Optimization of power wheelchair control for patients with severe Duchenne muscular dystrophy.
The extended survival of patients with Duchenne muscular dystrophy (DMD) achieved by the introduction of mechanical ventilation is raising new quality-of-life issues. We evaluated passive range of wrist extension, key pinch strength, and power wheelchair driving in 84 patients. The 47 drivers with restricted driving abilities were older than the 37 unrestricted drivers (27.2+/-5.0 y vs. 22.8+/-3.8 y) and had worse upper limb performance. By multiple logistic regression, only key pinch was significant ( R(2) = 0.224, P = 0.02. Eighteen restricted drivers were reassessed after having swapped a conventional joystick for another control system (mini-joystick, isometric mini-joystick, finger joystick, or pad) and having moved the position of the tested control system so that the patient could use it with different fingers, his chin or his mouth. All of them regained the ability to drive unrestricted. Adults with DMD gradually lose their ability to drive with a conventional joystick but can regain unrestricted driving with alternative control systems.
Pellegrini
Nadine
N
Medical ICU and Physiology-Functional Testing Unit, Garches Institute and Technological Innovation Center, Raymond Poincaré Teaching Hospital, AP-HP, 92380 Garches, France.
Guillon
Bruno
B
Prigent
Hélène
H
Pellegrini
Michel
M
Orlikovski
David
D
Raphael
Jean-Claude
JC
Lofaso
Frédéric
F
D000328:Adult; D016009:Chi-Square Distribution; D005069:Evaluation Studies as Topic; D006801:Humans; D016015:Logistic Models; D009048:Motor Skills / Q000502:physiology*; D020388:Muscular Dystrophy, Duchenne / Q000503:physiopathology* / Q000534:rehabilitation*; D011446:Prospective Studies; D012189:Retrospective Studies; D014910:Wheelchairs; D014953:Wrist / Q000502:physiology