Modifications in wheelchair propulsion technique with speed

Frontiers in Bioengineering and Biotechnology, 2015 · DOI: 10.3389/fbioe.2015.00171 · Published: October 26, 2015

Spinal Cord Injury Rehabilitation Biomechanics

Simple Explanation

This study investigated how manual wheelchair users with paraplegia change their propulsion technique when increasing speed to understand strategies that preserve shoulder health. The study found that increasing speed doesn't always lead to proportionally increased shoulder stress, and that reorienting hand position can help reduce shoulder joint load. The research suggests that understanding these individual adaptations can guide clinical decisions for preventing shoulder pain in wheelchair users.

Study Duration

Not specified

Participants

40 experienced manual WC users with paraplegia

Evidence Level

Not specified

Key Findings

1
Increased propulsion speed was accompanied by increases in reaction force magnitude and shoulder net joint moment, along with decreased pushrim contact duration.
2
27% of participants modified their wheelchair propulsion mechanics by regulating reaction force orientation relative to the upper extremity segments when increasing speed.
3
Reorienting the reaction force relative to the upper extremity can be an effective strategy for reducing rotational demands on the shoulder at increased speeds.

Research Summary

The study aimed to determine how manual wheelchair users modify propulsion mechanics with self-selected increases in speed to accommodate expected increases in reaction forces. Results indicated that increased propulsion speed led to increases in reaction force magnitude and shoulder net joint moment, but some participants reoriented reaction forces to mitigate rotational demands on the shoulder. The findings suggest that identifying and understanding these propulsion strategies can aid in preserving musculoskeletal health of the shoulder and improving quality of life for wheelchair users.

Practical Implications

Clinical Practice

Clinicians can assess individual wheelchair propulsion techniques to identify strategies that minimize shoulder joint stress during different speeds.

Rehabilitation Strategies

Rehabilitation programs can focus on training wheelchair users to reorient their hand position and reaction forces to reduce shoulder load while maintaining speed.

Wheelchair Configuration

Wheelchair customization, including seat height and axle position, can be optimized to redistribute mechanical demands on the upper extremity joints.

Study Limitations

1
The study used a stationary ergometer, which may not fully replicate real-world propulsion conditions.
2
Participants were excluded if they reported a history of shoulder pain, potentially limiting the generalizability of the findings to individuals with pre-existing shoulder issues.
3
The study focused on individuals with complete spinal cord injuries, and the results may not be directly applicable to those with incomplete injuries or other conditions.

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