1. Power Mobility: New Trends and Advances with Power Mobility Part Two: Power Assist Dave Neises, M.Ed, OTR/L, ATP

2. Sometimes called… PAW: power assist wheels PAPAW: pushrim-activated power-assisted wheelchairs (Nash et al 2008)

3. What are the Benefits?

4. In comparison to wheelchairs without power assist: -Less effort and energy -Lower hear rate -Less oxygen consumption -Less activation of upper limb and trunk muscles -Reduced stroke frequency and ROM -Less perceived exertion (Levy et al 2014) and (Nash et al 2008)

5. Most common power assist options

6. http://www.twion.de/fileadmin/content/Neu/Stellenan zeigen/Overview_Active_Drives_USA_20160418_2.p df

7. Comparison Chart http://www.twion.de/fileadmin/content/Neu/Stell enanzeigen/Overview_Active_Drives_USA_201604 18_2.pdf http://www.twion.de/fileadmin/content/Neu/Stell enanzeigen/Overview_Active_Drives_USA_201604 18_2.pdf

8. E-motion (Alber) [max 286 lbs] Pros -Assist on every push/direction/stopping -Programmability for strength differences Cons: -22 pounds per wheel

9. Smart Drive (MaxMobility) [max 331 lbs] Pros: - Only 13 pounds -Minimal push strokes -Alternative uses Cons: -Safety awareness -Off-road performance

10. Twion (Alber) [max 264 lbs] Pros -Only 13 pounds -Assist on every push/direction/ stopping -Smart phone functions Cons: ?

11. Xtender (Quickie/Sunrise Medical) [max 265 lbs] Pros: -Assist on every push/direction/ Stopping Cons: -38 pounds -Only available on Quickie wheelchairs

12. Funding Justification -Unable to consistently independently propel a manual wheelchair without power assist wheels. -Unable to independently propel long distances -Upper extremity, neck, or back pain when propelling a manual wheelchair without power assist wheels. Include pain scale 1-10, location, and frequency. -Caregivers unable to consistently independently push their child in a manual wheelchair up hills/inclines/ramps -MUST HAVE TRIALS WITH PAW BEING REQUESTED

13. Questions…

14. They sound similar…let’s see what you’ve got.

15. Contact Information David Neises, M.Ed, OTR/L, ATP (513) 636-8446 david.neises@cchmc.org

16. References cont. Karmarkar A, Cooper RA, Liu HY, Connor S, Puhlman J, (2008) Evaluation of Pushrim-Activated Power Assisted Wheelchairs (PAPAW) Using ANSI/RESNA Standards, Archives of Physical Medicine and Rehabilitation, 89(6), pp. 1191-1198. Ding D, Souza A, Cooper RA, Fitzgerald SG, Cooper RM, Kelleher AR, Boninger ML, Preliminary Study on the Impact of Pushrim Activated Power Assist Wheelchairs Among Individuals with Tetraplegia, American Journal of Physical Medicine and Rehabilitation, pp. 821-829, Vol. 87, No. 10, October 2008. Algood SD, Cooper RA, Fitzgerald SG, Cooper RM, Boninger ML, (2005) Effect of a Pushrim Activated Power Assist Wheelchair on the Functional Capabilities of Persons with Tetraplegia, Archives of Physical Medicine and Rehabilitation, 86(3), pp. 380-386. Algood SD, Cooper RA, Fitzgerald SG, Cooper R, Boninger ML, (2004) Impact of Pushrim-Activated Power-Assisted Wheelchair on the Metabolic Demands, Stroke Frequency, and Range of Motion Among Subjects with Tetraplegia, Archives of Physical Medicine and Rehabilitation (Model Systems Issue), Vol. 85, No. 11, pp. 1865-1871.

17. References cont. Corfman TA, Cooper RA, Boninger ML, Koontz AM, Fitzgerald SG, (2003) Range of Motion and Stroke Frequency Differences Between Manual Wheelchair Propulsion and Pushrim Activated Power Assisted Wheelchair Propulsion, Journal of Spinal Cord Medicine, Vol. 26, No. 2. Fitzgerald SG, Arva J, Cooper RA, Dvorznak MJ, Spaeth DM, Boninger ML, (2003) A Pilot Study on Community Usage of a Pushrim Activated Power Assist Wheelchair, Assistive Technology Journal, Vol. 15.2, pp. 113-119. Cooper RA, Corfman TA, Fitzgerald SG, Boninger ML, Spaeth DM, Ammer W, Arva J, (2002) Performance Assessment of a Pushrim Activated Power Assisted Wheelchair Control System, IEEE Transactions on Control Systems Technology, Vol. 10, No. 1, pp.121-126. Cooper, R. A., Fitzgerald, S.G., Boninger, M.L., Prins, K., Rentschler, A.J., Arva, J., and O’Connor T.J. (2001). Evaluation of a pushrim-activated, power-assisted wheelchair. Archives of Physical Medicine and Rehabilitation 82(5): 702-708.

18. References cont. Arva, J., Fitzgerald, S.G., Cooper, R.A., and Boninger, M.L. (2001). Mechanical efficiency and user power requirement with a pushrim activated power assisted wheelchair. Medical Engineering & Physics 23(10): 699-705. Howarth, S.J., Pronovost, L.M., Polgar, J.M., Dickerson, C.R., Callaghan, J.P. (2010) Use of a geared wheelchair wheel to reduce propulsive muscular demand during ramp ascent: analysis of muscle activation and kinematics. Clinical Biomechanics 25(1): 21- 8. Finley MA, Rodgers MM. (2007) Effect of 2-speed geared manual wheelchair propulsion on shoulder pain and function. Archives of Physical Medicine & Rehabilitation. 88:1622-7. (references provided by: University of Pittsburgh http://www.upmc-sci.pitt.edu/node/637)