Stopping Secondary Complications

New research is assisting the development of better transfer techniques that will help prevent injuries.
Reprinted from PN/Paraplegia News January 2015

Research groups across the globe are working to combat the problem of secondary disabilities and the barriers associated with wheelchair use

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There are currently about 2.7 million Americans who use wheelchairs for daily mobility, making up the largest regional population of wheelchair users in the world.

This number is only expected to grow because of aging baby boomers, longer lifespans and improved health care. But what happens when the device that gives you the freedom to move also comes with harmful side effects?

Many secondary disabilities and problems have been associated with wheelchair use such as pressure sores, arm pain and injuries. Moreover, many individuals have difficulty moving their wheelchairs around in various environments. These complications can be devastating for wheelchair users, making everyday tasks that were once easy painful and difficult.

The good news is research groups across the globe are working to combat the problem of secondary disabilities and the barriers associated with wheelchair use.

Articles in a recent special issue on wheeled mobility in the Biomed Research International Journal (October 2014) from scientists in the United States, the United Kingdom, Canada and Taiwan help advance our knowledge about how wheelchair use affects the person and what can be done to prevent injuries and help users achieve a higher degree of independence.

Surprise Findings

The first step in eliminating secondary disabilities is to identify what wheelchair features and tasks are responsible for causing them.

It might be surprising to learn certain wheelchair features meant to aid or provide relief to people who use wheelchairs can actually be harmful to certain people.

A study out of Taiwan cautioned that the forces between the body, backrest and range of motions and forces at the knees and feet during the sit-to-stand operation in a standing wheelchair may put certain people at risk of injury.

Research from the Human Engineering Research Laboratories (HERL) at the University of Pittsburgh showed that performing wheelchair pushups, an activity used to prevent pressure sores, may predispose people to shoulder pain and injuries.

To understand these shoulder injuries better, a Mayo Clinic study used magnetic resonance imaging to describe the shoulder injury sites that were most common among people who use wheelchairs who have shoulder pain.

A University of Montreal study found that the shoulder forces responsible for causing pain and injuries increase as the slope of a ramp increases and that pushing on steeper ramps was more difficult for users who also had a higher body mass index.

Attacking The Issue

Armed with better knowledge of how and why secondary disabilities occur, scientists are beginning to attack the issue using one of two ways.

They either develop educational and training programs that teach people who use wheelchairs how to operate their mobility devices in a way that prevents injury-causing habits or develop or modify existing technology to prevent secondary complications.

The October issue of Biomed Research International Journal presents a series of studies that have developed better education and training programs for people who use wheelchairs. The skills taught are aimed at minimizing injury risk and maximizing safety.

A HERL-based study developed two new clinical tools that can be used to better determine the appropriateness of power wheelchair use and identify specific areas to target power wheelchair driver training.

A second HERL study developed a tool called the Transfer Assessment Instrument, which assesses a patient’s transfer technique and can be used to help keep people who use wheelchairs from developing upper limb injuries.

A University of British Columbia study developed a wheelchair mobility training program that specifically targets older adults.

The hope is the development of these programs will allow people who use wheelchairs to move about their environments more freely and efficiently while lowering their risk for collisions, falls and overuse-related injuries.

Materials & Technologies

Other research presented in the journal focuses on special materials and technologies that have been developed to make wheelchair-related tasks easier.

Research at the University of Montreal showed that using a carbon fiber manual wheelchair frame reduces the effort required to push and also reduces shocks and vibrations compared to the titanium and aluminum models tested in the study.

A group at Brighton Doctoral College in England developed a wheelchair add-on system that ties the rear wheels together so it can be easily operated with one arm.

A new wheelchair-mounted robot arm developed at HERL moves a person from his or her wheelchair to another surface. This device eliminates any heavy lifting that would normally be required by a caregiver, reducing injury risk and increasing safety for both caregivers and people who use wheelchairs.

The Ultimate Goal

And finally, the journal describes new technologies that are used to monitor the real-world activity levels of people who use wheelchairs.

HERL researchers combined accelerometer and data-logging technologies to help determine the cumulative stresses that are placed on the upper body during everyday activities.

At Loughborough University in England, researchers are using a novel radio-frequency based indoor tracking system to collect detailed information on the pushing techniques used during wheelchair court sports.

The ultimate goal of all this research is simple — to find new ways that allow people who use wheelchairs to achieve an optimal level of independence while being protected from secondary complications associated with the very device that allows for that freedom.

Researchers around the world are working hard to make this goal a reality so people who use wheelchairs can lead healthy and active lifestyles without the worry of additional health-related complications.

To read more about the studies mentioned in this article, visit


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