title: Enhancement of operational efficiencies for people with high cervical spinal cord injuries using a flexible integrated pointing device apparatus.
abstract: OBJECTIVE
  To investigate the effectiveness of a universal integrated pointing device apparatus (IPDA), which can integrate numerous commercial pointing devices and can be controlled by various combinations of available movements, for people with cervical spinal cord injury (SCI) who cannot operate standard computer pointing devices.
  
  
  METHODS
  An exploratory quasi-experimental design. All subjects were required to perform specific mouse-operating (continuous-clicking, target-acquisition, drag-and-drop) tasks. People with SCI received clinical assessments and were classified into 2 groups based on pointing device used: group A, who used standard mouse devices, and group B (IPDA combinations), who were unable to use standard mouse devices. The measures of group A and group B were compared.
  
  
  METHODS
  Rehabilitation science center of a medical institution.
  
  
  METHODS
  Thirty-seven people with high cervical SCI and 30 able-bodied subjects.
  
  
  METHODS
  The IPDA.
  
  
  METHODS
  The efficiency of the people with SCI in each mouse-operation task was expressed as a percentage of that for able-bodied subjects (%NL).
  
  
  RESULTS
  Group B displayed similar operational efficiency in performing the drag-and-drop tasks ( approximately 30% NL) to group A, although they exhibited worse efficiency than group A in performing the other tasks (P<.05). Operational efficiencies of all tasks had negative relationships with age by using linear regression analysis (adjusted r(2)>.36, P<.001). The use of pointing devices was associated with American Spinal Injury Association Impairment Scale (P<.001), completeness (P<.001), and muscle strength (P<.01), particularly finger flexor muscle strength, but not with neurologic level or muscle tone.
  
  
  CONCLUSIONS
  The IPDA could help most people with high cervical SCI who could not use commercial mouse devices to achieve acceptable operational efficiencies. Pointing devices were assigned based on the underlying SCI severity and muscle strength, particularly finger flexor muscle strength.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial and Children Hospital, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan, Tao-Yuan 333, Taiwan. clingchen@gmail.com
authors.forename: Chia-Ling
authors.initials: CL
authors.lastname: Chen
authors.forename: Hsieh-Ching
authors.initials: HC
authors.lastname: Chen
authors.forename: Pao-Tsai
authors.initials: PT
authors.lastname: Cheng
authors.forename: Chih-Yong
authors.initials: CY
authors.lastname: Chen
authors.forename: Huang-Chung
authors.initials: HC
authors.lastname: Chen
authors.forename: Shih-Wei
authors.initials: SW
authors.lastname: Chou
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001696:Biomechanical Phenomena; D002574:Cervical Vertebrae / Q000293:injuries*; D016009:Chi-Square Distribution; D016287:Computer Peripherals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology*; D012984:Software; D013119:Spinal Cord Injuries / Q000503:physiopathology*; D018709:Statistics, Nonparametric; D014584:User-Computer Interface