Skills on Wheels: Development of a Pediatric Upper Extremity Pain Assessment, a Play-based Home Exercise Program, and Best Practices for Wheelchair Propulsion

Abstract

Skills on Wheels, a program based in Indianapolis, Indiana provides pediatric manual wheelchair users ranging from ages 6 to 17 with the chance to learn essential wheelchair skills important for daily use at home and in the community. The impact that manual wheelchair use has on a participant’s upper extremities, which are crucial for a participant’s ability to live their lives independently and have the best quality of life when engaging in Activities of Daily Living (ADLs)/Instrumental Activities of Daily Living (IADLs)/play continues to deserve further attention. Given the role the upper extremities have on a participant’s daily life, it is vital to examine the research to provide program participants with resources that will help prevent upper extremity pain and injuries in the future. Research supports home exercise programs (HEPS) and best practices with manual wheelchair propulsion to help prevent upper extremity pain as a result of prolonged upper extremity use. This doctoral capstone project aimed to investigate upper extremity kinematics and propulsion ergonomics among manual wheelchair users to provide best practices for participants, understand how Skills on Wheels’ current upper extremity HEP could be adapted/replaced to benefit its pediatric population to strengthen upper extremities, and to develop a pediatric-friendly upper extremity pain assessment for Skills on Wheels to provide pertinent upper extremity data to enhance outcomes. Data collection involved measuring range of motion (ROM), grip/pinch strength, receiving caregiver feedback, and a pain assessment to identify benefit of the resources provided for participants. Results highlight the benefits of using a play-based HEP and propulsion resources in maintaining upper extremity health and preventing pain among participants. Pain assessment data provide valuable information related to the upper extremity and pain participants may face engaging in various occupations.