Impact of Mobile Manual Standing Wheelchair on Standing Dosage and Utility

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Many standing frames and standing wheelchairs support people in the standing position but once upright their utility is limited to those activities that are immediately within the range of the position where the person stood up. Joystick-operated power wheelchairs can move between work surfaces while remaining in a standing posture but can be difficult to maneuver in tight spaces, require specialized equipment for transportation, and limit the user’s potential for exercise. Numerous exoskeletons are now available that allow the user to move while standing but require continuous counterbalance from upper extremity mobility aides thus eliminating potential for functional activities involving use of the hands while upright. We contend that for Veterans with SCI to stand enough to impact health outcomes, the standing device must enhance utility while integrating into their everyday life; at home, at work, and in the community. For this integration to occur, we believe the standing device must fulfill the following criteria: 1. Easy access, 2. Straightforward standing mechanism, 3. Mobility in both seated and standing positions, 4. Natural intuitive propulsion, 5. Stability, and 6. Independent operability. The Minneapolis Adaptive Design & Engineering (MADE) Program has recently developed a mobile manual standing wheelchair (MMSW) with all these features. Based on our initial in-lab pilot testing, Veterans who trialed the device demonstrated excellent functional mobility and stability in both seated and standing postures. User feedback received during this initial testing also indicated these unique mobility and stability features offer potential new utility for paralyzed Veterans. In the current proposal we will extend testing of our MMSW to the home and community environments of 48 Veterans with spinal cord injury recruited from the Minneapolis and Palo Alto VA Health Care Systems. The primary outcomes will include perceived utility as measured by the Wheelchair Outcome Measure (WhOM), and self-selected standing dose (time spent standing per day) and standing frequency (number of standing bouts per day) measured by an accelerometer data logger installed on the standing devices. For participants who currently use standing devices at home, we will assess the baseline perceived utility of their current device and will instrument their current device with a data logger to measure standing dose over the first two-month period. Participants who are naïve to standing will be able to receive additional therapy training sessions during this first two-month interval to build their tolerance for standing, if necessary. Participants will then be randomized to receive a study manual standing wheelchair either with or without the standing mobility feature installed. After two months of home and community use, perceived utility will be reassessed, and data loggers collected for analysis. We will also collect several secondary outcomes on psychosocial impact, device satisfaction, bowel and bladder function, spasticity, pain, sleep, and global quality of life. We hypothesize that Veterans with SCI will perceive the MMSW to have greater utility and will naturally increase their self-selected standing time/dose. If this study documents clinically significant gains in self-selected standing dose with the MMSW, we will pursue future studies, including multi-site, randomized trials to focus on the long-term health benefits for Veterans with SCI. If it does not, we will use qualitative data captured to develop improved future standing systems for Veterans with SCI.