Optimization of power wheelchair control for patients with severe Duchenne muscular dystrophy
(Neuromuscular
Disorders, 2004)
Nadine Pellegrini, Bruno Guillon, Helene Prigent,
Michel Pellegrini, David Orlikovskia, Jean-Claude Raphael, Frederic Lofaso, -
France
Abstract
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 (R2 = 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.