Impact of Mobile Manual Standing Wheelchair on Standing Dosage and Utility

许多站立架和站立轮椅只支撑一次站立姿势的人。 直立它们的效用仅限于直接在头寸范围内的活动 那个人站了起来。操纵杆操作的电动轮椅可以在工作面之间移动 当保持站立姿势但在狭小的空间中很难移动时，需要 专门的交通工具，限制了使用者的锻炼潜力。数不胜数 外骨骼现在可用，允许用户在站立时移动，但需要连续 上肢活动辅助器的平衡，从而消除功能活动的潜力 涉及在直立时使用双手。 我们认为，对于患有脊髓损伤的退伍军人来说，站立足以影响健康结果，站立装置 必须在融入日常生活的同时，在家庭、工作和社区中提高效用。 为了实现这种集成，我们认为立式设备必须满足以下标准：1.简单性 通道，2.直立机构，3.坐姿和站姿均可移动，4. 自然的直觉推进，5.稳定性，6.独立的可操作性。明尼阿波利斯适应性 设计与工程(Made)计划最近开发了一种可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，测试该设备的退伍军人 在坐姿和站姿下均表现出出色的功能机动性和稳定性。用户 在初始测试期间收到的反馈也表明了这些独特的机动性和稳定性特征 为瘫痪的退伍军人提供潜在的新实用工具。 在目前的提案中，我们将把我们的MMSW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退伍军人保健中心招募的48名脊髓损伤退伍军人中 系统。主要结果将包括通过轮椅结果衡量的感知效用 测量(谁)、自选站立剂量(每天站立时间)和站立 频率(每天站立比赛次数)由安装在上的加速度计数据记录器测量 立式设备。对于目前在家中使用立式设备的参与者，我们将评估 为其当前设备的感知效用提供基准，并将使用数据检测其当前设备 记录仪测量前两个月期间的驻留剂量。站起来太天真的参与者 将能够在第一个两个月的间隔期间接受额外的治疗培训课程 如有必要，他们对站立的容忍度。然后，参与者将被随机分配到研究手册中 安装或不安装站立移动功能的站立轮椅。在两个月的 将重新评估家庭和社区的使用情况、感知的效用，并收集数据记录器进行分析。 我们还将收集一些关于心理社会影响、设备满意度、肠道功能的次要结果 以及膀胱功能、痉挛、疼痛、睡眠和全球生活质量。 我们假设患有脊髓损伤的退伍军人会认为MMSW有更大的用处，自然会 增加他们自己选择的放置时间/剂量。如果这项研究记录了在临床上显著的进步 自行选择的固定剂量与MMSW，我们将继续未来的研究，包括多点， 着眼于脊髓损伤退伍军人的长期健康益处的随机试验。如果没有，我们 将使用收集的定性数据来为患有脊髓损伤的退伍军人开发改进的未来常备系统。

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.