Influence of dynamical, clinical and neuromotor measures in evaluating individuals with multiple sclerosis for manual wheelchair use.

摘要

Clinicans involved in the prescription of mobility devices for people with multiple sclerosis (MS) do not have research-based criteria to assist them in choosing the appropriate mobility device. Four studies were conducted to investigate clinical measures for determining the appropriateness of a manual wheelchair (MW) prescription. The first of these studies provided a review of the current status of mobility devices for people with MS. The second study considered the pushrim dynamics of people with MS compared to control groups. In general, individuals with MS were not able to attain a speed of 1m/s and fatigued more quickly. Propulsion technique and braking during hand-to-pushrim contact and release were found to be responsible for reduced speed. In the third study, the relationship of commonly used clinical examination techniques (Modified Ashworth Scale (MAS) and manual muscle testing (MMT)) were compared to indicators of the ability to push a MW (passive range-of-motion resistance torque, isokinetic and isometric strength) and a MS specific disability scale (Guys Neurological Disability Scale - GNDS). The MAS and MMT were shown to describe the majority of subjects with MS as having no impairment whereas the indicators demonstrated a range of ability level. Research into revising the MAS and MMT are proposed as well as development of new methods for evaluating spasticity and strength. The final study explored the statistical relationships between measures indicative of strength, coordination, disability level and kinematic and kinetic measures indicative of the ability to push a MW. Regression analysis found the upper extremity domain score of the GNDS to be highly related to maximum propulsion velocity (r2 = .68) and axle moment (r 2 = .61). Recommendations when considering a MW include not relying the MAS and MMT as indicators, but instead administering the GNDS upper extremity domain questionnaire and having the client perform a trial of propulsion at 1m/s. During the propulsion trial, the clinician should pay particular attention to the propulsion technique, hand-to-pushrim braking during contact and release and the ability to achieve a speed of 1m/s. In considering the outcome of this evaluation protocol, the clinician is more grounded in their recommendation for or against the use of a MW.