Ask An Expert
Jaimie Borisoff, PhD
Canadian Research Chair, Rehabilitation Engineering Design, British Columbia Institute of Technology
Dr. Borisoff focuses his research on how technology development can improve accessibility and mobility for people with SCI. One focus of his work is on expanding patients’ ability to interact more fully with others, the environment, and their world. This includes dynamic wheeled mobility, the ability to change your position in a wheelchair to suit different daily activities. Another area of interest is health and exercise; Dr. Borisoff is currently working on a hybrid exercise machine whereby active arm movements drive the legs as well, increasing cardiorespiratory fitness. Dr. Borisoff is also a Research Director at BCIT and an Adjunct Professor in the Department of Occupational Science and Occupational Therapy and the Biomedical Engineering Program, both at the University of British Columbia, as well as a Principal Investigator at ICORD.
Topic: Expert Spotlight with Dr. Jaimie Borisoff
SPOTLIGHT ON DR. JAIMIE BORISOFF
The PAR-QoL team is proud to present an expert spotlight event with
Dr. Jaimie Borisoff is a Canada Research Chair in Rehabilitation Engineering Design at the Bristish Columbia Institute of Technology (BCIT) in Burnaby and the International Collaboration on Repair Discoveries (ICORD) in Vancouver, BC, CA.
Between March 2 and April 17 (2015), visitors to the PAR-QoL website may submit questions to Dr. Borisoff to obtain his thoughts about spinal cord injury (SCI) and quality of life research (or other related research).
Dr. Borisoff will post his answers to selected questions on the PAR-QoL website sometime in May 2015 (date to be determined).
This is a unique opportunity for clinicians, students, researchers, community advocates and persons with SCI to gain insight and knowledge on the status of SCI and quality of life research from a leading expert in the field.
Your questions answered!
This is a great question and a constant source of frustration for people with SCI, including myself. As you know, it can be very difficult to get a decent cardio workout from a wheelchair. Especially as we age with SCI and start to face issues around chronic upper limb injuries from transfers and wheeling. Ideally, one would separate their daily mobility needs from their exercise routine.
SCI Action Canada (http://sciactioncanada.ca/) has great exercise recommendations and resources, including exercise routines that show benefits in fitness and upper limb pain reduction. And do not discount strength training as a means to also improve cardio health and burn fat. Also, check out these links to sports programs. I always think its best to combine something you enjoy doing with exercise, like playing basketball. http://sciactioncanada.ca/sport-resources
One area that researchers are studying is the combination of moving your arms and legs together to achieve a larger cardio workout and better fat burning in general. With the right equipment this can be possible even with complete lower limb injuries by passively moving the legs. Some equipment to check out are arm/leg bikes and other combined exercise machines. Ones that I have used are the SCIFIT (http://www.scifit.com/product/pro2-sport/) and Nustep (http://www.nustep.com/), but there are several others on the market. Researchers are finding that moving the legs too (even passively for those with no leg muscular function) results in an improved cardio response – you need to work a bit harder than by exercising with your arms alone. The trick now is getting access to this equipment. In Vancouver, we have the ICORD Physical Activity Research Centre (http://icord.org/parc/) with this type of equipment, which is free for anyone to use.
Handcycling is another great option that may be easier on your arms and hands than pushing a wheelchair for cardio fitness. Though, I would recommend a power-assist handbike to almost anyone. And you can still get a great workout with electric assist – it just let's you get up the big hills easier, or travel faster and farther, than arm power alone can take you.
I think there are many potential benefits to standing; although some caution is needed when beginning a standing program, especially for people with very low bone density and/or poor blood pressure regulation (e.g. a person may be at risk for passing out). We have interest in standing in our research program, from a couple different perspectives. One – for activities of daily living. Here, even partial standing or seat elevation in a wheelchair can be beneficial. Two – we and others have found evidence that people with SCI that also have poor blood pressure regulation (i.e. orthostatic hypotension) are at greater risk of developing a host of secondary complications such as cardiovascular disease and diabetes. It is interesting to speculate whether being active in a standing program would help with blood pressure regulation; although much more research in this area is needed - at this point it is purely speculation. Three – we are interested in active arm / passive leg exercise as I described in an earlier question. The next stage for this type of exercise would be to perform combined arm/leg exercise while standing, in hopes of providing an even greater cardio workout than when sitting. Again, much more research in this area is needed, however we are actively designing a new exercise machine in hopes of being able to do this. There are sites with other information about the benefits of standing:
RESNA has published a paper about the clinical applications and evidence from the literature supporting the use of wheelchair standing devices:
The EasyStand website also has many links to research articles on standing:
This is obviously a very difficult problem, and probably one with no easy answers. I have no suggestions for the systemic problem around lack of accessible housing. But perhaps there are some ways to make existing apartments slightly more accessible. I would encourage anyone with these sorts of issues to contact their closest Tetra Society (http://www.tetrasociety.org/). They have volunteer engineers who create devices or modifications to make life easier for people with disabilities. Sometimes very simple solutions can make a big difference, such as lowering a counter, or creating a wheel-under sink. I would love to hear from others in the comments section about resources and simple solutions they have found for these sorts of accessibility problems.
I look at this question in the opposite manner: what kind job can I NOT do from a wheelchair? I think this list is much smaller. Some jobs that immediately come to mind that would be difficult to perform from a wheelchair would be physical, so called blue collar, jobs such as logging or mining. But the list of jobs that are possible to perform from a wheelchair is very large. Most anything in an office environment for sure is possible. Lawyers and accountants. Bankers and other jobs in the financial industry. I know people in wheelchairs who are real estate agents, city planners, and landscape architects. Vancouver used to have two parking enforcement agents who worked from wheelchairs. I know doctors and occupational therapists. A chef. Air traffic controller. Jewelry designer. Several teachers and professors. Lab technicians. Jobs in adaptive sport and recreation. I am sure there are many others not listed here. Mark Smith, the Wheelchairjunkie, has an article about jobs in the mobility industry: http://www.wheelchairjunkie.com/mobilitycareers.html
Large companies and government organizations are becoming more attuned to diversification in the workplace as a means of attracting more great employees. They are starting to see the benefits of recruiting people with disabilities, so more opportunities are arising. Several governments have plans in place to promote employment opportunities for people with disabilities. There are several other non-governmental organizations to look into as well, both as advocates and resource centres, for example for equipment and technology to aid transition to the workforce. The The Neil Squire Society http://www.neilsquire.ca/ is a great place to start.
As for wheelchairs and modifications for the workplace? Keep in mind that I have a conflict of interest, but I think the Elevation wheelchair is well suited to the workplace (http://www.pdgmobility.com/products/elevation/index.html). From small seat and backrest adjustments for comfort when working at a desk, to sitting at an elevated height to work at a counter top or bench. But when you need full standing height in the workplace, then a manual or power standing wheelchair may be the solution. A list of manufacturers can be found at these two USATechGuide (http://usatechguide.org/index.php) links:
This concept of Dynamic Wheeled Mobility (DWM) was the topic of a workshop that Steve Mitchell and I gave at the most recent International Seating Symposium. You can check out our presentation materials, and also see information about the Elevation wheelchair that I developed, which is now a product of PDG Mobility, at: http://www.pdgmobility.com/products/elevation/index.html
This wheelchair offers two independent seat adjustment features that can be used at any time, "on the fly", by squeezing a lever under the seat. The rear seat height can be adjusted about 10 inches, from a low "dumped" position for wheeling, to a mid-position for typical sitting (e.g. at a desk), to a higher position for reaching shelves or speaking with someone standing. The backrest can also be adjusted forwards and backwards, for comfort as well as function. For instance, you can recline the back before wheeling down a hill. This makes the wheelchair much tippier such that a wheelie is not needed for stable downhill wheeling – much safer in rainy weather. DWM also has many other aspects that help with functional activities from a wheelchair. Check out the website if you want more information. And the videos are the easiest way to see how simple it is to change your position to suit different activities. Start here: https://www.youtube.com/watch?v=IWG6iC1jYb8