Seating & Mobility Senior Style

Optimizing Participation Slows Physical Decline in Seniors with Mobility Disabilities

There are advantages and disadvantages associated with growing old.

Of course, wisdom, senior discounts and bragging about adorable grandchildren are some of the positives. But on the other hand, loss of muscle mass, decreased range of motion and vision problems are definitely negatives. For a person aging with a mobility disability, the good doesn’t always outweigh the bad — because for them, the aging process is accelerated.

The lifespan of an aging wheelchair user is almost the same as an ablebodied senior, says Philip S. Requejo, Ph.D., co-director of the Rehabilitation Engineering Research Center (RERC) on Technologies for Successful Aging at the University of Southern California in Los Angeles. But the rate of physical decline is much faster for someone who’s been in a wheelchair. Aging wheelchair users face upper-extremity pain, rapid decline in bone mineral density, urinary control issues and breathing problems.

“If you take a curve of the age compared to overall physical decline,” he says, “it’s much faster for a wheelchair user. Therefore, what we’re trying to do is address those physical declines as much as possible and delay them as much as possible.”

The objective of the RERC is to optimize participation through technology while enhancing the lives of individuals aging with and into disabilities.

The aging wheelchair user has more needs because of the functional limitations and tremendous number of barriers that they have to face on a daily basis. The aging process even takes its toll on a person’s ability to perform tasks of daily living. For someone fairly young who has full muscle strength, being able to dress is not a problem. But for an older person with limitations, getting dressed becomes a challenge. The issue is exacerbated for someone who acquired higher-level spinal cord injuries at a young age and who is now older.

“Our project is really trying to address issues that will help aging wheelchair users have optimal mobility at home as well as in the community,” he says.

The RERC plans to develop specific adaptations to devices that would allow wheelchair users to perform daily activities. Requejo and his department are looking into developing technical solutions to specific problems, such as designing wheelchairs with special features that would make a person more functional in daily activities.

The plan is to use engineering-related technology to determine the proper wheelchair design (i.e., best positioning and most comfortable seating configurations) to minimize the load a person exerts on the shoulders when pushing different types of propulsion devices. These technologies, Requejo says, help in recognizing the best positioning and seating configurations that are most comfortable for the end-user.

In addition to technology, the RERC is developing clinical guidelines that will teach wheelchair users the best way to get in and out of their vehicles. They’re also developing a clinical tool used to evaluate the specific needs of an individual — for instance, the automobile best suited for a particular person.

“We look at configurations and heights, what are the best features that allow a wheelchair user to get in and out of the wheelchair and into the car and safely be able to drive,” he says. “Those things are useful to optimally maintain their mobility in the community.”

One of the biggest issues that people aging with mobility disabilities face is having to use their upper extremities much more than if they were able to walk, says Requejo, who is also director of the Rehabilitation Engineering Program at the Rancho Los Amigos National Rehabilitation Center in Downey, Calif. The constant usage of the same muscles results in loading of the shoulders, the arms and the wrists.

Pushing vigorously and repetitively on a daily basis loads the upper extremities, which contributes to pathologies in the shoulders. For a person with a spinal cord injury, the rate of developing shoulder pain is around 70 percent because of the chronic use of upper extremities. One way to minimize pathologies is by identifying factors that contribute to and prevent pain development. This is accomplished through studying movement patterns, the skills a person uses to get in and out of a vehicle, pushing techniques and how they maneuver through rough terrain. Requejo says educating people on the correct way to perform certain tasks, injury avoidance and things to look out for are all paramount in preserving one’s mobility.

“Their quality of life declines much faster with that inability to use their upper extremities for mobility, and their energy expenditure tends to go down,” Requejo says. “What we’re trying to do is maintain and preserve that ability as much as possible through many different technological approaches, exercise strengthening and proper education as the person ages.”

Maintaining good muscular strength as long as possible is important for a wheelchair user aging with a mobility disability. This can be obtained through having an exercise program that strengthens the muscles injured by the aging process. For instance, exercising the rotator cuff helps to stabilize the shoulder.

Other than exercise, there’s another big E that makes a world of difference — and that’s educating caregivers and the general public. The RERC is focusing on developing educational materials and content for caregivers who specialize in caring for wheelchair users.

“That’s actually something that I believe is crucial to address with the baby boomer population,” Requejo says. “We have more folks aging with and into disabilities.”

Requejo says a lot of work has been done in educating the person with the injury and caregivers on how to avoid issues that may develop, such as pressure ulcers.

“Our institution has services that provides wheelchair users with the type of help that they can seek when they need it.”

For people aging with mobility disabilities, it is imperative to try to decrease the rate of decline, including knowing where to go and how to get information regarding pain and barriers that may impede their independence. Most importantly, knowing how to care for oneself is key when striving for optimal participation.

“Participation, being the ability to really feel like they're living a meaningful life, that’s our overall goal.” Requejo hopes to accomplish this by using technology to address sensory motor function. His vision is to see people with mobility disabilities perform functional tasks on a daily basis, including using a wheelchair to go from one place to another, he says. “We want them to have as normal of a lifestyle as we can possibly provide them… so they can work, drive and play with their grandkids.”

This article originally appeared in the July 2011 issue of Mobility Management.

About the Author

Lunzeta Brackens is a contributing editor for Mobility Management.

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