Cognitive status is associated with performance of manual wheelchair skills in hospitalized older adults

Purpose: To examine the relationship between manual wheelchair skills and cognitive function in hospitalized older adults. Methods: The observational study included older adults who used a manual wheelchair following hip/knee surgery. Participants underwent a series of tests to evaluate manual wheelchair skills and cognitive performance. Four items appearing on the Wheelchair Skills Test: brake handling (locking/unlocking), a 10-metre forward roll, a 2-metre backward roll and rotating in place, were used to evaluate manual wheelchair skills. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), the Clock Drawing Test, and the Loewenstein Occupational Therapy Cognitive Assessment. The relationship between wheelchair skills and cognitive scores was assessed by a series of univariate linear regression analyses. Results: Fifty older adults, aged 65–85, participated in the study. The MoCA-7 (orientation) explained 19.3% of the variance related to the turn in place wheelchair skill, 18.8% of the variance related to the two-metre backwards roll and 31.9% of the variance related to the 10-metre forward roll. The addition of gender (to the MoCA-7) increased the explained variance related to the 10-metre forward roll and turn in place skills to 38.5% and 28.5%, respectively. As for the brakes handling skill test, gender explained 18.3% of the variance. The addition of the CDT (to gender) increased the explained variance for the brakes handling skill to 31.4%. Conclusions: Because cognitive impairments negatively affect the performance of wheelchair skills, rehabilitation therapists may need to adjust wheelchair mobility training methods for cognitively impaired older adults.Implication for rehabilitation Given the prevalence of older adults with cognitive impairments who use manual wheelchairs, it is critical to better understand the relationship between cognition and wheelchair skills. Poor results reported on the cognitive tests, specifically, visual attention and orientation, were found to be associated with poor performance of four manual wheelchair skills. Rehabilitation therapists should consider the cognitive status of older adults when teaching manual wheelchair skills, specifically in new users. Future studies should examine whether a customized preparation program, enhancing visuospatial orientation, can benefit manual wheelchair control in older adults.