The Influence of Seat Height on Hemiplegic-pattern Propulsion of Manual Wheelchairs

This study evaluates the effect of seat height on hemiplegic-pattern wheelchair propulsion. Each subject will act as their own control and measures will be obtained in a one sixty minute session. Five seat heights relative to the subject's leg length will be measured in a random order to see the effect on forward and backwards wheelchair propulsion.

Study Overview

• Status: Completed
• Conditions: Hemiplegia; Wheelchairs
• Intervention / Treatment: Device: Neutral seat height; Device: Very low seat height; Device: Low seat height; Device: Very high seat height; Device: High seat height

Detailed Description

Many people who have suffered a stroke require a wheelchair for mobility. Hemiplegia is a common result of stroke.Many people with hemiplegia propel themselves using their sound-side arms and legs ("hemiplegic-pattern propulsion") in manual wheelchairs.Often people using this pattern are prescribed wheelchairs with a reduced seat height to facilitate foot propulsion. Despite the seeming obviousness of the need to lower the seat height for people who use foot propulsion,there is little available evidence to help establish optimal wheelchair seat height. The study objective is to test the hypothesis that there is an optimum wheelchair seat height (expressed as a percentage of the lower leg length) for hemiplegic-pattern wheelchair propulsion. The investigators expect that the optimum seat height will be lower than that usually used for wheelchairs that are hand-propelled.

A single-subject design with able-bodied participants will be used to investigate 5 randomized seat heights. The 5 seat heights will be set relative to the subjects leg length at a single 60 minute data collection session All measures will be obtained during one session. The optimal seat height will be chosen based on wheelchair propulsion speed, push frequency and effectiveness over 10m going forward on smooth surface, and 5m going backwards over a soft surface.

• Study Type: Interventional
• Enrollment (Actual): 50
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Nova Scotia
    • Halifax, Nova Scotia, Canada, B3H 4K4
      • Nova Scotia Rehabilitation and Arthritis Centre

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• willing to participate
• is right-hand dominant (to simplify wheelchair and laboratory set-up)
• has a subjective unshod height of ≤ 183 cm (6'0")
• is able to be comfortably seated in the manual wheelchair used for the study
• is 18 years of age or older, is alert and cooperative
• is competent to provide informed consent
• is able to communicate in English
• does not have an unstable medical condition

Exclusion Criteria:

-

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Seat Height Intervention; Randomly assigned 5 wheelchair seat heights ranging from very low (2" below) to very high (2" above) the lower leg length of the participant.

Device: Neutral seat height; Seat height set relative to participant's leg length with neutral set at the measured lower leg length; Device: Very low seat height; Seat height set relative to participant's leg length, 2" below the measured lower leg length; Device: Low seat height; Seat height set relative to participant's leg length, 1" below the measured lower leg length; Device: Very high seat height; Seat height set relative to participant's leg length, 2" above the measured lower leg length; Device: High seat height; Seat height set relative to participant's leg length, 1" above the measured lower leg length

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
speed (m/s)	wheelchair propulsion speed over 10 m forward and 5 m backward	same day measure obtained immediately after seat adjustment, approximately 10 minutes
push frequency (cycles per second)	number of foot cycles completed over the 10 m forward and 5 m backward	same day measure obtained immediately after seat adjustment, approximately 10 minutes
Propulsion effectiveness	distance travelled per foot propulsion cycle	same day measure obtained immediately after seat adjustment, approximately 10 minutes

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
forward propulsion wheelchair skills test score	fail, pass with difficulty or pass for wheeling forward 10 m	same day measure obtained immediately after seat adjustment, approximately 10 minutes
propulsion difficulty questionnaire	Investigator developed questionnaire asking how difficult it was to perform the propulsion test. The participant will self-report his/her level of difficulty for this skill using a five-point Likert scale (1 =very easy, 2=somewhat easy, 3=neither easy nor difficult, 4= somewhat difficult and 5=very difficult). A single number will be reported.	same day measure obtained immediately after seat adjustment, approximately 10 minutes

Collaborators and Investigators

• Sponsor: Lee Kirby
• Investigators: Principal Investigator: Lee Kirby, MD, Nova Scotia Health Authority, Dalhousie University

Publications and helpful links

General Publications

• Heinrichs ND, Kirby RL, Smith C, Russell KFJ, Theriault CJ, Doucette SP. Effect of seat height on manual wheelchair foot propulsion, a repeated-measures crossover study: part 1 - wheeling forward on a smooth level surface. Disabil Rehabil Assist Technol. 2021 Nov;16(8):831-839. doi: 10.1080/17483107.2020.1741036. Epub 2020 Apr 2.
• Heinrichs ND, Kirby RL, Smith C, Russell KFJ, Theriault CJ, Doucette SP. Effect of seat height on manual wheelchair foot propulsion, a repeated-measures crossover study: part 2 - wheeling backward on a soft surface. Disabil Rehabil Assist Technol. 2022 Apr;17(3):325-330. doi: 10.1080/17483107.2020.1782490. Epub 2020 Jun 27.

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2018
• Primary Completion (Actual): September 1, 2019
• Study Completion (Actual): September 1, 2019

Study Registration Dates

• First Submitted: October 30, 2017
• First Submitted That Met QC Criteria: October 31, 2017
• First Posted (Actual): November 6, 2017

Study Record Updates

• Last Update Posted (Actual): September 11, 2020
• Last Update Submitted That Met QC Criteria: September 9, 2020
• Last Verified: September 1, 2020

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nervous System Diseases; Neurologic Manifestations; Paralysis; Hemiplegia
• Other Study ID Numbers: 1022716

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No