The Need for Updated Clinical Practice Guidelines for Preservation of Upper Extremities in Manual Wheelchair Users

Abstract

The purposes of this article were to examine the existing 2005 Clinical Practice Guidelines for preservation of the upper extremities in spinal cord injury and explore the literature to determine what might need to be included in an update. This is a consensus position article based on a literature review and the expertise of the authors. The findings support the original recommendations of the Clinical Practice Guidelines and provide evidence that suggests that information regarding equipment and skills training as well as impact to caregivers is needed.

A motor learning approach to training wheelchair propulsion biomechanics for new manual wheelchair users: A pilot study

“…2 The Clinical Practice Guidelines for the Preservation of Upper Limb Function Following Spinal Cord Injury (CPG) 9 recommendations are based upon this research and emphasize minimizing the force and frequency of pushes and using long pushes during propulsion. 2,10 The goal of the guidelines is to promote a more effective propulsion pattern, or a motion that requires fewer pushes on the pushrim but uses more of the pushrim to retain the same speed. 11 Increased propulsion effectiveness minimizes unnecessary upper extremity use during propulsion and may be one factor that leads to a reduction in chronic injuries of the upper extremities.…”

Evidenced Based Education Interventions to Preserve Upper Limb Function Among Full Time Manual Wheelchair Users

“…The recommendationsinclude, but are not limited to, education on effective MWP training, transfer training, exercises to increase strength of the upper extremity musculature and manage pain andappropriate equipment selection. A recent review of the guidelines bySawatzky, et al (Sawatzky, DiGiovine et al 2015)supported the findings and suggests the addition of information regarding equipment, skills and caregivertraining. The purpose of this paper is to examine education interventions to preserve UL function and prevent the development of pain and injury among full time MWU.…”

“…Sawatzky, et al (Sawatzky, DiGiovine et al 2015) emphasized the need to teach full time MCUs wheelchair skills in order to minimize the impact of detrimental forces on the upper extremity during mobility andimprove community participation.Wheelchair skills include the ability of an individual to maneuver their wheelchair to perform activities of daily living and move from point A to point B. Such skills can range from very simple items such as propelling or driving a wheelchair over a smooth surface or more complex tasks including performance of wheelies and ascending and descending curbs.…”

A systematic review: the influence of real time feedback on wheelchair propulsion biomechanics

“…Published clinical guidelines suggest that manual wheelchair users should aim to minimise peak force and repetition during completion of a task [2]. To achieve this, in terms of F o r P e e r R e v i e w propulsion biomechanics, manual wheelchair users are commonly advised to propel with a semicircular pattern [3] at a push rate of 1 push per second and push arc in the range of 85˚ to 100˚ [4].…”