Standards of Care and the SCI Clinical Guidelines

In 2005, the Consortium of Spinal Cord Medicine, made up of 21 organizations and with administrative and financial support from the Paralyzed Veterans of America, published a new set of clinical guidelines entitled, "Preservation of Upper Limb Function Following Spinal Cord Injury: A Clinical Practice Guideline for Healthcare Professionals." These clinical guidelines were formulated by 10 expert panel members and were reviewed by 38 additional experts that together represent a who's who in the field of spinal cord medicine.

Recommendations in the Clinical Guidelines

Several of the recommendations put forth in the clinical guidelines were specifically related to wheelchair propulsion and the prevention of upper limb pain and injury. These recommendations included:

  • Minimize frequency of repetitive upper limb tasks.
  • Minimize forces required to complete upper limb tasks.
  • Use long, smooth strokes that limit high impacts on the handrim.

To support these recommendations, the Clinical Guidelines refered to more than a dozen studies that relied on the SmartWheel to assess wheelchair propulsion. These studies indicate that the manner in which people propel their wheelchairs contributes to the onset of pain and injury in both the wrist and shoulder areas. For example, the more that wheelchair users are able to apply smoother, longer strokes on the handrim, reduce their stroke frequency, and minimize wasted forces, the more they will be able to prevent the onset of arm pain and injury.

The SmartWheel: Your Tool for Implementation of the Clinical Guidelines

Implementation of the above recommendations is an essential step in preserving upper limb function among people who use manual wheelchairs. And, as can be seen in the Table below, the SmartWheel is unique in its ability to assist in this process.

Clinical Guidelines What the SmartWheel Measures
Minimize frequency of repetitive upper limb tasks (e.g., minimize number of pushes on the handrim.) The SmartWheel measures push frequency, or number of pushes on the handrim over a given distance or time interval.
Minimize forces required to complete upper limb tasks (e.g., reduce overall forces exerted on the handrim.) The SmartWheel measures all push forces exerted on the handrim when propelling the wheelchair.
Use long, smooth strokes that limit high impacts on the handrim. The SmartWheel measures push length and peak forces exerted on the handrim.

SmartWheel Reports

The SmartWheel Clinical Wizard Software, using the measurements listed in the Table, creates reports that facilitate comparisons of propulsion characteristics for two different wheelchairs, for different set-ups or configurations of the same wheelchair, and for the same person and wheelchair but at different points in time (e.g., before and after a propulsion training program). Put simply, the SmartWheel reports allow clinicians to assess, evaluate, and compare wheelchair propulsion as they engage in efforts to implement the clinical guidelines. In this way, the SmartWheel data on wheelchair propulsion benefits people who use wheelchairs much in the same way that pressure mapping data has been used to prevent pressure ulcers and improve quality of life.

We Don't Make the Wheelchair. We Make the Wheelchair Better.
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