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Biomedical subjects

M L Boninger

Publications and source records attributed to M L Boninger.

At least 19 recordsLinked to original sources

An autoregressive modeling approach to analyzing wheelchair propulsion forces.

Biomechanical signals collected during wheelchair propulsion are often analyzed by computing averages and/or peak values over several strokes. Due to the complex nature of the signals, this type of analysis may not be specific to identifying factors that may predispose a wheelchair user to joint pain/injury. Hence, a new technique is introduced that uses a system identification approach, autoregressive (AR) modeling, to analyze wheelchair propulsion force waveforms. In this application an AR method was used to create a model force waveform based on current and past values of digital pushrim force data. The feasibility of the AR modeling method over point-wise methods to detect asymmetry among force waveforms was tested with a group of 20 wheelchair users. Subjects propelled at a constant 0.9 m/s on a roller system during which 20 s of force data were collected from the SMART(Wheel)s, force and torque sensing pushrims. Both methods showed that the wheelchair users as a group propelled evenly, however, individual analysis using the AR model error estimates indicated that twenty-five percent demonstrated significant asymmetry in their force waveforms. If only point-wise means and variances of the applied bilateral forces were considered, most subjects would have appeared symmetrical. Thus, the AR modeling approach is more sensitive to detecting anomalies in propulsion technique.

Adult↗

Kinematic comparison of Hybrid II test dummy to wheelchair user.

Hybrid test dummies provide a safe alternative to human subjects when investigating mechanisms of wheelchair tips and falls. The data that researchers acquire from these test dummies are more useful if the test dummy represents the population being studied. The goal of this study was to measure the validity of a 50th percentile Hybrid II test dummy (HTD) as an accurate representation of a wheelchair user. A test pilot with T8 paraplegia due to traumatic spinal cord injury served as a basis for validation. Simple modifications were made to the HTD to approximate the trunk stability characteristics of a person with a spinal cord injury. An HTD, a modified HTD, and a human test pilot were seated in an electric-powered wheelchair and several braking tests performed. The standard HTD underestimated the kinematics when compared to the test pilot. The modified HTD had less trunk stability than the standard HTD during all braking methods. The modified HTD and wheelchair test pilot had similar trunk stability characteristics during kill switch and joystick full-reverse braking conditions. The modified HTD is a satisfactory representation of a wheelchair user with a spinal cord injury; however, the modified test dummy underestimates the trunk dynamics during the less extreme joystick release braking. Work should continue on the development of a low-speed, low-impact test dummy that emulates the wheelchair user population.

Biomechanical Phenomena↗

Does computer game play aid in motivation of exercise and increase metabolic activity during wheelchair ergometry?

GAME(Wheels) is an interface between a portable roller system and a computer that enables a wheelchair user to play commercially available computer video games. The subject controls the game play with the propulsion of their wheelchair's wheels on the rollers. The purpose of this study was to investigate whether using the GAME(Wheels) System during wheelchair propulsion exercise can help increase the individual's physiological response and aid in the motivation to exercise. Fifteen subjects participated in this study. The subjects propelled their wheelchairs on a portable roller that was equipped with the GAME(Wheels) System. There were two exercise trials consisting of 2 min of warm-up, 16 min of exercise and 2 min of cool-down. Physiological data (ventilation rate, oxygen consumption, heart rate) were collected. A significant difference (P<0.05) was found between exercise with GAME(Wheels) versus without GAME(Wheels) for average ventilation rate and average oxygen consumption. The differences were found during time periods of transition from warm-up to exercise, and before and after the midpoint of exercise. Written questionnaires showed that 87% of the individuals tested reported the system would help them work out on a regular basis. Playing the video game helped these individuals to reach their exercise training zone faster and maintain it for the entire exercise trial.

Adult↗

Mechanical efficiency and user power requirement with a pushrim activated power assisted wheelchair.

The objective of this study was to quantify the difference in mechanical efficiency and user power generation between traditional manual wheelchairs and a pushrim activated power assisted wheelchair (PAPAW). Ten manual wheelchair users were evaluated in a repeated measures design trial with and without the PAPAW for propulsion efficiency. Subjects propelled a Quickie GP equipped with the PAPAW and their own chair on a computer controlled wheelchair dynamometer at five different resistance levels. Power output, user power with the PAPAW hubs, subjects' oxygen consumption per minute and mechanical efficiency were analyzed. Metabolic energy and user power were significantly lower (p<0.05), and mechanical efficiency significantly higher with the PAPAW than with subjects' own chairs. Subjects needed to generate on average 3.65 times more power when propelling their own wheelchairs as compared to PAPAW. Mean mechanical efficiency over all trials was 80.33% higher with the power assisted hubs. PAPAW provides on average 73% of the total power when subjects propel with power assistance. Significantly increased efficiency and reduced requirement of user power is achieved using the PAPAW. With use, the PAPAW may contribute to delaying secondary injuries of manual wheelchair users. In addition, it may be suitable for people who have (or at risk for) upper extremity joint degeneration, reduced exercise capacity, low strength or endurance who currently use electric powered wheelchairs.

Adult↗

Evaluation of a pushrim-activated, power-assisted wheelchair.

OBJECTIVE: To evaluate a novel pushrim-activated, power-assisted wheelchair (PAPAW) for compliance with wheelchair standards, metabolic energy cost during propulsion, and ergonomics during selected activities of daily living (ADLs). DESIGN: A 3-phase study, the second and third of which were repeated-measures designs. SETTING: A rehabilitation engineering center within a Veterans Affairs medical center. PATIENTS: Eleven full-time, community-dwelling, manual wheelchair users (4 women, 6 men) with spinal cord injuries or multiple sclerosis. INTERVENTIONS: Phase 1: Compliance testing, with a test dummy, in accordance with the wheelchair standards of the American National Standards Institute and the Rehabilitation Engineering and Assistive Technology Society of North America. Phase 2: Metabolic energy consumption testing-at 2 speeds and 3 resistance levels-in subjects' manual wheelchair and the PAPAW. Phase 3: Evaluation of ability to perform ADLs and ergonomics of the PAPAW compared with the subjects personal wheelchair. MAIN OUTCOME MEASURES: Phase 1: The PAPAW's static stability, static strength, impact strength, fatigue strength, environmental response, obstacle climbing ability, range, maximum speed, and braking distance. Phase 2: Subjects' oxygen consumption per minute, minute ventilation, and heart rate during different speeds and workloads with a PAPAW and their own wheelchairs. Phase 3: Subject ratings of perceived comfort and basic ergonomics while performing selected ADLs. Completion time, stroke frequency, and heart rate during each ADL. RESULTS: Phase 1: The PAPAW was found to be in compliance with wheelchair standards. Phase 2: With the PAPAW, the user had a significantly lower oxygen consumption (&Vdot;O(2)mL/min: p <.0001; &Vdot;O(2)mL/kg x min: p <.0001) and heart rate (p <.0001) when compared with a manual wheelchair at different speeds. Phase 3: The PAPAW had a significantly higher mean ergonomic evaluation (p <.01) than the subjects' personal wheelchairs. The results of comparing the ratings of the car transfer between the PAPAW and the subjects' personal wheelchair showed a significant difference in the task of taking the wheels off (p <.001) and putting the wheels back on (p =.001), with the PAPAW receiving lower ratings. CONCLUSION: This study indicated that the PAPAW is compliant with wheelchair standards, reduces the energy demand placed on the user during propulsion, and that subjects rated its ergonomics favorably when compared with their personal wheelchair. PAPAWs may provide manual wheelchairs with a less physiologically stressful means of mobility with few adaptations to the vehicle or home environment.

Adult↗

Comparison of fatigue life for 3 types of manual wheelchairs.

OBJECTIVES: To examine 3 types of manual wheelchairs-ultralight wheelchairs (UWs), lightweight wheelchairs (LWs), and depot wheelchairs (DWs)-and to compare the fatigue life between the wheelchair types. DESIGN: A database of different manual wheelchairs tested according to the International Organization for Standardization (ISO). Fatigue life was determined by using standards that define methods accepted internationally using double-drum and curb-drop testing equipment. SETTING: A rehabilitation engineering center. SPECIMENS: Sixty-one manual wheelchairs: 25 DWs, 22 UWs, and 14 LWs. MAIN OUTCOME MEASURES: Wheelchairs were examined for differences in fatigue life based on equivalent cycles. Unique survival curves were fit and compared for each wheelchair type. RESULTS: The UWs lasted the longest, with a mean of 309,362 equivalent cycles. The DWs faired the worst, with a mean of 117,210 equivalent cycles. The Kaplan-Meier survival curves were significantly different (p < .001), with the UWs having the longest fatigue life. CONCLUSION: Fatigue life for UWs is significantly greater (p < .05) than LWs and DWs, indicating wheelchairs differ in durability.

Equipment Failure↗

Resident research education in physical medicine and rehabilitation: a practical approach.

The Accreditation Council for Graduate Medical Education includes training in research as a required component of physical medicine and rehabilitation residency programs. Unfortunately, there is a lack of practical information on how to meet this requirement. In this paper, information is provided for individuals involved in resident education on how to teach residents about research.

Curriculum↗

Comparison of three different models to represent the wrist during wheelchair propulsion.

Due to the high incidence of secondary wrist injury among manual wheelchair users, recent emphasis has been placed on the investigation of wheelchair propulsion biomechanics. Accurate representation of wrist activity during wheelchair propulsion may help to elucidate the mechanisms contributing to the development of wrist injuries. Unfortunately, no consensual wrist biomechanical model has been established. In order to determine if different methodologies obtain similar results, this investigation created and compared three different wrist models: 1) a fixed joint center placed between the styloids (midstyloid joint center); 2) a joint center with 2 degrees of freedom computed from de Leva's joint center data; and 3) a floating joint center. Results indicate that wrist flexion and extension angles are highly consistent between models, however, radial and ulnar deviation angles vary considerably. Mean maximum right flexion angles were found to be 3.5 degrees, 2.2 degrees, and 5.0 degrees for the midstyloid, de Leva, and floating joint center models, respectively. Extension angles were 22.3 degrees, 23.6 degrees, and 23.6 degrees, respectively. Mean maximum right radial deviation angles for the midstyloid, de Leva, and floating joint center models were 26.0 degrees, 26.9 degrees, and 45.1 degrees, respectively, and ulnar deviation angles were found to be 30.5 degrees, 38.8 degrees, and 10.2 degrees, respectively. This information is useful when comparing kinematic studies and further supports the need for consensual methodology.

Biomechanical Phenomena↗

Physiological responses to two wheelchair-racing exercise protocols.

OBJECTIVE: This study investigated the blood lactate accumulation during two wheelchair-racing protocols. During exercise, energy is required, which causes metabolism to increase and blood lactate to accumulate. Proper training can reduce the amount of blood lactate accumulation and increase tolerance to blood lactate accumulation during aerobic exercise. METHODS: Eleven male wheelchair elite track athletes with a spinal cord injury were tested to determine their blood lactate response to speed and resistance workouts. A computer-monitored wheelchair dynamometer was used during all exercise tests. The order of the test (e.g., speed or resistance workout) was randomized. Blood pressure and blood samples were taken immediately before and after completion of each exercise test. RESULTS: The difference between the blood lactate concentrations before and after testing were 8.56 +/- 4.42, and 11.67 +/- 4.69 mM for the resistance and speed tests, respectively. CONCLUSIONS: Our results showed that the blood lactate responses were significantly different for the resistance and speed workouts.

Adult↗

Manual wheelchair pushrim biomechanics and axle position.

OBJECTIVE: The biomechanics of wheelchair propulsion have been linked to upper extremity injury. Specifically, prior studies have correlated increased median nerve dysfunction with increasing propulsion frequency and a higher rate of rise of the resultant, or total, pushrim force. Despite this link, there is little research on the effect of wheelchair setup on propulsion biomechanics. The objective of this study was to determine the effect of rear axle position relative to the shoulder on pushrim biomechanics. DESIGN: Case series. SETTING: Biomechanics laboratory. PARTICIPANTS: Forty individuals with paraplegia who use manual wheelchairs for mobility. INTERVENTION: Subjects propelled their own wheelchairs on a dynamometer at two different steady-state speeds and going from a dead stop to maximum speed. Bilateral biomechanical data were obtained using a force- and moment-sensing pushrim and a motion analysis system. MAIN OUTCOME MEASURES: Position of the axle relative to the shoulder at rest both horizontal (XPOS) and vertical (YPOS), and pushrim biomechanical variables including frequency of propulsion, peak and rate of rise of the resultant force, planar moment, and push angle. Partial correlation coefficients between relative axle position and propulsion biomechanics variables were calculated. RESULTS: After controlling for subject characteristics, XPOS was significantly correlated with the frequency of propulsion (p < .01) and the rate of rise of the resultant force (p < .05). In addition, both XPOS and YPOS were significantly correlated with the push angle at multiple speeds (p < .05). CONCLUSION: Specific biomechanical parameters known to correlate with median nerve injuries were found to be related to axle position relative to the shoulder. Providing wheelchair users with adjustable axle position and then fitting the user to the wheelchair can improve propulsion biomechanics and likely reduce the risk of injury.

Adult↗

User assessment of manual wheelchair ride comfort and ergonomics.

OBJECTIVE: To examine wheelchair-user perceived ride comfort during propulsion and to compare the ride comfort of ultralight and lightweight manual wheelchairs. An ultralight wheelchair is defined as having a high degree of adjustability, whereas a lightweight wheelchair has minimal adjustability. DESIGN AND PARTICIPANTS: Repeated measures design of a sample of 30 community-dwelling manual wheelchair users evaluating 7 different manual wheelchairs over an activities of daily living course. SETTING: A rehabilitation engineering center. MAIN OUTCOME MEASURES: Subject ratings of perceived ride comfort and basic ergonomics while propelling over the activities of daily living course. Ratings were recorded for each wheelchair on individual tasks and for the course overall. RESULTS: The Invacare Action XT wheelchair was ranked best for both ride comfort and basic ergonomics. The ride-comfort scores (p < .05) and wheelchair ergonomics ratings (p < .05) for the ultralight wheelchair group were significantly different from those for lightweight wheelchair group. CONCLUSION: There are differences in perceived ride comfort and basic ergonomics between the designs of the wheelchairs (lightweight vs ultralight). Subjects perceived that ultralight wheelchairs were more comfortable and had better basic ergonomics than lightweight wheelchairs.

Activities of Daily Living↗

Analysis of position and isometric joysticks for powered wheelchair driving.

The control interface is one of the most critical components of the electric-powered wheelchair (EPW). The control interface must accommodate the user's limitations and maximize the user's abilities. This study extended Fitts' Law for target-acquisition to a continuously updated target. The extended Fitts' Law was used to examine EPW driving with a standard position sensing joystick and a prototype isometric joystick (IJ). The extended Fitts' Law provides insight into the difficulty of performing target-acquisition tasks with an EPW. The test results showed significant differences (p < 0.05) among the two types of joysticks for selected measures of information processing capacity, movement time, root-mean-square-error, and average velocity while performing turning maneuvers. The mean values indicate that the IJ may provide superior turning performance.

Algorithms↗

Road loads acting on manual wheelchairs.

A barrier to performing more in-depth analyzes during the wheelchair design process is a lack of dynamic reaction force and moment data, and the instrumentation to collect this data. Instrumentation was developed to collect the dynamic force and moment data. New data collections methodologies and analysis techniques were implemented to facilitate computer-aided-engineering for wheelchair designs. Data were collected during standardized wheelchair fatigue tests, while driving over a simulated road course within a laboratory, and while driving in the community. Seventeen subjects participated in this study. Based upon the three test conditions, a pseudo-statistical distribution of the force and moment data at both a caster and rear wheel was developed. The key parameters describing the distribution and the extremums of the data (minima and maxima) were compared using analysis of variance. The results showed that the force and moment distributions and extreme values were similar for the both sets of human trials (i.e., simulated road course and field trials). However, the standardized testing (i.e., wheelchair fatigue testing) differed from both human trials. The force/moment data gathered during this study are suitable for inputs in finite element analysis and dynamic modeling. Our results suggest that the fatigue tests should be modified to change the magnitude and increase the frequency of the forces and moments imparted on the wheelchair. The data reported from this study can be used to improve wheelchair standards and to facilitate computer-aided-engineer in wheelchair design.

Acceleration↗

Frequency analysis of kinematics of racing wheelchair propulsion.

The purpose of this study was to describe the frequency content of racing wheelchair propulsion motion data. The selection of the filter corner frequency in previous kinematic analyses of manual wheelchair propulsion was commonly based on gait literature. An estimate of the frequency separating the signal and the noise was determined to make recommendations for low-pass digital filters. The global (noncoordinate specific) cutoff frequency was 6 Hz. The directional cutoff frequencies were 5.1, 3.9, and 5.6 Hz, in the anterior-posterior, superior-inferior and medial-lateral directions, respectively. Recommendations for the corner frequencies of low-pass Butterworth digital filters based on the cutoff frequency are higher than the corner frequencies used in previous studies of manual wheelchair propulsion kinematic data. This study provides a foundation for the data reduction of manual wheelchair propulsion kinematic data that is independent of gait literature.

Adult↗

Evaluation of a manual wheelchair interface to computer games.

The sedentary lifestyle of many people with spinal cord injury (SCI) has lead to cardiovascular diseases being a major health concern. A suitable exercise program may help improve the SCI individual's cardiovascular fitness level. GAMEWheels is an interface between a custom wheelchair roller system and a computer that enables an individual to control computer video games by driving his or her wheelchair. The purpose of Phase 1 was to evaluate the design of the GAMEWheels system and to determine the type of computer video game that is likely to motivate wheelchair users to exercise. Phase 2 included physiologic testing of wheelchair users and the GAMEWheels system to investigate whether the system elicits an exercise training response. Thirty-five subjects were recruited to evaluate the GAMEWheels by playing three commercial computer games (Phase 1) and to identify the computer game that they would prefer to use when exercising. The feedback from Phase 1 was used with test subjects to verify that the GAMEWheels system elicits an exercise training effect (Phase 2). Phase 2 included 10 subjects using the GAMEWheels system to play Need for Speed II. During game play, physiologic data were collected and the subjects' oxygen consumption and heart rate were analyzed. Analysis showed that the GAMEWheels system induced nine subjects to reach their training zone, defined as 50% and 60% of their maximum oxygen consumption and heart rate, respectively. This study demonstrates that the GAMEWheels system elicits an exercise training response.

Adult↗

Durkan gauge and carpal compression test: accuracy and diagnostic test properties.

STUDY DESIGN: A prospective, criterion-based validity study. OBJECTIVES: To assess the diagnostic properties of the carpal compression test (CCT) when performed with the Durkan carpal tunnel syndrome (CTS) gauge, and to determine the measurement validity of the gauge. BACKGROUND: The CCT has been reported to be highly sensitive (.87-.89) and specific (.93-1.0) in the diagnosis of CTS when it is done with thumb pressure. The accuracy of measurements with the Durkan CTS gauge, however, has not been established and the diagnostic sensitivity and specificity of the CCT when the gauge is used has not been independently confirmed. METHODS AND MEASURES: The study sample included 33 women and 19 men, aged 18 to 85 years (45.7 +/- 13.5 years). The accuracy of the gauge was determined with a force dynamometer and holding frame. Standard nerve conduction studies (NCS) and the CCT were performed on the symptomatic extremity of all subjects. A compatible history and the NCS results were used to confirm CTS. RESULTS: The Durkan gauge registered pressures of 11.94 psi and 15.25 psi at the 12 and 15 psi gauge marks, respectively. Test sensitivity and specificity were .36 (95% CI = .17-.54) and .57 (95% CI = .39-.74), respectively. CONCLUSIONS: Pressure measurements obtained with the Durkan CTS gauge were accurate. The CCT when performed with the Durkan gauge, however, was neither sensitive or specific for the diagnosis of CTS.

Adolescent↗

Fatigue-life of two manual wheelchair cross-brace designs.

OBJECTIVE: To compare the durability of two designs of cross-braces for folding manual wheelchairs and to determine the nature of wheelchair cross-brace failures. DESIGN: Fatigue testing of two folding wheelchair cross-brace designs (one with a rectangular cross-section and the other with a circular cross-section). A total of 20 cross-brace pairs were tested. RESULTS: The cross-braces with a circular cross-section endured a mean +/- SD of 100,159 +/- 45,814 cycles before experiencing a fatigue failure, whereas the cross-braces with a rectangular cross-section endured an average of 261,254 +/- 160,741 cycles. A t test showed significant differences (p = .01) in fatigue-life between cross-braces with a circular cross-section versus cross-braces with a rectangular cross-section. All 20 cross-braces experienced similar fatigue failures that would develop at the bolt hole where the two cross-braces connect to form a hinge. CONCLUSION: The results suggest that the rectangular cross-brace design has a longer fatigue-life than the circular cross-brace design. People should regularly inspect the cross-brace for cracks. The area around the bolt forming the hinge should be inspected carefully. If a crack is observed, the cross-brace should be replaced immediately.

Persons with Disabilities↗

Wheelchair pushrim kinetics: body weight and median nerve function.

OBJECTIVES: Individuals who use manual wheelchairs are at high risk for median nerve injury and subsequent carpal tunnel syndrome (CTS). To gain a better understanding of the mechanism behind CTS in manual wheelchair users, this study examined the relation between (1) pushrim biomechanics and function of the median nerve, (2) pushrim biomechanics and subject characteristics, and (3) median nerve function and subject characteristics. DESIGN: Case series. SETTING: Biomechanics laboratory and an electromyography laboratory. PARTICIPANTS: Thirty-four randomly recruited individuals with paraplegia who use a manual wheelchair for mobility. INTERVENTION: Subjects propelled their own wheelchair on a dynamometer at 0.9m/sec and 1.8m/sec. Bilateral biomechanical data were obtained using a force- and moment-sensing pushrim and a motion analysis system. Bilateral nerve conduction studies focusing on the median nerve were also completed. MAIN OUTCOME MEASURES: Pearson's correlation coefficients between subject characteristics, median nerve conduction studies, and propulsion biomechanics; a regression model of nerve conduction studies incorporating subject characteristics and pushrim biomechanics. RESULTS: Subject weight was significantly related to median nerve latency (r = .36, p = .03) and median sensory amplitude (r = -.43, p = .01). Height was also significantly related to median sensory amplitude (r = -.58, p = .01). Subject weight was significantly related to the peak resultant force applied to the pushrim (r = .59, p < .001). Height, weight, and weight-normalized pushrim forces were successfully incorporated into a linear regression model predicting median sensory amplitude (r = .63, p < .05) and mean median latency (r = .54, p < .05). CONCLUSION: This study found subject weight to be related to pushrim forces and median nerve function. Independent of subject weight, pushrim biomechanics were also related to median nerve function. Through weight loss and changes in pushrim biomechanics, it may be possible to prevent median nerve injury in manual wheelchair users.

Adult↗