Abstract
Study Design:
Cross-sectional study.
Objectives:
The purpose of this study was to examine stroke characteristics of long-term manual wheelchair users during an extended manual wheelchair propulsion trial and the extent to which changes in propulsion biomechanics occurred.
Setting:
Human Engineering Research Laboratories, VA Rehabilitation Research and Development Center, VA Pittsburgh Healthcare Systems, Pittsburgh, PA, USA.
Methods:
Kinetic data were recorded from 21 subjects with paraplegia at four time points over the course of a 10-min propulsion trial at a steady state speed of 1.4 m s−1. Upper extremity kinetic parameters were recorded using Smartwheels, force and torque sensing pushrims.
Results:
Subjects for propulsion biomechanics changed from early to late during the 10-min trial. Individuals displayed decreased maximum rate of rise of resultant force (P=0.0045) with a simultaneous increase in push time (P=0.043) and stroke time (P=0.023), whereas stroke frequency remained static. In addition, there was a decrease in out of plane moment application (P=0.032).
Conclusion:
Individuals seemed to naturally accommodate their propulsive stroke, using less injurious propulsion biomechanics over the course of a 10-minute trial on a dynamometer. The findings may have occurred as a result of both biomechanical compensations to a challenging propulsion trial and accommodation to propelling on a dynamometer. These results suggest that subjects may be capable of independently incorporating favorable biomechanical strategies to meet the demands of a challenging propulsion scenario.
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References
Preserving Upper Limb Function in Spinal Cord Injury. A Clinical Practice Guideline for Health-Care Professionals. Consortium for Spinal Cord Medicine. Spinal Cord Medicine, Clinical Practice Guideline: Washington, DC, 2005.
Subbarao JV, Klopfstein J, Turpin R . Prevalence and impact of wrist and shoulder pain in patients with spinal cord injury. J Spinal Cord Med 1994; 18: 9–13.
Boninger ML, Cooper RA, Shimada SD, Rudy TE . Shoulder and elbow motion during two speeds of wheelchair propulsion: a description using a local coordinate system. Spinal Cord 1998; 36: 418–426.
Robertson RN, Boninger ML, Cooper RA, Shimada SD . Pushrim forces and joint kinetics during wheelchair propulsion. Arch Phys Med Rehabil 1996; 77: 856–864.
Rodgers MM, Gayle GW, Figoni SF, Kobayashi M, Lieh J, Glaser RM . Biomechanics of wheelchair propulsion during fatigue. Arch Phys Med Rehabil 1994; 75: 85–93.
Rodgers MM, McQuade KJ, Rasch EK, Keyser RE, Finley MA . Upper-limb fatigue-related joint power shifts in experienced wheelchair users and nonwheelchair users. J Rehabil Res Dev 2003; 40: 27–37.
Boninger ML, Koontz AM, Sisto SA, Dyson-Hudson TA, Chang M, Price R et al. Pushrim biomechanics and injury prevention in spinal cord injury: recommendations based on CULP-SCI investigations. J Rehab Res Dev 2005; 42 (3, Supp 1): 9–20.
Cooper RA, Robertson RN, VanSickle DP, Boninger ML, Shimada SD . Methods for determining three-dimensional wheelchair pushrim forces and moments—a technical note. J Rehabil Res Dev 1997; 34: 162–170.
Tolerico ML, Ding D, Cooper RA, Spaeth DM, Fitzgerald SG, Cooper R et al. Assessing mobility characteristics and activity levels of manual wheelchair users. J Rehabil Res Dev 2007; 44: 561–572.
Koontz AM, Yang Y, Price R, Tolerico ML, Digiovine CP, Sisto SA et al. Multisite comparison of wheelchair propulsion kinetics in persons with paraplegia. J Rehabil Res Dev 2007; 44: 449–458.
van der Woude LH, Geurts C, Winkelman H, Veeger HE . Measurement of wheelchair rolling resistance with a handle bar push technique. J Med Eng Technol 2003; 27: 249–258.
de Groot S, Veeger HE, Hollander AP, van der Woude LH . Consequence of feedback-based learning of an effective hand rim wheelchair force production on mechanical efficiency. Clin Biomech 2002; 17: 219–226.
Dallmeijer AJ, van der Woude LH, Veeger HE, Hollander AP . Effectiveness of force application in manual wheelchair propulsion in persons with spinal cord injuries. Am J Phys Med Rehabil 1998; 77: 213–221.
Rodgers MM, Keyser RE, Rasch EK, Gorman PH, Russell PJ . Influence of training on biomechanics of wheelchair propulsion. J Rehabil Res Dev 2001; 38: 505–511.
Kotajarvi BR, Basford JR, An KN, Morrow DA, Kaufman KR . The effect of visual biofeedback on the propulsion effectiveness of experienced wheelchair users. Arch Phys Med Rehabil 2006; 87: 510–515.
Algood SD, Cooper RA, Fitzgerald SG, Cooper R, Boninger ML . Impact of a pushrim-activated power-assisted wheelchair on the metabolic demands, stroke frequency, and range of motion among subjects with tetraplegia. Arch Phys Med Rehabil 2004; 85: 1865–1871.
de Groot S, Veeger DH, Hollander AP, van der Woude LH . Wheelchair propulsion technique and mechanical efficiency after 3 wk of practice. Med Sci Sports Exerc 2002; 34: 756–766.
Boninger ML, Cooper RA, Baldwin MA, Shimada SD, Koontz A . Wheelchair pushrim kinetics: body weight and median nerve function. Arch Phys Med Rehabil 1999; 80: 910–915.
Acknowledgements
This study was supported by the Office of Research and Development, Rehabilitation Research and Development Service, Department of Veterans Affairs, Grant# B3142C’.
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Rice, I., Impink, B., Niyonkuru, C. et al. Manual wheelchair stroke characteristics during an extended period of propulsion. Spinal Cord 47, 413–417 (2009). https://doi.org/10.1038/sc.2008.139
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DOI: https://doi.org/10.1038/sc.2008.139
