Handrim wheelchair propulsion training effect on overground propulsion using biomechanical real-time visual feedback. Influence of training on biomechanics of wheelchair propulsion. Physical capacity after 7 weeks of low-intensity wheelchair training Effects of hybrid cycling versus handcycling on wheelchair-specific fitness and physical activity in people with long-term spinal cord injury: a 16-week randomized controlled trial Wheelchair skills training program: A randomized clinical trial of wheelchair users undergoing initial rehabilitation. Power-assisted wheels ease energy costs and perceptual responses to wheelchair propulsion in persons with shoulder pain and spinal cord injury. Lower limb power rehabilitation (LLPR) using interactive video game for improvement of balance function in older people. The COSTAR wheelchair study: a two-centre pilot study of self-propulsion in a wheelchair in early stroke rehabilitation Physical work capacity after 7 wk of wheelchair training: effect of intensity in able-bodied subjects. Locomotor Training Approaches for Individuals with Spinal Cord Injury: A Preliminary Report of Walking‐related Outcomes The use of a simulated environment (easy street) to retrain independent living skills in elderly persons: a randomized controlled trial. Combination training and resistance training as effective interventions to improve functioning in elders. Exercise training in COPD: how to distinguish responders from nonresponders. An exercise trial for wheelchair users: project workout on wheels. Increased velocity exercise specific to task training versus the National Institute on Aging's strength training program: changes in limb power and mobility. Comparison of training methods to improve walking in persons with chronic spinal cord injury: a randomized clinical trial A randomized controlled pilot study assessing the feasibility of combined motor–cognitive training and its effect on gait characteristics in the elderly
OBJECTIVE To compare the effects of 2 manual wheelchair propulsion training programs on h and rim kinetics , contact angle , and stroke frequency collected during overground propulsion . DESIGN R and omized controlled trial comparing h and rim kinetics between 3 groups : a control group that received no training , an instruction-only group that review ed a multimedia presentation , and a feedback group that review ed the multimedia presentation and real-time visual feedback . SETTING Research laboratory . PARTICIPANTS Full-time manual wheelchair users ( N=27 ) with spinal cord injury living in the Pittsburgh area . INTERVENTIONS Propulsion training was given 3 times over 3 weeks , and data were collected at baseline , immediately after training , and at 3 months . MAIN OUTCOME MEASURES Contact angle , stroke frequency , peak result ant force , and peak rate of rise of result ant force . RESULTS Both feedback and instruction-only groups improved their propulsion biomechanics across all surfaces ( carpet , tile , and ramp ) at both target and self-selected speeds compared with the control group . While controlling for velocity , both intervention groups showed long-term reductions in the peak rate or rise of result ant force , stroke frequency , and increased contact angle . CONCLUSIONS Long-term wheelchair users in both intervention groups significantly improved many aspects of their propulsion technique immediately after training and 3 months from baseline . Furthermore , training with a low-cost instructional video and slide presentation was an effective training tool alone A quasi-experimental longitudinal design was used to compare pre- and posttraining biomechanical and physiological characteristics of wheelchair propulsion in manual wheelchair users ( MWCU ) across fresh and fatigue states . An instrumented wheelchair ergometer , 3D motion analysis , and computerized open-circuit spirometry were used to collect joint kinetics and kinematics , h and rim kinetics , propulsion temporal characteristics , and oxygen uptake pre- and posttraining during a submaximal exercise test to exhaustion . Each subject ( n = 19 ) participated in a specific intervention program of supervised therapeutic exercise ( strengthening , stretching , and aerobic exercise ) for 6 weeks . Pre- and posttraining measurements were compared with the use of ANOVA with repeated measures . Significant training effects included increased exercise loads for all strengthening activities , decreased stroke frequency , increased maximum elbow extension angle , increased trunk and shoulder flexion/extension range of motion ( ROM ) , increased h and rim propulsive moment , increased wrist extension moment , and increased power output . Results suggest that this training program increased biomechanical economy ( as defined by propulsive moment ) without increasing shoulder or elbow joint stresses Purpose . To simulate the effect of low-intensity exercise in early rehabilitation , we investigated the effect of a 7-week low-intensity norm duration h and rim wheelchair training on the physical capacity in untrained able-bodied individuals . Method . Twenty-five able-bodied participants were r and omly assigned to an experimental and control group : 10 participants exercised 7 weeks , three times a week at 30 % heart rate reserve ( HRR ) for 30 min ( experimental group ) . The control group consisted of  15 participants who did not receive training .  Physical capacity ( maximal isometric strength , sprint power , peak power output and peak oxygen uptake ) and submaximal performance [ heart rate ( HR ) , oxygen uptake ( VO2 ) , mechanical efficiency ( ME ) ] were assessed pre- and post-training . The levels of upper-body discomfort were determined with the use of a Local Perceived Discomfort scale . Results . Compared to the control group the experimental group significantly improved on sprint power ( + 31.2 % ) , peak aerobic power output ( + 34 % ) , submaximal HR , VO2 and ME ( + 16.9 % ) . The participants did not experience high levels of local discomfort in the upper body during the training . Conclusions . Low-intensity norm duration h and rim wheelchair training which significantly improved peak aerobic and sprint power output , efficiency and physical strain in able-bodied untrained individuals . Training at 30 % HRR ( 3 × /week , 30 min/session ) may be appropriate in untrained individuals , such as novice wheelchair users at the start of their rehabilitation , to prevent early fatigue and overuse and enhance motivation . Please note that this article was published in error in a previous issue of the Journal . This paper was su bmi tted and accepted as part of the Special Issue entitled 4th International State-of-the-art-Congress ‘ Rehabilitation : Mobility , Exercise & Sports ’ and has therefore been republished in this issue . The publisher apologises for this error Study design : This is an open r and omized controlled trial . Objective : The objective of this study was to investigate the effects of a 16-week hybrid cycle versus h and cycle exercise program on fitness and physical activity in inactive people with long-term spinal cord injury ( SCI ) . Setting : The study was conducted in two rehabilitation centers with a specialized SCI unit . Methods : Twenty individuals ( SCI⩾8 years ) were r and omly assigned to a hybrid cycle ( voluntary arm exercise combined with functional electrical stimulation (FES)-induced leg exercise ) or a h and cycle group . During 16 weeks , both groups trained twice a week for 30 min at 65–75 % heart rate reserve . Outcome measures obtained before , during and after the program were fitness ( peak power output , peak oxygen consumption ) , submaximal VO2 and heart rate ( HR ) , resting HR , wheelchair skill performance time score ) and physical activity ( distance travelled in wheelchair and Physical Activity Scale for Individuals with Physical Disabilities ( PASIPD ) score ) . Changes were examined using a two-factor mixed- measures analysis of variance . Results : For all fitness parameters , except for submaximal VO2 , no interaction effects were found . The hybrid cycle group showed a decrease in VO2 over time in contrast to the h and cycle group ( P=0.045 ) . An overall reduction in HRrest ( 5±2 b.p.m . ; P=0.03 ) and overall increase in PASIPD score ( 6.5±2.1 ; P=0.002 ) were found after 16 weeks of training . No overall training effects were found for the other fitness and activity outcome measures . Conclusion : In the current study , hybrid cycling and h and cycling showed similar effects on fitness and physical activity , indicating that there seem to be no additional benefits of the FES-induced leg exercise over h and cycle training alone OBJECTIVE To test the hypothesis that a brief , formalized period of additional wheelchair skills training is safe and results in significantly greater improvements in wheelchair skills performance than a st and ard rehabilitation program . DESIGN R and omized controlled trial . SETTING Rehabilitation center . PARTICIPANTS Thirty-five wheelchair users ( 20 with musculoskeletal disorders , 15 with neurologic disorders ) admitted for initial rehabilitation . Subjects ' mean age + /- st and ard deviation ( SD ) was 59+/-18.3 years . INTERVENTION Subjects r and omly allocated to the treatment group participated in the Wheelchair Skills Training Program ( WSTP ) , averaging 4.5+/-1.5 training sessions , each 30 minutes long . Subjects in the control group did not receive any wheelchair skills training beyond that given in a typical rehabilitation stay . MAIN OUTCOME MEASURES Wheelchair Skills Test ( WST ) , version 2.4 , before and after training . Changes in total percentage WST score and individual skill scores were examined . RESULTS There were no adverse incidents . The control group 's mean percentage score + /- SD increased from 60.1%+/-14.4 % to 64.9%+/-13.3 % , an 8 % improvement of the posttest relative to the pretest ( P=.01 ) . The WSTP group 's mean score increased from 64.9%+/-9.4 % to 80.9%+/-5.6 % , a 25 % improvement of the posttest relative to the pretest ( P<.000 ) . The WSTP group showed significantly greater improvements than the control group ( P<.000 ) . Among the specific skills , significantly greater improvements were seen in the WSTP group for the gravel and high-curb descent skills ( P<.001 ) . CONCLUSIONS The WSTP is safe and practical and has a clinical ly significant effect on the independent wheeled mobility of new wheelchair users . These findings have implication s for the st and ards of care in rehabilitation programs OBJECTIVE Test effects of pushrim-activated power-assisted wheelchairs ( PAPAWs ) on the energetics and perceptual responses to steady-state and intensity- grade d wheelchair propulsion in persons with paraplegia and tetraplegia having chronic shoulder pain . DESIGN Test , retest with a control condition . SETTING Academic medical center . PARTICIPANTS Subjects ( N=18 ) aged 19 to 70 years with chronic , motor-complete paraplegia and tetraplegia having confirmed shoulder pain . INTERVENTIONS Study participants underwent testing on 4 r and omized nonconsecutive days during either 6 minutes of steady-state or 12 minutes of intensity- grade d wheelchair propulsion on stationary rollers . Participants used their own manual wheelchair and either their customary wheels or power-assist wheels attached with an axle bracket . MAIN OUTCOME MEASURES Oxygen consumption ( V(.)O2 , L/min ) , distance ( m ) , energy cost ( L/m ) , and ratings of perceived exertion ( RPE ; Borg Categorical 6 - 20 Scale ) were measured during propulsion . RESULTS Significant main effects of testing were observed for V(.)O2 , heart rate , and RPE in both subject groups . Distances propelled were significantly increased in both groups across both tests and in each of their 2-minute exercise stages . CONCLUSIONS Use of PAPAWs by persons with paraplegia and tetraplegia having shoulder pain significantly lowers energy cost responses and perceived exertion compared with manual wheelchair propulsion while significantly increasing the distanced propelled Declined balance functions have adverse effects on elderly population .  Lower limbs muscle power training is currently an emerging concept in rehabilitation on individuals with decreased balance and mobility . In this prospect i ve , controlled study , we used a human-computer interactive video-game-based rehabilitation device ( LLPR ) for training of lower limb muscle power in the elderly . Forty ( aged > 65 years ) individuals were recruited from the community . Twenty participants in the exercise group received 30-min training , twice a week , using the LLPR system . The LLPR system allows participants to perform fast speed sit-to-st and ( STS ) movements . Twenty age-matched participants in the control group performed slow speed STS movements , as well as strengthening and balance exercises , with the same frequency and duration . The results were compared after 12 sessions ( 6 weeks ) of training . The mechanical and time parameters during STS movement were measured using the LLPR system . Modified falls efficacy scale ( MFES ) , Tinetti Performance-Oriented Mobility Assessment ( POMA ) , function reach test , five times sit to st and ( FTSS ) and Timed Up and Go ( TUG ) were administered to participants as clinical assessment s. Results showed that in the exercise group , all the mechanical and time parameters showed significant improvement . In control group , only the maximal vertical ground reaction force ( MVGRF ) improved significantly . For clinical assessment s ( balance , mobility , and self-confidence ) , exercise group showed significantly better scores . The STS movements in video-game-based training mimic real life situations which may help to transfer the training effects into daily activities . The effectiveness of lower limb muscle training is worthy of further investigation Objective : It is uncertain whether self-propulsion in a wheelchair should be encouraged or discouraged in the early stages of stroke rehabilitation . Design : A two-centre pilot study to assess the feasibility of performing a multicentre r and omized controlled trial on this subject . Setting : Clatterbridge and Aintree Stroke Rehabilitation Units , Merseyside , UK . Subjects : Forty early stroke patients ( mean age 67 years ) in whom it was uncertain whether self-propulsion in a wheelchair should be encouraged were studied . Intervention : A central r and omization service at Newcastle University was used to determine the policy about wheelchair provision and use for each patient . They were allocated to either an ‘ encouraged to self-propel ’ or a ‘ discouraged from self-propulsion group ’ . Outcome measures used : Independent outcome assessment was performed by postal question naire and telephone interview using the Barthel ADL Scale , Nottingham Extended ADL Scales and the shortened General Health Question naire ( GHQ-12 ) at 3 and 12 months . Patient 's length of stay and their Ashworth tone score were also measured either at three months or when they were discharged from hospital . Results : After considerable preparation time it was possible to conduct a trial on self-propulsion in early stroke rehabilitation in the two-pilot centres . No major differences were found between the pilot groups for any of the outcome measures . Conclusions : A multicentre r and omized controlled trial to assess this question is feasible but further work is being conducted before proceeding , to satisfy the concerns expressed to our group regarding the appropriateness of the intervention and the outcome measures . Address for correspondence : JA Barrett , Clatterbridge Hospital , Wirral , Merseyside CH69 4JY , UK . e-mail : PURPOSE The purpose of this study was to study the effects of a 7-wk wheelchair training program on physical work capacity in able-bodied subjects . Effects of training intensities of 50 and 70 % heart rate ( HR ) reserve ( HRR ) were studied for different subject groups . METHODS Twenty-seven able-bodied male subjects participated in this study . They were r and omly divided into a control group ( N = 8) , a 50%-intensity group ( N = 9 ) , and a 70%-intensity group ( N = 10 ) . The 50%- and the 70%-intensity groups received a 7-wk wheelchair training program : three times a week , one-half hour wheelchair exercise on a motor driven treadmill at an average intensity of 50 and 70 % of the HRR , respectively . Before and after the training period , parameters for physical work capacity ( maximal isometric strength ( Fiso ) , sprint power ( P30 ) , maximal power output ( POmax ) and peak oxygen uptake ( VO2peak ) ) , and submaximal performance ( mechanical efficiency , HR ) at 20 and 40 % of the estimated POmax ( ME20 , ME40 ; HR20 , HR40 ) were obtained during tests on a stationary wheelchair ergometer . RESULTS A two-factor ANOVA for repeated measures on the within-subjects factor " pre-post tests , " the between-subject factor training ( 50 % and 70 % training vs control ) and the interaction term showed that the 50%-intensity group significantly increased on P30 and POmax compared with the control group . The 70 % intensity group significantly increased on P30 , POmax and VO2peak compared with the control group ( P < 0.05 ) . The 70 % group did not show significantly higher increases in P30 and POmax over training than the 50 % intensity . No significant effects were found for the Fiso and the parameters at submaximal PO . CONCLUSIONS The wheelchair training at both intensities can have favorable effects on maximal physical work capacity in able-bodied subjects , and possibly also on mechanical efficiency at submaximal power output . Effects are seen in parameters for both aerobic and anaerobic work capacities . Although training at 70 % intensity was more effective than the 50 % intensity , training at 50 % HRR may initially be more appropriate in untrained individuals , such as novice wheelchair users at the start of their rehabilitation , to prevent fatigue and enhance motivation Background and Purpose Body weight supported ( BWS ) locomotor training improves overground walking ability in individuals with motor-incomplete spinal cord injury ( SCI ) . While there are various approaches available for locomotor training , there is no consensus regarding which of these is optimal . The purpose of this ongoing investigation is to compare outcomes associated with these different training approaches . Subjects and Methods Twenty-seven subjects with chronic motor-incomplete SCI have completed training and initial and final testing at the time of this preliminary report . Subjects were r and omly assigned to 1 of 4 different BWS assisted-stepping groups , including : ( 1 ) treadmill training with manual assistance ( TM ) , ( 2 ) treadmill training with stimulation ( TS ) , ( 3 ) overground training with stimulation ( OG ) , or ( 4 ) treadmill training with robotic assistance ( LR ) . Prior to and following participation we assessed walking-related outcome measures including overground walking speed , training speed , step length , and step symmetry . Results Data pooled across all subject groups showed a significant effect of training on walking speed . While the differences between groups were not statistically significant , there was a trend toward greater improvement in the TS and OG groups . Post hoc subgroup analysis of outcomes from subjects with slower initial walking speed ( < 0.1 m/s ; n = 15 ) compared to those with faster initial walking speeds ( ≥ 0.1 m/s ; n = 12 ) identified meaningful differences in outcomes with walking speed increasing by 85 % in the slower group and by only 9 % in the faster group . Step length of both stronger and weaker limb increased in all groups with the exception of those in the LR group . Step symmetry was increased in the TM and LR groups . Discussion and Conclusion These results represent preliminary findings of changes in walking-related function associated with different forms of BWS locomotor training for individuals with chronic , motor-incomplete SCI . Early data indicates that locomotor outcomes in these individuals appear to be comparable across training approaches . For the individuals in this study sample , those with the greatest deficits in walking function benefitted the most from locomotor training BACKGROUND Older adults who receive training for functional skills in context ually appropriate environments may show greater functional improvement than persons trained in a traditional environment . Functionally limited older adults receiving training in context ually appropriate environments ( simulated home and community setting s ) may show greater improvement in activities of daily living ( ADL ) than persons trained in a traditional manner . METHODS Eighty-eight patients from a day hospital , aged 65 years or older , were r and omized to either receive rehabilitation in a simulated environment ( Easy Street ) or in a gymnasium setting . Rehabilitation focused on retraining functional skills in a context ually appropriate environment ( Easy Street ) or in a traditional setting ( gymnasium ) using motor learning principles for a period of 16 weeks . Outcome measures included the Structured Assessment of Instrumental Living Skills ( SAILS ) , a performance measure with criterion and timed components ; a self-report health status question naire , the Short Form-36 ( SF-36 ) ; and the patient-orientated goal -directed Canadian Occupational Performance Measure ( COPM ) . RESULTS There were no group differences on any of the outcome measures : SAILS ( p = .3 ) ; the SF-36 physical ( p = .83 ) and mental ( p = .51 ) ; and the COPM performance scale ( p = .94 ) and satisfaction scale ( p = .40 ) . CONCLUSIONS Although we have not excluded benefits of context ually appropriate rehabilitation environments with different intervention approaches , at different stages of rehabilitation or with patients at higher functional levels , our results suggest the appropriateness of a moratorium on these expensive interventions pending demonstration of clear positive effects determined from further study The purpose of the study was to determine whether resistance training ( RT ) or a combination of resistance and aerobic training ( CT ) result ed in the most improvement in measures of functional ability in functionally limited elders . Elderly adults who exhibited some limits in functional ability were r and omly assigned to either a CT , RT , or control ( C ) group . Both RT and CT exercised three times per week for 16 weeks . At Weeks 0 and 17 , participants completed six measures of strength and six functional tests . A 3 ( group ) x 3 ( time ) ANOVA with repeated measures on the time factor was used to analyze the results . CT and RT scored significantly better than C at Week 17 for biceps curl , elbow extension , chair st and , and time up the stairs . These findings demonstrate that RT and CT are both effective at increasing measures of strength and functional ability in elderly adults who begin exercise with functional limitations PURPOSE Pulmonary rehabilitation programs consistently have improved exercise capacity , quality of life , and symptoms over the past decade . Although training has been shown to be an essential component of the rehabilitation program , individual patients do not always benefit to the same extent . The present study was design ed to investigate which patients were achieving significant benefit of exercise training . METHODS Forty-nine stable out patients with moderate to severe COPD ( FEV1 37 (15)%pred ) were evaluated before and after 12 weeks of exercise training ( 3 times per week ) . Responders in exercise capacity were defined as having 15 % increase in maximal workload and /or 25 % increase in walking distance , while responders in quality of life showed an improvement of at least 10 points on the chronic respiratory disease question naire . With multivariate discriminant analysis , responders were distinguished from nonresponders based upon their initial characteristics . RESULTS Thirty-two patients were responders in terms of improved exercise capacity . Ventilatory reserve ( VE/MVV ) , inspiratory muscle strength ( Plmax ) , and peripheral muscle strength ( h and grip force and quadriceps force ) were significant predictors of the training response ( P < 0.05 ) ( accuracy 80 % P < 0.001 ) . Although the explained variance was modest , patients that were clearly ventilatory limited and had normal skeletal muscle strength were not likely to benefit from exercise training in terms of exercise capacity . No physiologic variables predicted whether a patient would increase quality of life after exercise training . CONCLUSION Patients with reduced exercise capacity who experience less ventilatory limitation to exercise and more reduced respiratory and peripheral muscle strength  are more likely to improve with exercise training . Improvements in quality of life after exercise training were significant but remained unpredictable with variables included in the present trial There is growing interest in promoting health for people with disabilities , yet evidence regarding community-based interventions is sparse . This paper describes the design details of a r and omized controlled trial ( RCT ) that will test the effectiveness of a multi-component behaviorally based , intervention to promote exercise adoption ( over 6 months ) and maintenance ( up to one year ) among wheelchair users and includes descriptive data on participant characteristics at baseline . Participants were r and omly assigned to either a staff-supported intervention group or a self-guided comparison group . The primary study aim is to assess the effectiveness of the multi-component behaviorally based intervention for promoting physical activity adoption and maintenance . The RCT will also assess the physical and psychosocial effects of the intervention and the complex interplay of factors that influence the effectiveness of the intervention . Therefore , the primary outcome derives from participant reports of weekly exercise ( type , frequency , duration ) over 52 weeks . Secondary outcomes collected on four occasions ( baseline , 3 months , 6 months , 12 months ) included physiological outcomes ( VO(2 ) peak , strength ) , disability-related outcomes ( pain , fatigue , participation ) , and psychosocial outcomes ( exercise self-efficacy , exercise barriers , quality of life , depression , mood ) . This study will provide evidence regarding the effectiveness of a multi-component behaviorally based intervention for promoting exercise adoption among people with mobility impairments that necessitate wheelchair use BACKGROUND This study was design ed to evaluate the benefits of InVEST ( Increased Velocity Specific to Task ) training on limb power and mobility among mobility-limited older adults . METHODS We conducted a single blinded , r and omized controlled trial among 138 mobility-limited community-dwelling older adults , evaluating two 16-week supervised exercise programs . The intervention group participated in InVEST training , and the control group participated in the National Institute on Aging 's ( NIA ) strength training program . Primary outcomes were changes in limb power per kilogram and mobility performance as measured by the Short Physical Performance Battery ( SPPB ) . RESULTS After 16 weeks , InVEST produced significantly greater improvements in limb power than NIA ( p=.02 ) . There was no significant difference in strength improvements . Both groups had significant changes in SPPB of greater than 1 unit . Self-reported function was also significantly improved in both groups . Differences between groups were not statistically different . In a post hoc analysis when participants were categorized by the manifestation of baseline leg velocity impairments ( N=68 ) , InVEST training produced effect size differences in SPPB that were clinical ly meaningful ( SPPB Group x Time difference 0.73 units , p=.05 ) . CONCLUSIONS Among mobility-limited older adults , both NIA and InVEST produce robust changes in observed physical performance and self-reported function . These improvements were not meaningfully different by statistical or clinical criteria . Compared with NIA , InVEST training produced greater improvements in limb power and equivalent improvements in strength . Observed differences between NIA and InVEST based upon baseline leg impairment status are informative for futures studies Abstract Objective To compare two forms of device-specific training – body-weight-supported ( BWS ) ambulation on a fixed track ( TRK ) and BWS ambulation on a treadmill ( TM ) – to comprehensive physical therapy ( PT ) for improving walking speed in persons with chronic , motor-incomplete spinal cord injury ( SCI ) . Methods Thirty-five adult subjects with a history of chronic SCI ( > 1 year ; AIS ‘ C ’ or ‘ D ’ ) participated in a 13-week ( 1 hour/day ; 3 days per week ) training program . Subjects were r and omized into one of the three training groups . Subjects in the two BWS groups trained without the benefit of additional input from a physical therapist or gait expert . For each training session , performance values and heart rate were monitored . Pre- and post-training maximal 10-m walking speed , balance , muscle strength , fitness , and quality of life were assessed in each subject . Results All three training groups showed significant improvement in maximal walking speed , muscle strength , and psychological well-being . A significant improvement in balance was seen for PT and TRK groups but not for subjects in the TM group . In all groups , post-training measures of fitness , functional independence , and perceived health and vitality were unchanged . Conclusions Our results demonstrate that persons with chronic , motor-incomplete SCI can improve walking ability and psychological well-being following a concentrated period of ambulation therapy , regardless of training method . Improvement in walking speed was associated with improved balance and muscle strength . In spite of the fact that we withheld any formal input of a physical therapist or gait expert from subjects in the device-specific training groups , these subjects did just as well as subjects receiving comprehensive PT for improving walking speed and strength . It is likely that further modest benefits would accrue to those subjects receiving a combination of device-specific training with input from a physical therapist or gait expert to guide that training Objective : ( 1 ) To develop a motor – cognition training programme ; ( 2 ) to evaluate the ability to recruit and retain elderly people ; ( 3 ) to assess the effects of the interventions . Design : Pilot r and omized controlled trial . Setting : Assisted living facility . Participants : Sixteen subjects ( 11 female ) living in an assisted living facility were r and omized to a motor or motor – cognition group . Interventions : Both groups received machine-driven strength training and balance exercises for 45 minutes , twice weekly , for 12 weeks . In addition , the motor – cognition group received computerized training for attention 3–5 times per week for 10 weeks . Main outcome measures : Baseline and post-intervention ( 12 weeks ) assessment s focused on recruitment , attrition and adherence . Secondary outcome measures assessed dual-task costs of gait ( velocity , cadence , step time , step length ) , exp and ed timed get-up- and -go , falls efficacy and reaction time . Results : Of 35 subjects initially approached , 16 started and 14 completed the study , result ing in 46 % recruitment , 19 % attrition and > 80 % adherence rates . There is more evidence of altered levels in the motor – cognitive treatment group with significant differences in average change for fear of falling ( P = 0.017 ) and foot reaction time ( P = 0.046 ) . No statistical significance was reached for gait parameters . Conclusions : Motor – cognition training is feasible and shows trends to stronger improvement in walking and reaction time . The application in a main study is deemed feasible . A minimum of ±55 subjects per group are required to achieve a power of 80 % at the 5 % level of significance based on step length and considering the expectable attrition rate in a required larger scale study
Conclusion : Exercise training programs seem to be effective in improving wheelchair propulsion capacity .
However , there is remarkably little research , particularly for individuals who do not have spinal-cord injury
Objective : An adequate wheelchair propulsion capacity is required to perform daily life activities .
Exercise training may be effective to gain or improve wheelchair propulsion capacity .
This review investigates whether different types of exercise training programs are effective in improving wheelchair propulsion capacity .