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.”