The aim of this study was to design and test the reliability of an assessment tool that could be used by physiotherapists to quantify the mobility of wheelchair-dependent paraplegics. The assessment tool examined six key tasks fundamental to the mobility of wheelchair-dependent paraplegics, comprising moving from lying to sitting, completing a horizontal transfer, completing a vertical transfer, pushing on¯at ground, pushing on ramps and negotiating kerbs. A six-point scoring system was used to assess the level of mobility attained by subjects on each task. The scoring system was di erent for each task and took into account the level of assistance and time required to complete the task or the complexity of the task. Twenty wheelchair-dependent paraplegics were assessed independently by two therapists using the assessment tool. The Cohen's Weighted Kappas describing inter-rater reliability of each task ranged between 0.82 ± 0.96, indicating a high reliability between therapists. It was concluded that the assessment tool is a reliable way of assessing the mobility of wheelchair-dependent paraplegics.Keywords: paraplegia; independence; mobility; physical therapy; assessment IntroductionThe primary aim of physiotherapy for wheelchairdependent paraplegics is to optimise mobility. Presently, however, there is no sensitive tool for measuring mobility which is suitable for use with this population. Such a measurement tool would enable physiotherapists to quantify the e ects of therapy, and in turn to conduct research, justify funding and communicate e ectively amongst health professionals.There are many measures used to quantify a person's level of disability. Some measures such as the Functional Independent Measure (FIM), 1 the Barthel Index 2 and the Modi®ed Barthel Index, 3,4 were designed to be used with many di erent types of disabled populations. Others, like the Spinal Cord Independent Measure (SCIM) 5 and The Quadriplegic Index of Function 6,7 were speci®cally intended for the spinal cord injured population. None, however, were speci®cally designed to assess the mobility of paraplegics. Whilst these measures are useful for certain purposes, they do not distinguish important functional di erences in the mobility of wheelchairdependent paraplegics.The two scales most commonly used for the spinal cord injured population are the Modi®ed Barthel Index 3,4,7 and the FIM. 7 ± 9 Yet neither of these scales distinguish between levels of mobility commonly seen in paraplegics. For example, with both scales, all patients capable of pushing a wheelchair outside receive the same score, regardless of their competency at this skill. Likewise, a patient capable of transferring from a wheelchair to a bed receives the same score as a patient capable of far more complex and di cult skills, such as transferring from¯oor to wheelchair.The poor sensitivity of the FIM has recently been demonstrated in a study of 100 spinal injured patients. 10 This study found no di erence in the group FIM scores of C 8 quadriplegics. T 1 ± 5 parap...

The purpose of this study was to compare the oxygen uptake and heart rate responses during submaximal arm cranking to combined arm cranking+electrical stimulation (ES)-induced leg cycling in individuals with spinal cord injury (SCI). Seven subjects with paraplegia (T 4 ± T 12 ) performed combined arm and leg cycling exercise for 5 min, followed by arm cranking alone at the same power output for a further 5 min. During both exercise conditions, steady state oxygen consumption (VO 2 ), carbon dioxide output (VCO 2 ), expired ventilation (V E ) and heart rate (HR) were determined. The respiratory exchange ratio (RER) and oxygen pulse were calculated from the measured variables. During combined arm+electrical stimulation-induced leg cycling exercise, the VO 2 was 25% higher (1.58 l min 71 vs 1.26 l min 71), but the HR was 13% lower (132 b min 71 vs 149 b min 71 ), than during arm cranking exercise alone. Oxygen pulse and VCO 2 were also signi®cantly higher (by 42% and 25%, respectively) during combined arm+ES-induced leg exercise, but there were no dierences between the two exercise conditions for V E or RER. These data suggest that the absence of the leg`muscle pump' and a reduced venous return of blood to the heart elevate exercise heart rates during submaximal arm cranking. Conversely, combined arm cranking+ES-induced leg cycling exercise provides the body with a greater metabolic stress than arm cranking alone, while reducing the cardiac stress. The mechanism explaining the heart rate response, however, remains unclear, but may have been in¯uenced by the blood pressure variations across the range of lesions. The ®ndings from this study may have implications for the relative bene®t of combined arm+ES-induced leg cycling training for people with paraplegia.

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