Improved efficiency with a wheelchair propelled by the legs using voluntary activity or electric stimulation.

[antiquity]

Arch Phys Med Rehabil 2001 Sep;82(9):1198-1203

Improved efficiency with a wheelchair propelled by the legs using voluntary activity or electric stimulation.

Stein RB, Chong SL, James KB, Bell GJ.

Division of Neuroscience (Stein, Chong, James) and Faculty of Physical Education (Bell), University of Alberta, Edmonton, Alb, Canada.

Stein RB, Chong SL, James KB, Bell GJ. Improved efficiency with a wheelchair propelled by the legs using voluntary activity or electric stimulation. Arch Phys Med Rehabil 2001;82;1198-1203. OBJECTIVE: To determine whether a new leg-propelled wheelchair provides enhanced efficiency and mobility to wheelchair users. DESIGN: Observational; subjects were tested while wheeling with the arms and legs and while walking (where possible) for 4-minute periods in random order with approximately 10-minute rest periods between exercise sets. SETTING: Tests were done on an indoor 200-meter track. PATIENTS: Group 1, 13 controls; group 2, 9 persons with complete spinal cord injury (SCI); group 3, 13 persons with other motor disorders (retaining some voluntary control of the legs). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Physiological Cost Index (PCI), (computed as change in heart rate divided by velocity of movement) and oxygen consumption (&Vdot;O(2)) RESULTS: Arm wheeling took significantly more effort (mean PCI =.52 beats/m) than walking (.33 beats/m) in control subjects. Leg wheeling was most efficient (.23), requiring less than half the effort of arm wheeling and 30% less effort than walking. For SCI subjects, leg wheeling with functional electric stimulation (FES) required less than half the effort (.18) of arm wheeling (.40). The FES group could not walk. Subjects in group 3 could walk, but with substantial effort (1.81) compared with arm (.76) or leg wheeling (.64). Results for &Vdot;O(2) were similar. CONCLUSIONS: Better wheelchair efficiency can be obtained for many disabled individuals, by moving the leg muscles voluntarily or with FES.

Copyright 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

[Curt Leatherbee]

I have thought about that quite a bit, I ride a stationary FES bike for 11 miles every other day and I have thought about the possibility of fixing foot pedals on my handcycle and using a remote FES unit on the handcycle to pedal with my legs. I would think it would have the potential to work fine, that way I would be able to take my bike ride while using my legs.

In fact I even thought if I was to do it, why not ride Cross Country using my legs (I am a t-4 complete) and Raise money for Spinal Cord Injury Research..... think about it the headlines "Paralyzed man rides Across the Country using his legs" Think about the kind of money I could raise being the first Paralyzed person to do this using their legs. I am going to talk to Steven Petrofsky about this on Monday, this really has me thinking. I would think something like this would raise a super amount of interest in Spinal Cord Injury Research especially if I were to be on the news and people were to see footage of someone Paralyzed riding along.

[Jeff]

I've thought of this idea myself, before. With the right amount of organization behind you it could do a whole lot. The key is turning the ride into a money-raising affair. That takes a lot of planning. It means having fund-raisers all along the way with the cooperation of leaders of communities and civic organizations. Also, getting as many locals to ride with you as you enter/leave their town could also help a lot. And a website, of course, would give you global reach. Those who make it happen can go on to starting a foundation in order to make grants available. Probably a very satisfying pursuit. I also think it could provide an important platform for educating the masses about the need for more research. Maybe they could then help not only by opening their wallets, but by also making research a priority for them in choosing government leaders.

I hope someone does it!!! If you decide to go for it I'm sure I can help. Plus, I'm sure you can get a lot of help with your web site. Definitely worth considering.

[Jeff]

When I was taking classes one Summer in the late 80's at UVM, there were some med students there from Wright State who were familiar with Petrofsky's program. According to them, wheelchair efficiency was a primary goal of their's. FES walking was close to impossible with quads and high paras but leg-powered wheelchairs were a great idea they were pursuing. I'm not sure what happened, but stationary bikes are all that have become commercial products. For a price, I'm sure they would build one for someone, though. If insurance was paying for FES, I'm sure we'd have a lot more options, right now.

[Curt Leatherbee]

I have talked with him about the idea of FES on a trike before and he said it has been done very successfully before (back in the '80's) in fact on the bikes they even had a throttle control to regulate the speed (increased or decreased the pulse rate of Stimulation to the legs) he told me people could ride along for miles on these bikes. The reason none were ever sold commercially was due to the liability factor as of course the feet had to be strapped onto the pedals and if the throttle ever jammed and you came to an intersection you would be screwed.

Anyhow, hopefully Electrologic will have an interest in my proposal, I would think all the publicity would be great for them and I know all the dollars raised would be great for Spinal Cord injury research. Perhaps there would be even better candidates to do this trip than me, I ride for an hour every other day on level 3/8 I am sure there must be people out there who are up to at least level 6 or 7. It is hard to imagine as level 3 seems like a lot of torque, but I am sure someone who has been using the FES bike for 10 years or so must be up there in levels.

[Sue Pendleton]

Especially since a woman thought it up first. Alicia Conglin (sp) and a friend arm pedaled across the USA this past year. Would you be interested in discussing this on here with her? She also had jackets and T-shirts made up to sell along the way and give to sponsors. I realize you want to add either passive or FES induced leg pedaling too.. I think that's cool!

Keep on talking. You have a winter coming up to prepare and do whatever else you think needs done and someone to learn from. Her group rode under the moniker Ride2Provide because they supported care (sports mainly) and cure (research).

Sue

[Sue Pendleton]

http://www.ride2provide.org/

And for those unfamiliar with Shake A Leg, it's a sailing organization for the disabled. I'll add the URL to the links list.

[Wise Young]

Think of all the electricity that we are throwing away when people do their FES induced exercises and the energy is just wasted. If a million people generated even 10 watts per day, that is 10 megawatts of power. If the savings of 5 cents per kilowatt hour were donated to spinal cord injury research, this would yield $50,000 per day or over $20 million per year. That is not peanuts.

Wise.

[This message was edited by Wise Young on September 17, 2001 at 04:09 PM.]

[KLD]

Maybe a chair like this could be used together with FES???

http://www.ezchair.com/

I have seen these in use, easy to pedal for someone who is weak in their legs but still able to move.

[Jeff]

Dr. Young - While riding my FES bike I've often thought about harnessing the pedaling to produce electricity. I never thought about donating the proceeds, though. It's a good idea. I think, though, that the equipment used to generate the electricity, measure it, and get it back onto the grid so someone can buy it, plus the information systems required to transfer funds, etc, would be too large of an investment. I hope we don't need FES long enough to pay for that kind of infrastructure!

Maybe we could have huge FES centers in larger cities where hundreds of pedalers are harnessed to put electricity back into the building's power supply in order to reduce costs. I'm sure the FES bikes produce a lot more energy than they consume. And, of course, the fuel eaten by the bikers before they arrive is all their own donation. Maybe some of us are overweight and can even convert some unwanted pounds into useable energy.

I think something like that is probably doable with the least overhead required. Maybe that could be one way to help encourage more FES centers to be opened.

Hehe - But, I'm actually 75% serious!!!