Toward understanding mechanisms of inadvertent lower extremity displacements from wheelchair footplates in Veterans with SCI/D: Multi-modal evaluation of leg movements during power wheelchair use.

NIH RePORTER · VA · I01 · · view on reporter.nih.gov ↗

Abstract

Veterans with sensorimotor deficits due to spinal cord injuries and disorders (SCI/D) and other neurological disorders often use power wheelchairs (PWC) for independent mobility. While PWC are critically important to improving quality of life, lower limb injuries can occur when the foot is not positioned properly on the footplate during PWC operation. In Veterans with SCI/D, sensory loss, paralysis, spasticity, contractures and obesity create barriers to recognizing and correcting lower limb mispositioning. Veterans with SCI/D have sustained fractures, abrasions, contusions, pressure injuries, and amputations after inadvertent lower extremity displacements (ILED) from their PWC foot plates, at an estimated system cost of $970,011 for the first 10 such Veterans admitted to the Cleveland VA SCI/D Center. Veterans Advocates with SCI/D report that ILEDs occur during transfers, pressure relief, colliding with objects, muscle spasms, and driving over rough terrain. PWC seating functions, like tilt and leg elevation, may misalign the feet on the footplate when returning to upright. Yet, there is little documentation of the root cause of lower extremity injuries in the medical record, and ILED incidence and prevalence are poorly described in the literature. No scientific reports of how the lower limbs move during WC operation have been identified. This important knowledge can guide interventions to prevent future foot displacements and subsequent injuries. The VA-patented FootSafe system of force and proximity sensors with a wirelessly-connected smart device was developed as an assistive technology to detect foot position relative to the PWC footplates and warn PWC users when an ILED occurs, thus empowering them to either reposition their legs to safety or call for help if needed. Other AT solutions also may be possible, however. Therefore, to create useful and accurate sensing algorithms in future, it is first critical to understand the potential range of ILEDs and whether different PWC user groups are more or less vulnerable to these events. As noted above, Persons with SCI/D can serve as an exemplar of PWC users with sensorimotor losses creating risk of ILEDs and subsequent injuries. This research project will use a 3 pronged approach to understanding lower limb movements and ILED occurrence during PWC mobility. Focus groups of Veterans with SCI/D, their caregivers, and seating specialists will be convened to advise on the ILEDs they are primarily concerned about, how much limb displacement is acceptable and when they feel corrections are required to prevent harm, to design terrains courses and determine PWC speeds needed to increase likelihood of capturing ILEDs during testing, and to reach consensus on what constitutes a clinically significant ILED and the needed sensitivity for detection by future algorithms. FootSafe will be used in combination with motion capture and depth camera technologies to compare the biomechanics and kinematics of lower li...

Key facts

NIH application ID
10999647
Project number
1I01RX003942-01A2
Recipient
LOUIS STOKES CLEVELAND VA MEDICAL CENTER
Principal Investigator
KATH BOGIE
Activity code
I01
Funding institute
VA
Fiscal year
2024
Award amount
Award type
1
Project period
2024-09-01 → 2028-08-31