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No. 307 The Impact of Wheelchair Provision in a Less Resourced Setting
PM&R
motor impairments in the state of Chihuahua, Mexico. Design: Cohort study. Setting: Non-profit organization helping children with disabilities. Participants: Children with disabilities such as cerebral palsy, hip dysplasia, myelomeningocele, scoliosis and clubfoot who present with motor impairments. Interventions: A database was formed from data collected first by chart review and then phone interview using a standardized questionnaire. Data collected included the type of assistive technology devices required. The interview also evaluated the acquisition method of these devices and the numbers of patients that still need devices but lack access to them. The interview was recorded and an informed consent was previously required. Main Outcome Measures: The data were analyzed by an epidemiological software. Level of Evidence: Level 2. Results: As the population of this study contains a heterogeneous group of diseases, it is important to organize the results by disease. The interview results show that out of 42 patients with cerebral palsy, 58.5% need an assistive device. Out of the 52 patients with hip dysplasia, 17.3% need an assistive device. The entire population with myelomeningocele showed a need for assistive devices. Out of 18 patients with scoliosis, 27.8% need external assistance and out of 42 clubfoot patients, 30% need an assistive device. Lastly 33.5% of the remaining 111 patients who have other diseases need an assistive device. The major acquisition form of these devices by those who had them was 42.4% by direct purchase and 57.6% by donation or loan. Conclusions: A substantial need for assistive devices by children with motor disabilities exists. A lack of rehabilitation engineering decreases the availability of such devices thereby increasing their price. The patients and their families often cannot afford what is available to them.
Vol. 6, Iss. 8S2, 2014
S153
No. 307 The Impact of Wheelchair Provision in a Less Resourced Setting. Maria Luisa Toro; Jonathan Pearlman, PhD. Disclosure: None. Objective: To investigate the impact of wheelchairs (WC) provided to individuals with mobility impairments and how the WC provided relates to WC breakdown measures of participation, quality of life, health status, and WC skills. Design: Controlled longitudinal study. Setting: WC provision centers in Yogyakarta, Indonesia. Participants: 323 people with mobility impairments (and their caregiver when applicable) were interviewed. 146 received a WC and 177 were on a waiting list for one. Interventions: A WC provided with associated services compliant with World Health Organization 8 Steps WC Service Provision. Main Outcome Measures: Baseline and approximately 6-month follow up were taken. Demographics information Craig handicap assessment reporting technique, short form wheelchair assessment checklist, World Health Organization WHOQOL-BREF, functional mobility assessment, and wheelchair skills test questionnaire translated into Bahasa Indonesia. Level of Evidence: 2. Results: 165 had cerebral palsy, 44 spinal cord injury, 28 post polio, and 86 other conditions. Of those who received a WC, 62 received a pediatric WC, 46 a rough terrain WC, 29 hospital-style WC, and 5 other type of WC. Impact of WC provision varied across WC type and between control and the intervention group and over the different time points. Conclusions: The findings from this study will inform efforts to improve the quality of WC and the WC provision process. They will also provide insight on the impact of WC provision on the quality of life of people with mobility impairments in a less resourced setting.
REHABILITATION IN HEMOPHILIA
No. 305 Energy Expenditure and Walking Speed in Lower Limb Amputees: An Old Problem Revisited Again. Teuta Osmani Vllasolli; Beti Zafirova; Ardiana Murtezani; Bukurije Rama. Study Design: Prospective cross-sectional. Study Background: Although there are many aspects of walking on which the clinician might focus, energy expenditure and walking speed often have been recommended for use as a measures of status and outcome. Objectives: The objective of this study was to measure the physiological cost index (PCI) and comfort walking speed (CWS) at three levels of lower limb amputation: transfemoral, transtibial, and at Syme level and the relation of these physiological variables with prosthetic ambulation supported with walking aids and stump length. Methods: The eighty-nine individuals with lower limb amputation for reason other than peripheral vascular disease (PVD) were recruited among patients at the Department of Prosthetics and Orthotics at the University Clinical Center of Kosovo. The PCI was assessed by five minutes of continuous indoor walking at CWS. Results: There were found significant differences in PCI (f¼29.87 p<0.001) and CWS (f¼19.33 p<0.001) between three amputation groups. Prosthetic ambulation supported with crutches showed an important impact in PCI (f¼35.1 p<0.001) and CWS (f¼28.42 p<0.001). Stump length resulted in significantly increased PCI (r¼0.53 p¼0.02) and reduced CWS (r¼0.58 p¼0.004) in transfemoral amputees. Conclusions: PCI and CWS were significantly determined by level of amputation and prosthetic walking supported by walking aids. Clinical relevance: From existing literature it is difficult to extrapolate the comparison of the energy cost of walking at three level amputation of lower limb. To our knowledge this is the first study comparing the energy expenditure in three levels of amputation: transfemoral, transtibial, and Syme due to reasons other than PVD.
No. 308 Effectiveness of Training Program in Open Waters Pool and Land Exercise in Adolescents With Hemophilic Arthropathy. Gibraltar Conde Aideé; Adolfina Berges García; Sergio Gadea Gómez; Miguel Angel Gutierrez Agama. Disclosure: None. Objective: To evaluate the effectiveness of a training program of swimming in open waters in the pool and land exercise. Setting: Training program in open waters pool and land exercise for 10 months. Participants: Adolescents with hemophilia A or B. Main Outcome Measures: Three measurements were made with scale hemophilia joint health score (HJHS 2.1). Evidence level: 2. Results: Of adolescents included 80% had hemophilia A (moderate and severe) and 20% hemophilia B (severe). The joints with the most damage were the elbows and ankles. There was a reduction in the HJHS 2.1 between the second and third measurements, statistically significant difference (p < 0.05). The items that showed significant differences were edema in elbows and muscle strength in ankles. Conclusions: The training program in open waters pool and land exercise are effective to decrease the severity of hemophilic arthropathy in adolescents.
REHABILITATION OF PATIENTS WITH SPINAL CORD INJURY No. 310 Gait Analysis in Children Affected By Myelomeningocele After Kinesiology Taping Method in Lower Extremities. Francisco Anaya; Hector Rentería; Karla Bustamante; Sandra Montes. Disclosure: None. Objective: To analyze the immediate effects on gait using kinesiology taping in lower limbs in children with
motor impairments in the state of Chihuahua, Mexico. Design: Cohort study. Setting: Non-profit organization helping children with disabilities. Participants: Children with disabilities such as cerebral palsy, hip dysplasia, myelomeningocele, scoliosis and clubfoot who present with motor impairments. Interventions: A database was formed from data collected first by chart review and then phone interview using a standardized questionnaire. Data collected included the type of assistive technology devices required. The interview also evaluated the acquisition method of these devices and the numbers of patients that still need devices but lack access to them. The interview was recorded and an informed consent was previously required. Main Outcome Measures: The data were analyzed by an epidemiological software. Level of Evidence: Level 2. Results: As the population of this study contains a heterogeneous group of diseases, it is important to organize the results by disease. The interview results show that out of 42 patients with cerebral palsy, 58.5% need an assistive device. Out of the 52 patients with hip dysplasia, 17.3% need an assistive device. The entire population with myelomeningocele showed a need for assistive devices. Out of 18 patients with scoliosis, 27.8% need external assistance and out of 42 clubfoot patients, 30% need an assistive device. Lastly 33.5% of the remaining 111 patients who have other diseases need an assistive device. The major acquisition form of these devices by those who had them was 42.4% by direct purchase and 57.6% by donation or loan. Conclusions: A substantial need for assistive devices by children with motor disabilities exists. A lack of rehabilitation engineering decreases the availability of such devices thereby increasing their price. The patients and their families often cannot afford what is available to them.
Vol. 6, Iss. 8S2, 2014
S153
No. 307 The Impact of Wheelchair Provision in a Less Resourced Setting. Maria Luisa Toro; Jonathan Pearlman, PhD. Disclosure: None. Objective: To investigate the impact of wheelchairs (WC) provided to individuals with mobility impairments and how the WC provided relates to WC breakdown measures of participation, quality of life, health status, and WC skills. Design: Controlled longitudinal study. Setting: WC provision centers in Yogyakarta, Indonesia. Participants: 323 people with mobility impairments (and their caregiver when applicable) were interviewed. 146 received a WC and 177 were on a waiting list for one. Interventions: A WC provided with associated services compliant with World Health Organization 8 Steps WC Service Provision. Main Outcome Measures: Baseline and approximately 6-month follow up were taken. Demographics information Craig handicap assessment reporting technique, short form wheelchair assessment checklist, World Health Organization WHOQOL-BREF, functional mobility assessment, and wheelchair skills test questionnaire translated into Bahasa Indonesia. Level of Evidence: 2. Results: 165 had cerebral palsy, 44 spinal cord injury, 28 post polio, and 86 other conditions. Of those who received a WC, 62 received a pediatric WC, 46 a rough terrain WC, 29 hospital-style WC, and 5 other type of WC. Impact of WC provision varied across WC type and between control and the intervention group and over the different time points. Conclusions: The findings from this study will inform efforts to improve the quality of WC and the WC provision process. They will also provide insight on the impact of WC provision on the quality of life of people with mobility impairments in a less resourced setting.
REHABILITATION IN HEMOPHILIA
No. 305 Energy Expenditure and Walking Speed in Lower Limb Amputees: An Old Problem Revisited Again. Teuta Osmani Vllasolli; Beti Zafirova; Ardiana Murtezani; Bukurije Rama. Study Design: Prospective cross-sectional. Study Background: Although there are many aspects of walking on which the clinician might focus, energy expenditure and walking speed often have been recommended for use as a measures of status and outcome. Objectives: The objective of this study was to measure the physiological cost index (PCI) and comfort walking speed (CWS) at three levels of lower limb amputation: transfemoral, transtibial, and at Syme level and the relation of these physiological variables with prosthetic ambulation supported with walking aids and stump length. Methods: The eighty-nine individuals with lower limb amputation for reason other than peripheral vascular disease (PVD) were recruited among patients at the Department of Prosthetics and Orthotics at the University Clinical Center of Kosovo. The PCI was assessed by five minutes of continuous indoor walking at CWS. Results: There were found significant differences in PCI (f¼29.87 p<0.001) and CWS (f¼19.33 p<0.001) between three amputation groups. Prosthetic ambulation supported with crutches showed an important impact in PCI (f¼35.1 p<0.001) and CWS (f¼28.42 p<0.001). Stump length resulted in significantly increased PCI (r¼0.53 p¼0.02) and reduced CWS (r¼0.58 p¼0.004) in transfemoral amputees. Conclusions: PCI and CWS were significantly determined by level of amputation and prosthetic walking supported by walking aids. Clinical relevance: From existing literature it is difficult to extrapolate the comparison of the energy cost of walking at three level amputation of lower limb. To our knowledge this is the first study comparing the energy expenditure in three levels of amputation: transfemoral, transtibial, and Syme due to reasons other than PVD.
No. 308 Effectiveness of Training Program in Open Waters Pool and Land Exercise in Adolescents With Hemophilic Arthropathy. Gibraltar Conde Aideé; Adolfina Berges García; Sergio Gadea Gómez; Miguel Angel Gutierrez Agama. Disclosure: None. Objective: To evaluate the effectiveness of a training program of swimming in open waters in the pool and land exercise. Setting: Training program in open waters pool and land exercise for 10 months. Participants: Adolescents with hemophilia A or B. Main Outcome Measures: Three measurements were made with scale hemophilia joint health score (HJHS 2.1). Evidence level: 2. Results: Of adolescents included 80% had hemophilia A (moderate and severe) and 20% hemophilia B (severe). The joints with the most damage were the elbows and ankles. There was a reduction in the HJHS 2.1 between the second and third measurements, statistically significant difference (p < 0.05). The items that showed significant differences were edema in elbows and muscle strength in ankles. Conclusions: The training program in open waters pool and land exercise are effective to decrease the severity of hemophilic arthropathy in adolescents.
REHABILITATION OF PATIENTS WITH SPINAL CORD INJURY No. 310 Gait Analysis in Children Affected By Myelomeningocele After Kinesiology Taping Method in Lower Extremities. Francisco Anaya; Hector Rentería; Karla Bustamante; Sandra Montes. Disclosure: None. Objective: To analyze the immediate effects on gait using kinesiology taping in lower limbs in children with