Assisted reach and transfers in individuals with tetraplegia: towards a solution

Abstract

The purpose of this study was to investigate the in¯uence of a prototype trunk orthosis to assist an individual with tetraplegia. A single case study (26 year old male, C5 motor complete) using an interrupted time series analysis was conducted to investigate the individual's ability to reach, forward and laterally, and transfer with and without the orthosis. All tasks were performed on an AMTI 1 force platform in the long sitting position, with landmarks of the trunk and limbs recorded using Peak Performances Technologies 1 motion analysis system. After a familiarisation period ten trials were attempted for each phase of the analysis. With the orthosis the subject altered the sitting posture and signi®cantly (F=9.55, P=0.003) increased the distance the subject was able to reach. The median frequency of the centre of pressure (COP) displacement during the reaching task was not signi®cantly altered. The ability to displace the COP when attempting to transfer increased from 16.0 (+3.4 cm) to 19.6 (+2.5 cm), however this was not statistically signi®cant. The likely user population, the overall functional bene®ts, the compliance of the users and possible modi®cations to the device to facilitate use with functional electrical stimulation are all possible directions for future research.

Preserving transfer independence among individuals with spinal cord injury

“…Curtis et al 47 using kinematic analysis reported that subjects with paraplegia were more e ective in performing a modi®ed functional reach task when they used a stabilization strap. 47 Kamper et al 48 used kinematic and center of pressure analysis to compare the lateral postural stability of individuals with SCI and nonimpaired subjects during sudden perturbations. They reported that all non-impaired subjects maintained stability with all perturbations, while all individuals with a SCI failed to maintain stability when exposed to higher-level perturbations.…”

Movement patterns and muscular demands during posterior transfers toward an elevated surface in individuals with spinal cord injury

“…11 As a result, preliminary work to increase trunk stability during transfer activities through the use of a prototype trunk orthosis and orthotic device to facilitate transfers has been initiated. 12,13 Individuals with SCI often have to transfer toward an elevated surface (eg bed transfers, car transfers, floor to wheelchair transfers using a push-up technique, climbing up stairs using a push-up technique). It is suggested that transferring toward an elevated surface might be more challenging than transferring on an even surface for individuals with SCI because of the mechanical disadvantages associated with this particular task.…”

Preliminary investigation of the lateral postural stability of spinal cord-injured individuals subjected to dynamic perturbations

“…Postural instability may hinder the ability to perform transfers as well. 5 Seated balance may also be challenged when these dynamic forces are externally applied. This is the focus of this study.…”

“…Several studies have described improved performance with the addition of trunk orthoses or belts. 2,5,7 However, use of these items is limited due to unwanted restrictiveness as well as di culty in donning and do ng the current designs.…”