@unpublished{pittir23196,
           month = {October},
           title = {BIOMECHANICAL VALIDATION OF TRANSFER ASSESSMENT INSTRUMENT (TAI) IN EVALUATING DIFFERENT INDEPENDENT TRANSFERS IN WHEELCHAIR USERS},
          author = {Chung-Ying Tsai},
            year = {2014},
        keywords = {Wheelchair; Transfer; Biomechanics; Assessment},
             url = {http://d-scholarship-dev.library.pitt.edu/23196/},
        abstract = {Transfers are one of the most essential and physically demanding daily activities for wheelchair users (WUs). The Transfer Assessment Instrument (TAI) is the first tool to standardize the way clinicians evaluate transfer techniques and to help identify specific skills to target during transfer training. The study was to validate the function of the TAI, indicate the effects of transfer skills in performing toilet transfers in two different setups, and evaluate the immediate effects of individualized TAI-based structured transfer training. Up to twenty-six WUs performed transfers to a level-height bench and a toilet with a side and front setup while force plates, load cells, and a motion capture system recorded the biomechanics of their natural transferring skills. Their skills were simultaneously evaluated by two clinicians using the TAI. Logistic and multiple linear regression models were used to determine the relationships between TAI scores and the joint kinetic variables on both arms. Multivariate analysis of variance models were built to test biomechanical differences between using and non-using skill groups during toilet transfers with a side and front setup respectively. Wilcoxon signed-rank test was used to compare the differences of the biomechanical variables between pre and post TAI-based transfer training. The results showed that the completion of TAI skills was associated with lower resultant moments and/or their rates of rise at both shoulders and/or elbows (p{\ensuremath{<}}0.02). Some skills increased the moment magnitude or rate on the leading side (p{\ensuremath{<}}0.03). Compared to WUs who did not use skills, WUs who scooted forward in their wheelchair and used an appropriate handgrip and head-hip techniques had better shoulder positioning and lower joint forces and moments on both arms in toilet transfers with a side setup (p{\ensuremath{<}}0.04), and WUs who used close wheelchair positioning had significantly lower trailing arm loading (p=0.03) in a front setup. The TAI-based transfer training intervention improved the leading shoulder posture (p{\ensuremath{<}}0.04) and reduced the joint forces and moments and their rates on both shoulders and trailing elbow and wrist (p{\ensuremath{<}}0.05). Structured training and the routine practice of TAI skills is recommended to help reduce the risk of developing secondary injuries.}
}