Biomedical subjects

Michael L Boninger

Publications and source records attributed to Michael L Boninger.

14 recordsLinked to original sources

PubMed2003

Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy.

STUDY DESIGN: A blinded, prospective diagnostic test study was conducted. OBJECTIVES: To assess the reliability and accuracy of individual clinical examination items and self-report instruments for the diagnosis of cervical radiculopathy, and to identify and assess the accuracy of an optimum test-item cluster for the diagnosis of cervical radiculopathy. SUMMARY OF BACKGROUND DATA: Although cervical radiculopathy remains largely a clinical diagnosis, the reliability and diagnostic accuracy of clinical examination items, individually or in combination, for cervical radiculopathy is largely unknown. METHODS: Patients with suspected cervical radiculopathy or carpal tunnel syndrome received standardized electrophysiologic examination of the symptomatic upper quarter followed by a standardized clinical examination by physical therapist examiners blinded to diagnosis. Diagnostic properties were assessed using a neural impairment reference criterion standard. RESULTS: The study involved 82 patients. More than two thirds of 34 clinical examination items had reliability coefficients rated at least fair or better, and 13 items had likelihood ratio point estimates above 2 or below 0.50. A single diagnostic test item cluster of four variables was identified and produced a positive likelihood ratio point estimate of 30.3. The 95% confidence intervals for all likelihood ratio point estimates in this study were wide. CONCLUSIONS: Many items of the clinical examination were found to be reliable and to have acceptable diagnostic properties, but the test item cluster identified was more useful for indicating cervical radiculopathy than any single test item. Upper limb tension Test A was the most useful test for ruling out cervical radiculopathy. Further investigation is required both to validate the test item cluster and to improve point estimate precision.

Adult↗

PubMed2003

Seat and footrest shocks and vibrations in manual wheelchairs with and without suspension.

OBJECTIVE: To examine differences in the shock and vibration transmitted to an occupant of a manual wheelchair with and without suspension caster forks and with and without rear-suspension systems. DESIGN: Repeated-measures engineering testing. SETTING: Rehabilitation engineering center with a wheelchair standards test laboratory. SPECIMENS: Six manual wheelchairs. INTERVENTIONS: An American National Standards Institute/Rehabilitation Engineering and Assistive Technology Society of North America wheelchair test dummy and a Hybrid III test dummy were used to test shock and vibration transmission in wheelchairs equipped with original equipment manufacturer (OEM) caster forks and suspension caster forks. Ultralight wheelchairs, half of which had factory-equipped rear-suspension systems, were tested. Testing was conducted on a double-drum wheelchair test machine. MAIN OUTCOME MEASURES: Shocks were examined by using peak acceleration and the frequency at which peak acceleration occurs for the seat and footrest. Vibration was characterized by the acceleration power per octave for the seat and footrest. RESULTS: Significant differences were found in the peak accelerations at the seat (P=.0004) and footrest (P=.0007) between the wheelchairs with the OEM caster forks and those with the suspension casters. The wheelchairs with suspension had significantly different frequencies at which the peak accelerations occurred for both the seat (P=.01) and footrest (P=.0001). The wheelchairs with suspension caster forks had a lower total power per octave than the wheelchairs with the OEM caster forks. For the footrest vibrations, significant differences were found between the types of caster forks for all octaves except those associated with frequencies more than 78.75Hz. There were significant differences for wheelchairs with and without rear suspension for total power per octave of seat vibrations in the octaves between 7.81 and 9.84Hz (P=.01) and 12.40 and 15.63Hz (P=.008). CONCLUSIONS: Suspension caster forks reduce the shock and vibration exposure to the user of a manual wheelchair. Rear-suspension systems reduce some of the factors related to shock and vibration exposure, but they are not clearly superior to traditional designs.

Acceleration↗

PubMed2003

Shoulder magnetic resonance imaging abnormalities, wheelchair propulsion, and gender.

OBJECTIVE: To investigate the relationship between pushrim forces and the progression of shoulder injuries in manual wheelchair users. DESIGN: Longitudinal case series. SETTING: Biomechanics laboratory and magnetic resonance imaging (MRI) facility at a Veterans Health Administration medical center and university hospital, respectively. PARTICIPANTS: Fourteen individuals with spinal cord injury (8 men, 6 women) who used manual wheelchairs. INTERVENTION: Subjects propelled their own wheelchairs on a dynamometer at 0.9 and 1.8m/s. Bilateral biomechanical data were obtained by using force and moment sensing pushrims at time 1. Bilateral shoulder MR images were also completed on 2 occasions, at time 1 and, approximately 2 years later, at time 2. MAIN OUTCOME MEASURES: The peak pushrim forces in a pushrim coordinate system were calculated, weight normalized and averaged over 5 strokes (presented as % body weight). MRI abnormalities were graded by using a summated scale. Differences between scores between times 1 and 2 were calculated. RESULTS: Subjects were divided into 2 groups based on change in MRI score. Seven subjects were in the group with worsening scores (MRI+; mean, 8.14 points; range, 5-16), and 7 were in the group with improving or unchanging scores (MRI-; mean, -1.00 point; range, -5 to 1). There was no significant difference between groups with respect to age, body mass index, or years from injury. There were significantly more women in the MRI+ group (6 women, 1 man) than in the MRI- group (7 men) (P=.001). The MRI+ group used significantly greater weight-normalized radial force, or force directed toward the axle at time 1, to propel their wheelchairs at each speed (P<.01): MRI+ at 0.9m/s (mean radial force +/- standard deviation, 5.2%+/-1.0%) and MRI- at 0.9m/s (mean radial force, 3.2%+/-1.7%) (P=.028); and MRI+ at 1.8m/s (mean radial force, 6.6%+/-1.2%) (P=.023) and MRI- at 1.8m/s (mean radial force, 4.1%+/-2.2%). In a separate analysis, women were found to propel with a significantly higher radial force. A logistic regression found a significant relationship between radial force at time 1 and increased risk of progression of MRI findings over time. CONCLUSION: Individuals who propel with a greater percentage of force directed toward the axle were at increased risk of progression of MRI findings over time. Most people in this group were women. Clinicians should instruct wheelchair users in effective propulsion techniques and should pay particular attention to women who use wheelchairs. Reducing forces during wheelchair propulsion may minimize the likelihood of developing shoulder injuries.

Adult↗

PubMed2003

Use of the Independence 3000 IBOT Transporter at home and in the community.

BACKGROUND: The INDEPENDENCE 3000 IBOT Transporter (IBOT) is an electronically stabilizing mobility device for people with disabilities. It operates in 4 functions: Standard, Balance (raised on 2 rear wheels), 4 Wheel (for inclines, curbs, and uneven terrain), and Remote (for loading into a vehicle). OBJECTIVE: The purpose of this study was to observe the IBOT at use in the home and in the community. METHODS: Data were obtained via observations by trained clinicians, data recorded from a computerized data logger, and reports from each expert. PARTICIPANTS: Participants included 10 unimpaired nonwheelchair users (6 men, 4 women) and 4 expert wheelchair users (men with spinal cord injuries, T7-L1). The participants used the IBOT to perform a variety of activities, including holding eye-level discussions with colleagues and shopping by balancing on 2 wheels, going up and down steep ramps, traversing outdoor surfaces (eg, grass, dirt trails), and climbing curbs. OBSERVATIONS: The Balance and 4-Wheel functions were helpful and worked well. The IBOT required attention to control in the Standard function. The seat height was too high for most tables and desks, and the IBOT was challenging to use in the bathroom. CONCLUSION: The IBOT is a functional mobility device that expands the options of wheelchair users. It is most useful outdoors and where there is sufficient space to use its unique Balance function.

Activities of Daily Living↗

PubMed2003

Range of motion and stroke frequency differences between manual wheelchair propulsion and pushrim-activated power-assisted wheelchair propulsion.

BACKGROUND/OBJECTIVE: The objective of this study was to examine the use and efficacy of a pushrim-activated power-assist wheelchair (PAPAW) in the reduction of upper extremity range of motion (ROM) and stroke frequency in manual wheelchair users. METHODS: Ten manual wheelchair users were evaluated using a repeated-measures design with and without the use of a PAPAW for maximum ROM of shoulder flexion/extension, abduction/adduction, internal/external rotation, and horizontal flexion/extension; elbow flexion/extension; wrist flexion/extension, supination/pronation, and ulnar/radial deviation; and stroke frequency. Participants propelled a Quickie 2 manual wheelchair configured as a PAPAW and their own wheelchair on a computer-controlled dynamometer at 3 different resistance levels and 2 different speeds. RESULTS: The use of the PAPAW significantly (P < 0.05) decreased shoulder flexion/extension and horizontal flexion/extension, elbow flexion/extension, and wrist flexion/extension and ulnar/radial deviation for many speed and resistance combinations. Univariate analysis revealed that stroke frequency was unaltered in all cases. CONCLUSION: These findings provide the foundation for studying the utility of the PAPAW in reducing the risk of upper limb injury and neuropathy in the manual wheelchair user population.

Adult↗

PubMed2003

Investigating neck pain in wheelchair users.

OBJECTIVE: Despite the fact that wheelchair users are exposed to risk factors for neck and upper back pain (NP), little is known about the impact and possible diagnoses associated with NP. The purpose of this study was to examine the significance of NP in wheelchair users and to determine if a portion of the NP may be myofascial in origin. DESIGN: Cross-sectional cohort study using questionnaires and physical exams to evaluate NP in a convenience sample of wheelchair users from the National Veteran's Wheelchair Games. Main outcome measures included reported NP, visual analog scale of neck complaints, Neck Disability Index, and physical examination findings of trigger points. RESULTS: Sixty-six percent of subjects reported NP since becoming a wheelchair user and, 60% reported pain during the past month. Neither age nor length of time in a wheelchair was significantly different between those subjects who did and those subjects who did not report pain. Of those respondents who reported NP, 60% visited the doctor about the pain and 40% limited their daily activities due to the pain. Trigger-point palpation reproduced pain in 54% of those respondents who experienced pain in the past month (n = 34). CONCLUSION: This study provides a first step in defining the prevalence and significance of NP among wheelchair users. Clinicians who work with this population need to ask subjects about symptoms and consider a myofascial origin for that pain when considering treatment.

Adult↗

PubMed2003

Peer review: issues in physical medicine and rehabilitation.

Peer review, although the standard for evaluating scientific research, is not without flaws. Peer reviewers have been shown to be inconsistent and to miss major strengths and deficiencies in studies. Both reviewer and author biases, including conflicts of interest and positive outcome publication biases, are frequent topics of study and debate. Additional concerns have been raised regarding inappropriate authorship and adequate reporting of the ethical process involving human and animal experimentation. Despite these issues, a good peer review can provide positive feedback to authors and improve the quality of research reported in medical journals. This article reviews some issues and points of concern regarding the peer-review process, and it suggests guidelines for new (and established) reviewers in the area of physical medicine and rehabilitation. It also provides suggestions for editorial considerations and improvements in the peer-review process for physical medicine and rehabilitation research journals.

Ethics, Research↗

PubMed2003

Whole-body vibration during manual wheelchair propulsion with selected seat cushions and back supports.

Although the exposure to whole-body vibrations (WBV) has been shown to be detrimental to seated humans, the effects of wheelchairs and seating systems on the transmission of vibration to an individual have not been thoroughly examined. The purpose of this study was to determine if the selected wheelchair seat cushions and back supports minimize the transmission of vibrations. Thirty-two wheelchair users traversed an activities of daily living course three times using 16 randomly selected seating systems as well as their own. Vibrations were measured using triaxial accelerometers at the seat and participant's head. The weighted fore-to-aft (Tx), vertical (Tz), and resultant (Tr) transmissibility based on the vibrational-dose-value (VDV) were used to determine if differences existed among the four seat cushions and back supports. The obstacles that seem to have the largest effect on the transmission of WBV are the single event shocks and the repeated event shocks. Comparisons between the individuals own seating system and the tested seating systems suggest that the individuals are not using the most appropriate seating system in terms of the reduction of vibration transmission.

Acceleration↗

PubMed2003

Proper propulsion.

Explore the source record for details and available documents.

Equipment Design↗

PubMed2002

The science behind mobility devices for individuals with multiple sclerosis.

There is a growing body of research related to prescription of mobility devices. This research enables clinicians and clients to make clinical decisions related to mobility based on sound research. Unfortunately, there is little research investigating appropriate prescriptions in degenerative disorders such as multiple sclerosis (MS). In this article we will review the literature on mobility devices in MS and how it can be used to assist with clinical decision-making considering the progressive nature of this condition. In addition, we will review other research not conducted on individuals with MS that is relevant to this population. Finally we will present a call for future research that should help address this critical area.

Canes↗

PubMed2002

Comparison of virtual and real electric powered wheelchair driving using a position sensing joystick and an isometric joystick.

There are limited interface options for electric powered wheelchairs, which results in the inability of some individuals to drive independently. In addition, the development of new interface technologies will necessitate the development of alternative training methods. This study compares a conventional position sensing joystick to a novel isometric joystick during a driving task in a virtual environment and a real environment. The results revealed that there were few differences in task completion time and root-mean-square error (RMSE) between the two types of joysticks. There were significant correlations between the RMSE in the virtual environment and the real environment for both types of joysticks. The data indicate that performance in the virtual environment was representative of driving ability in the real environment, and the isometric joystick performed comparably to the position sensing joystick.

Algorithms↗

PubMed2002

Driving characteristics of electric-powered wheelchair users: how far, fast, and often do people drive?

OBJECTIVES: To determine the driving characteristics of electric-powered wheelchair users during unrestricted community activities and to compare the activity levels among an active group and a group of regular users. DESIGN: Multisite engineering evaluation of electric-powered wheelchair driving activity during unrestricted community mobility. SETTING: Data were collected in the communities of Pittsburgh, PA, and the National Veterans Wheelchair Games (NVWG) in San Antonio, TX. PARTICIPANTS: Seventeen people participated, all of whom used electric-powered wheelchairs as their primary means of mobility. INTERVENTION: Each subject was asked standarized questions about self and wheelchair use. Data logger and sensor installed on wheelchair. Data downloaded from logger. MAIN OUTCOME MEASURES: Speed, distance traveled, and the time that each subject's personal wheelchair was being driven were recorded for 24hr/d over approximately 5 days for each subject by using a custom-built data logger. RESULTS: The NVWG group traveled faster than the Pittsburgh group, but this difference was only statistically significant on the first day. The NVWG group was more likely to travel longer than the Pittsburgh group with significant differences seen in day 4 (P = .03) and day 5 (P = .05). Total distance traveled during the 5-day period and average distance traveled per day were also significantly different between the groups (P = .02 for both 5-day distance and daily distance), with the NVWG group traveling longer (17,164 +/- 8708m) when compared with the Pittsburgh group (8335 +/- 7074m) over the 5-day period. Both distance traveled and speed increased during afternoon and evening hours. The maximum distance traveled by any subject for each hour across the 2 groups was used to create the theoretic maximum distance day, which resulted in 7970m of driving. CONCLUSION: Drivers of electric-powered wheelchairs are most active during the afternoon and evening hours. Over the 5-day period of this study, there was little variation in the speed or distance driven per day. The subjects participating in the NVWG were more active than their counterparts during a typical week at home. The maximum theoretic distance that a wheelchair user in our group would travel is less than 8km. The range of current electric-powered wheelchairs appears adequate, if not generous, for the subjects in our study.

Activities of Daily Living↗

PubMed2002

Propulsion patterns and pushrim biomechanics in manual wheelchair propulsion.

OBJECTIVES: To classify stroke patterns of manual wheelchair users and to determine if different patterns of propulsion lead to different biomechanics. DESIGN: Case series. SETTING: Biomechanics laboratory. PARTICIPANTS: Thirty-eight individuals with paraplegia who use manual wheelchairs for mobility. INTERVENTION: Subjects propelled their own wheelchair on a dynamometer at 2 different steady state speeds. Bilateral biomechanical data were obtained by using a force and moment sensing pushrim and a motion analysis system. MAIN OUTCOME MEASURES: The propulsive stroke of each participant for each speed and side was classified as following 1 of 4 patterns. These 4 patterns were then compared by using a mixed-model analysis of variance. The biomechanical variables that were compared were cadence, peak and rate of rise of the resultant force, mechanical effective force, push angle, and ratio of time spent pushing to time in recovery. RESULTS: The most common propulsive stroke involved the user lifting the hand over the pushrim during the recovery phase. The stroke pattern was independent of axle position and varied from side to side and between speeds. After controlling for subject characteristics, significant differences were observed between stroke patterns in cadence and ratio of time spent pushing to time in recovery. A stroke pattern that involves using a semicircular motion with the hand below the pushrim during the recovery phase of the propulsion stroke was associated with a lower cadence and more time spent in the push phase relative to the recovery phase. CONCLUSION: The semicircular motion of propulsion displayed characteristics consistent with reduced repetition and more efficient propulsion. Use of this propulsion style may reduce trauma to the upper extremities. Clinicians should consider training individuals in this propulsion style.

Adult↗

PubMedDate not supplied

Filter frequency selection for manual wheelchair biomechanics.

Wheelchair locomotion is an important form of mobility for many individuals with spinal cord injury. However, manual wheelchair propulsion can lead to upper-limb pain and can be very inefficient. This has led investigators to apply biomechanics to the study of wheelchair use. The objectives of this study were (1) to determine the frequency content of the motion of both hands during two speeds of wheelchair propulsion, (2) to obtain the filter frequencies necessary to remove noise from wheelchair motion data, and (3) to provide signal-to-noise ratio data for wheelchair kinematics. The participants in this study were a random sample of manual wheelchair users with paraplegia caused by spinal cord injury. Subjects propelled their personal wheelchairs on a computer-controlled dynamometer at speeds of 0.9 m/s and 1.8 m/s. Motion data were collected at 60 Hz with the use of a commercial infrared marker-based system. The main outcome measures were arm motions and noise frequency spectra, filter cutoff frequencies, and signal-to-noise ratio. Our results indicate that there is no useful signal power above 6 Hz during manual wheelchair propulsion at the speeds that we analyzed. In many cases, there was no useful signal power above 4 Hz. This would indicate that the frequency content of manual wheelchair propulsion is similar to that of human gait. The mean signal-to-noise ratio varied from a high of 91 dB to a low of 21.8 dB. The signal-to-noise ratio was greatest in the x direction (along the line of progression) and lowest in the z direction (medial-lateral). Manual wheelchair propulsion kinematic data should be low-pass filtered at approximately 6 Hz for speeds at or below 1.8 m/s. The data presented in the archival literature appear to have been filtered at an appropriate frequency.

Adult↗