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Improving the Health, Care, and Well-being for People who use Wheelchairs

People use wheelchairs as a result of many health conditions, including neurological conditions such as spinal cord injuries, strokes, or cerebral palsy; or orthopedic conditions such as severe arthritis or spinal stenosis.  Regardless of the reason for needing a wheelchair, all people who use wheelchairs for mobility face similar health risks and problems related to the use of this specialized technology.  Associate Professor Barbara Crane’s 20+ years of physical therapy practice specializing in prescribing highly customized wheelchairs and seating systems for people with a variety of disabilities has led to an endless supply of research questions and opportunities. Crane was recognized by the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) for her extensive work.  See Crane.

All of the research projects focusing on wheelchair usage try to answer real clinical questions and improve the health and well-being of, and the ability of clinicians to care for, people who use wheelchairs.  Crane’s research has two main foci – 1) improve the ability of clinical specialists to evaluate and quantify the sitting posture of people who use wheelchairs; and 2) improve the technology available for people who use wheelchairs to prevent the very real complications such as pressure ulcers, repetitive stress injuries, and pain conditions.  An extension of the latter focus involves studying ways to prevent pressure ulcers in multiple environments, including: wheelchairs, hospital beds, operating room tables, emergency room stretchers, hospital bedside chairs etc.  This work is being done in partnership with Saint Francis Hospital and in collaboration with Michelle Kunsman, Physical Therapist and Certified Wound Specialist and faculty member in the department of Physical Therapy. 

Focus 1 – Quantifying sitting posture of people who use wheelchairs

Barbara Crane’s interest in this research focus began in 2000 while she was a doctoral student at the University of Pittsburgh.  She was invited to join a group of international clinical experts, engineers, and manufacturers working together to develop an international standard for seated posture measurement.  The result of this work culminated in an international standard – ISO 16840-1, finalized in 2006.  Crane continues to work with this international group to this day in the on-going development of this and other international standards related to wheelchairs and wheelchair seating and positioning.  She currently works with a national group, funded through an educational training grant by the Paralyzed Veterans of America (PVA) on developing a Clinical Application Guide to help clinicians use the standardized measures in the international standard in their everyday practice.

MeasuresIn a parallel effort, she has been working with colleagues in Japan who have been developing and testing tools and methods for posture measurement.  They have developed two unique tools – the Rysis photographic assessment system, and the Horizon measurement device.  Both are specially adapted to allow measurement of the body and wheelchair seat angles specified in the International Standard.  They are about to begin work on a project to refine the body landmarks used in the standard.  This research project, Refining Descriptions of Anatomical Landmarks for Seated Posture Measurement, will be funded by the Institute for Translational Research in ENHP.

Focus 2 – Preventing Pressure Ulcers and Improving Technology for Wheelchair Users

Crane’s research also focuses on two significant clinical problems for people who use wheelchairs – pressure ulcers and discomfort associated with sitting all day in a wheelchair.  Her doctoral research involved development of an assessment for wheelchair seating discomfort and culminated in the “Tool for Assessing Wheelchair disComfort” or TAWC.  This assessment has been used by researchers and clinicians around the world to assess and monitor this very significant clinical problem.  It is also used to help guide researchers in the development and testing of new wheelchair seating technologies, like the Kinetic Seating System (KiSS) currently under investigation in the Physical Therapy Human Performance Laboratory.  This dynamic seating system was specifically designed to address the comfort needs of people who use wheelchairs by allowing small, subtle movements in both the seat and back support of the wheelchair, similar to current constructions of high end office chair equipment.

Wheelchair pressure In addition to this evaluation of dynamic seating, a second initiative aimed at preventing a very serious consequence of wheelchair use – pressure ulcers is under way.  One recently concluded project was conducted with Genesis Health and Rehabilitation Centers in which the collaborators studied the impact of sitting on mechanical lift slings on wheelchair seat interface pressure (see article).  The FSA pressure mapping system was used to investigate these pressures, which are a significant risk factor in the development of pressure ulcers for those who use wheelchairs.