standing devices allow patients to stand as an alternative means for relieving pressure, but none allow the user to manually wheel about his/her environment when in a fully standing position. The ability to be mobile in the standing position should increase the utility of these systems, increase dosages of standing, and subsequently lead to reductions in secondary complications associated with prolonged sitting. The primary goal of this project is to develop a commercially-viable mobile manual standing wheelchair in close collaboration with a standing wheelchair company. During the first year of the project, a mobile manual standing wheelchair prototype will be developed for a Veteran with a spinal cord injury between the levels of T5 and T8. This wheelchair will be designed to mimic the seating configuration of the Veteran's usual wheelchair (e.g. seat and backrest angles, foot rest height) to allow for comparison of the new mobile manual standing wheelchair with the usual wheelchair. The subject will undergo Wheelchair Skills Testing with (1) their usual wheelchair, (2) the mobile manual standing wheelchair in a seated posture, and (3) the mobile manual standing wheelchair in a standing posture. During the 100 meter test, the subject will also be timed and propulsion cadence will be measured along with perceived exertion on a 10 point Borg scale. Higher speed, lower cadence, and lower perceived exertion will be indicative of improved propulsion efficiency. The subject will also work with therapists in the Minneapolis VA SCI/D Center's apartment to identify possible problems with using the device in the kitchen, bedroom, and bathroom. Information gathered during these tests will be used to improve the design. Retesting of the mobile manual standing wheelchair prototypes will occur after each design iteration. In the second year of the project, two additional mobile manual standing wheelchairs will be developed for two additional Veterans with SCI/D (T1-T4 level and T9-T12 level) and testing will be conducted using the same protocol as for the first subject. In parallel, the first subject's wheelchair will be tested for durability at the standing wheelchair company using the multi-drum test and the drop test. Design changes will be made to address any failures that occur during durability testing. In year 3 of the project, the second and third subjects' wheelchairs will be sent to the Pittsburgh VA Health Care System for more extensive ANSI/RESNA testing. Any additional design changes that are needed to address failures will be made and testing will be repeated. The end result of the proposed work will be a commercially-viable product that has been developed in close collaboration with a standing wheelchair company. There is a high likelihood that this system will be commercialized after this project, providing Veterans with SCI/D an important new technology that promotes standing and reduces secondary complications of prolonged sitting, such as pressure ulcers.
This study will develop a commercially-viable mobile manual standing wheelchair for Veterans with paralysis due to spinal cord injuries and disorders. The proposed wheelchair will enable mobility in both sitting and standing postures, unlike manual standing wheelchairs currently on the market. This improved functionality will facilitate standing in everyday activities and can provide numerous health benefits, such as increased functional reach and reduced pressure ulcers. These benefits will ultimately improve long-term quality of life and reduce cost of care fo Veterans with spinal cord injuries and disorders.
