Impact of Mobile Manual Standing Wheelchair on Standing Dosage and Utility

许多站立式框架和站立式轮椅支持人们站立的位置，但一旦 直立的，它们的效用仅限于那些直接在该位置范围内的活动 那个人站起来的地方操纵杆操作的电动轮椅可以在工作表面之间移动 虽然保持站立姿势，但在狭窄的空间中可能难以操纵， 运输专用设备，并限制用户的运动潜力。许多 外骨骼现在是可用的，其允许使用者在站立时移动， 上肢活动辅助装置的平衡，从而消除了功能活动的可能性 包括直立时使用手。 我们认为，对于脊髓损伤的退伍军人来说，站立足以影响健康结果， 必须在融入日常生活的同时增强实用性;在家里，在工作中，在社区中。 为了实现这种整合，我们认为站立设备必须满足以下标准：1.容易 访问，2.直的站立机构，3.在坐着和站着的位置，4。 自然直觉推进，5。稳定性，6。独立的可操作性。明尼阿波利斯Adaptive 设计与工程（MADE）计划最近开发了一种移动的手动站立轮椅 （MMSW）具有所有这些功能。根据我们最初的实验室试点测试， 在坐姿和站立姿势下均表现出出色的功能活动性和稳定性。用户 在最初的测试中收到的反馈也表明了这些独特的移动性和稳定性特征 为瘫痪的退伍军人提供潜在的新用途。 在目前的提案中，我们将把MMSW的测试扩展到家庭和社区环境 从明尼阿波利斯和帕洛阿尔托VA医疗保健招募的48名脊髓损伤退伍军人 系统.主要结果将包括通过轮椅结果测量的感知效用 测量（WhOM）和自选站立剂量（每天站立的时间）和站立 频率（每天站立的次数）由安装在 站立的设备。对于目前在家使用站立式设备的参与者，我们将评估 他们当前设备的基线感知效用，并将使用数据对其当前设备进行仪表化 记录器测量头两个月期间的站立剂量。未尝试站立的参与者 将能够在这头两个月的时间间隔内接受额外的治疗培训课程， 他们对站立的容忍度，如果有必要的话。然后，受试者将被随机分配接受研究手册 安装或未安装站立移动功能的站立式轮椅。经过两个月的 家庭和社区使用，感知效用将被重新评估，数据记录器将被收集用于分析。 我们还将收集有关心理社会影响、器械满意度、肠道和 以及膀胱功能、痉挛、疼痛、睡眠和整体生活质量。 我们假设，SCI退伍军人会认为MMSW有更大的效用， 增加他们自己选择的站立时间/剂量。如果本研究记录了在以下方面的临床显著获益： 自我选择的MMSW站立剂量，我们将继续进行未来的研究，包括多中心， 随机试验，重点关注SCI退伍军人的长期健康益处。如果没有，我们 将使用捕获的定性数据，为SCI退伍军人开发改进的未来常设系统。

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.