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Comellas M, Chan V, Zondervan DK, Reinkensmeyer DJ. A Dynamic Wheelchair Armrest for Promoting Arm Exercise and Mobility After Stroke. IEEE Trans Neural Syst Rehabil Eng 2022; 30:1829-1839. [PMID: 35776829 PMCID: PMC9354471 DOI: 10.1109/tnsre.2022.3187755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Arm movement recovery after stroke can improve with sufficient exercise. However, rehabilitation therapy sessions are typically not enough. To address the need for effective methods of increasing arm exercise outside therapy sessions we developed a novel armrest, called Boost. It easily attaches to a standard manual wheelchair just like a conventional armrest and enables users to exercise their arm in a linear forward-back motion. This paper provides a detailed design description of Boost, the biomechanical analysis method to evaluate the joint torques required to operate it, and the results of pilot testing with five stroke patients. Biomechanics results show the required shoulder flexion and elbow extension torques range from −25% to +36% of the torques required to propel a standard pushrim wheelchair, depending on the direction of applied force. In pilot testing, all five participants were able to exercise the arm with Boost in stationary mode (with lower physical demand). Three achieved overground ambulation (with higher physical demand) exceeding 2 m/s after 2–5 practice trials; two of these could not propel their wheelchair with the pushrim. This simple to use, dynamic armrest provides people with hemiparesis a way to access repetitive arm exercise outside of therapy sessions, independently right in their wheelchair. Significantly, Boost removes the requirements to reach, grip, and release the pushrim to propel a wheelchair, an action many individuals with stroke cannot complete.
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Aissaoui R, Gagnon D. Effect of Haptic Training During Manual Wheelchair Propulsion on Shoulder Joint Reaction Moments. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:827534. [PMID: 36188985 PMCID: PMC9397983 DOI: 10.3389/fresc.2022.827534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
Abstract
Background Manual wheelchair propulsion remains a very ineffective means of locomotion in terms of energy cost and mechanical efficiency, as more than half of the forces applied to the pushrim do not contribute to move the wheelchair forward. Manual wheelchair propulsion training using the haptic biofeedback has shown an increase in mechanical efficiency at the handrim level. However, no information is available about the impact of this training on the load at the shoulders. We hypothesized that increasing propulsion mechanical efficiency by 10% during propulsion would not yield clinically significant augmentation of the load sustained at the shoulders. Methods Eighteen long-term manual wheelchair users with a spinal cord injury propelled a manual wheelchair over a wheelchair simulator offering the haptic biofeedback. Participants were asked to propel without the Haptic Biofeedback (HB) and, thereafter, they were subjected to five training blocks BL1–BL5 of 3 min in a random order with the haptic biofeedback targeting a 10% increase in force effectiveness. The training blocs such as BL1, BL2 BL3, BL4, and BL5 correspond, respectively, to a resistant moment of 5, 10, 15, 20, and 25%. Pushrim kinetics, shoulder joint moments, and forces during the propulsive cycle of wheelchair propulsion were assessed for each condition. Results The tangential force component increases significantly by 74 and 87%, whereas value for the mechanical effective force increases by 9% between the pretraining and training blocks BL3. The haptic biofeedback resulted in a significant increase of the shoulder moments with 1–7 Nm. Conclusion Increases in shoulder loads were found for the corresponding training blocks but even though the percentage of the increase seems high, the amplitude of the joint moment remains under the values of wheelchair propulsion found in the literature. The use of the HB simulator is considered here as a safe approach to increase mechanical effectiveness. However, the longitudinal impact of this enhancement remains unknown for the impact on the shoulder joint. Future studies will be focused on this impact in terms of shoulder risk injury during manual wheelchair propulsion.
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Affiliation(s)
- Rachid Aissaoui
- Laboratoire de Recherche en Imagerie et Orthopédie (LIO), Centre de Recherche du Centre Hospitalier Universitaire de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Génie des systèmes, École de technologie supérieure (ETS), Montreal, QC, Canada
- *Correspondence: Rachid Aissaoui
| | - Dany Gagnon
- School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
- Pathokinesiology Laboratory (www.pathokin.ca), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Montreal, QC, Canada
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Ott J, Pearlman J. Scoping review of the rolling resistance testing methods and factors that impact manual wheelchairs. J Rehabil Assist Technol Eng 2021; 8:2055668320980300. [PMID: 33598312 PMCID: PMC7863146 DOI: 10.1177/2055668320980300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/04/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Rolling resistance (RR) is a drag force acting on manual wheelchairs that is associated with increased propulsion force and is linked to secondary disabling conditions of the upper limbs. A scoping review was conducted to understand how RR of manual wheelchairs has been measured and to identify limitations of those test methods and the factors tested. Methods A total of 42 papers were identified and reviewed, and test methods were categorized based on the measurement style of RR, testing level, and if multiple parameters could be tested. Additionally, 34 articles were reviewed for what factors were tested. Results Seven different testing methods categories were identified: drag test, treadmill, motor draw, deceleration, physiological expenditure, ergometer/dynamometer, and robotic test rig. Relevant articles were categorized into testing factor categories: camber, toe, tire type, tire pressure, caster type, mass, mass distribution, and type of surface. Conclusions The variety of testing methods suggests the need for a standardized method that can be used for wheelchair wheel design and selection to reduce RR. It is important to use adjustments, such as a forward rear axle position to mitigate RR as well as using high-pressure pneumatic tires that are properly inflated.
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Affiliation(s)
- Joseph Ott
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA.,International Society of Wheelchair Professionals, Pittsburgh, PA, USA
| | - Jonathan Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA.,International Society of Wheelchair Professionals, Pittsburgh, PA, USA
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Méndez-Domínguez N, Aguiñaga-Malanco SE, López-Muñoz R, Santos-Zaldivar KP. Bases para el abordaje multidisciplinario de la seudo paresia y seudo parálisis de hombro por patología del manguito rotador. ACTA ORTOPÉDICA MEXICANA 2020; 34:242-248. [DOI: 10.35366/97559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
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Russell IM, Wagner E, Requejo P, Mulroy S, Flashner H, McNitt-Gray J. Characterization of the shoulder net joint moment during manual wheelchair propulsion using four functional axes. J Electromyogr Kinesiol 2019; 62:102340. [DOI: 10.1016/j.jelekin.2019.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 06/22/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022] Open
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Relationship between linear velocity and tangential push force while turning to change the direction of the manual wheelchair. BIOMED ENG-BIOMED TE 2017; 62:439-445. [DOI: 10.1515/bmt-2015-0173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 07/27/2016] [Indexed: 11/15/2022]
Abstract
AbstractWheelchair propulsion is a major cause of upper limb pain and injuries for manual wheelchair users with spinal cord injuries (SCIs). Few studies have investigated wheelchair turning biomechanics on natural ground surfaces. The purpose of this study was to investigate the relationship between tangential push force and linear velocity of the wheelchair during the turning portions of propulsion. Using an instrumented handrim, velocity and push force data were recorded for 25 subjects while they propel their own wheelchairs on a concrete floor along a figure-eight-shaped course at a maximum velocity. The braking force (1.03 N) of the inside wheel while turning was the largest of all other push forces (p<0.05). Larger changes in squared velocity while turning were significantly correlated with higher propulsive and braking forces used at the pre-turning, turning, and post-turning phases (p<0.05). Subjects with less change of velocity while turning needed less braking force to maneuver themselves successfully and safely around the turns. Considering the magnitude and direction of tangential force applied to the wheel, it seems that there are higher risks of injury and instability for upper limb joints when braking the inside wheel to turn. The results provide insight into wheelchair setup and mobility skills training for wheelchair users.
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Proposing a new index to quantify instantaneous symmetry during manual wheelchair propulsion. J Biomech 2017; 51:137-141. [DOI: 10.1016/j.jbiomech.2016.11.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 11/24/2022]
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Abstract
Accessibility to buildings promotes social participation through the application of inclusive design. However, architectural frameworks for constructing accessibility ramps are based on scant scientific evidence. This article presents a statement of established standards for construction criteria for accessibility ramps and makes recommendations from the perspective of inclusive design. A literature review was performed using the databases Medline, OTseeker, PsycINFO, and CINAHL (2000 to 2013), combining keywords referring to: universal accessibility, inclusive design, accessibility ramps, biomechanics, obesity, and disabilities. Non-scientific literature was also explored (e.g. building codes). The fifty-eight articles selected were grouped under five themes: 1) ramps and users; 2) materials and climate; 3) visual reference; 4) "wayfinding"; 5) durability, aesthetics and culture. Recommendations encouraging interdisciplinary practice, pegged to inclusive design, are exhibited (e.g. tracking, tilt, contrast).
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Requejo PS, Furumasu J, Mulroy SJ. Evidence-Based Strategies for Preserving Mobility for Elderly and Aging Manual Wheelchair Users. TOPICS IN GERIATRIC REHABILITATION 2015; 31:26-41. [PMID: 26366040 PMCID: PMC4562294 DOI: 10.1097/tgr.0000000000000042] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Elderly and aging manual wheelchair (MWC) users have increased risk for accelerated loss of function and mobility that greatly limits independence and affects quality of life. This review paper addresses important issues for preserving function and mobility for elderly and aging individuals who use a MWC by presenting the current available evidence and recommendations. These include recommendations for maximizing function, by decreasing pain, improving the ability to self-propel, and prolonging mobility and endurance through ergonomics, individualized wheelchair selection and configuration, and adaptations for increasing the capacity to handle the daily mobility demands through training, strengthening, and exercise. Each recommendation is supported by current research in each relevant area.
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Affiliation(s)
- Philip S. Requejo
- Physical Therapy Department, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey, CA 90242, USA
- Rehabilitation Engineering Program, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey, CA 90242, USA
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey, CA 90242, USA
| | - Jan Furumasu
- Physical Therapy Department, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey, CA 90242, USA
| | - Sara J. Mulroy
- Physical Therapy Department, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey, CA 90242, USA
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey, CA 90242, USA
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Gil-Agudo Á, Solís-Mozos M, Crespo-Ruiz B, Del-Ama Eng AJ, Pérez-Rizo E, Segura-Fragoso A, Jiménez-Díaz F. Echographic and kinetic changes in the shoulder joint after manual wheelchair propulsion under two different workload settings. Front Bioeng Biotechnol 2014; 2:77. [PMID: 25566539 PMCID: PMC4275037 DOI: 10.3389/fbioe.2014.00077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/07/2014] [Indexed: 11/13/2022] Open
Abstract
Manual wheelchair users with spinal cord injury (SCI) have a high prevalence of shoulder pain due to the use of the upper extremity for independent mobility, transfers, and other activities of daily living. Indeed, shoulder pain dramatically affects quality of life of these individuals. There is limited evidence obtained through radiographic techniques of a relationship between the forces acting on the shoulder during different propulsion conditions and shoulder pathologies. Today, ultrasound is widely accepted as a precise tool in diagnosis, displaying particularly effectiveness in screening the shoulder rotator cuff. Thus, we set out to perform an ultrasound-based study of the acute changes to the shoulder soft tissues after propelling a manual wheelchair in two workload settings. Shoulder joint kinetics was recorded from 14 manual wheelchair users with SCI while they performed high- and low-intensity wheelchair propulsion tests (constant and incremental). Shoulder joint forces and moments were obtained from inverse dynamic methods, and ultrasound screening of the shoulder was performed before and immediately after the test. Kinetic changes were more relevant after the most intensive task, showing the significance of high-intensity activity, yet no differences were found in ultrasound-related parameters before and after each propulsion task. It therefore appears that further studies will be needed to collect clinical data and correlate data regarding shoulder pain with both ultrasound images and data from shoulder kinetics.
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Affiliation(s)
- Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Marta Solís-Mozos
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Beatriz Crespo-Ruiz
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Antonio J Del-Ama Eng
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Enrique Pérez-Rizo
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | | | - Fernando Jiménez-Díaz
- Laboratory of Performance and Sports Rehabilitation, Faculty of Sport Science, University of Castilla-La Mancha , Toledo , Spain
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Force Application During Handcycling and Handrim Wheelchair Propulsion: An Initial Comparison. J Appl Biomech 2013; 29:687-95. [DOI: 10.1123/jab.29.6.687] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of the study was to evaluate the external applied forces, the effectiveness of force application and the net shoulder moments of handcycling in comparison with handrim wheelchair propulsion at different inclines. Ten able-bodied men performed standardized exercises on a treadmill at inclines of 1%, 2.5% and 4% with an instrumented handbike and wheelchair that measured three-dimensional propulsion forces. The results showed that during handcycling significantly lower mean forces were applied at inclines of 2.5% (P< .001) and 4% (P< .001) and significantly lower peak forces were applied at all inclines (1%:P= .014, 2.5% and 4%:P< .001). At the 2.5% incline, where power output was the same for both devices, total forces (mean over trial) of 22.8 N and 27.5 N and peak forces of 40.1 N and 106.9 N were measured for handbike and wheelchair propulsion. The force effectiveness did not differ between the devices (P= .757); however, the effectiveness did increase with higher inclines during handcycling whereas it stayed constant over all inclines for wheelchair propulsion. The resulting peak net shoulder moments were lower for handcycling compared with wheelchair propulsion at all inclines (P< .001). These results confirm the assumption that handcycling is physically less straining.
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Moon Y, Jayaraman C, Hsu IMK, Rice IM, Hsiao-Wecksler ET, Sosnoff JJ. Variability of peak shoulder force during wheelchair propulsion in manual wheelchair users with and without shoulder pain. Clin Biomech (Bristol, Avon) 2013; 28:967-72. [PMID: 24210512 PMCID: PMC3858527 DOI: 10.1016/j.clinbiomech.2013.10.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/28/2013] [Accepted: 10/09/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Manual wheelchair users report a high prevalence of shoulder pain. Growing evidence shows that variability in forces applied to biological tissue is related to musculoskeletal pain. The purpose of this study was to examine the variability of forces acting on the shoulder during wheelchair propulsion as a function of shoulder pain. METHODS Twenty-four manual wheelchair users (13 with pain, 11 without pain) participated in the investigation. Kinetic and kinematic data of wheelchair propulsion were recorded for 3 min maintaining a constant speed at three distinct propulsion speeds (fast speed of 1.1 m/s, a self-selected speed, and a slow speed of 0.7 m/s). Peak resultant shoulder forces in the push phase were calculated using inverse dynamics. Within individual variability was quantified as the coefficient of variation of cycle to cycle peak resultant forces. FINDINGS There was no difference in mean peak shoulder resultant force between groups. The pain group had significantly smaller variability of peak resultant force than the no pain group (P<0.01, η²=0.18). INTERPRETATION The observations raise the possibility that propulsion variability could be a novel marker of upper limb pain in manual wheelchair users.
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Affiliation(s)
- Y Moon
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801, USA
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Huang YC, Guo LY, Tsai CY, Su FC. Mechanical energy and power flow analysis of wheelchair use with different camber settings. Comput Methods Biomech Biomed Engin 2013; 16:403-12. [DOI: 10.1080/10255842.2011.623675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Effects of rolling resistances on handrim kinetics during the performance of wheelies among manual wheelchair users with a spinal cord injury. Spinal Cord 2012. [PMID: 23184024 DOI: 10.1038/sc.2012.140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Repeated cross-sectional study. OBJECTIVES To compare the effects of rolling resistances (RRs) on handrim kinetic intensity at the non-dominant upper limb and on handrim kinetic symmetry during wheelies performed by manual wheelchair users (MWUs) with spinal cord injury (SCI). SETTING Pathokinesiology Laboratory. METHODS Sixteen individuals with SCI who were able to perform wheelies participated in this study. During a laboratory assessment, participants randomly performed wheelies on four RRs: natural high-grade composite board, 5-cm thick soft foam, 5-cm thick memory foam, and with the rear wheels blocked by wooden blocks. Four trials were conducted for each of the RRs. Participant's wheelchair was equipped with instrumented wheels to record handrim kinetics, whereas the movements of the wheelchair were recorded with a motion analysis system. RESULTS The net mean and peak total forces, including its tangential and mediolateral components, were greater during take-off compared with the other phases of the wheelie, independently of RR. During take-off, the greatest net mean and peak total and tangential forces were reached with the wheels blocked. Symmetrical tangential and mediolateral force intensities were applied at the dominant and non-dominant handrims. CONCLUSION Wheelies performed on low or moderate density foam generate similar forces at the handrim than on a natural surface and significantly less forces than with the wheels blocked. Hence, when teaching individuals with an SCI to perform a stationary wheelie, the use of low or moderate density foam represents a valuable alternative for minimizing upper limb effort and may also optimize quasi-static postural steadiness.
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Hwang S, Kim S, Kim Y. Torque and power outputs on skilled and unskilled users during manual wheelchair propulsion. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2012:4820-4822. [PMID: 23367006 DOI: 10.1109/embc.2012.6347072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Manual wheelchair users are at a high risk of pain and injuries to the upper extremities due to mechanical inefficiency of wheelchair propulsion motion. The kinetic analysis of the upper extremities during manual wheelchair propulsion in various conditions needed to be investigated. We developed and calibrated a wheelchair dynamometer for measuring kinetic parameters during propulsion. We utilized the dynamometer to investigate and compare the propulsion torque and power values of skilled and unskilled users under four different conditions. Skilled manual wheelchair users generated lower torques with more power than unskilled users and reacted alertly and sensitively to changing conditions. We expect that these basic methods and results may help to quantitatively evaluate the mechanical efficiency of manual wheelchair propulsion.
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Affiliation(s)
- Seonhong Hwang
- Department of Biomedical Engineering, Yonsei University, Wonju, Gangwon, South Korea.
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Measurement of shoulder joint loads during wheelchair propulsion measured in vivo. Clin Biomech (Bristol, Avon) 2011; 26:982-9. [PMID: 21719168 DOI: 10.1016/j.clinbiomech.2011.05.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 05/25/2011] [Accepted: 05/30/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent in vivo measurements show that the loads acting in the glenohumeral joint are high even during activities of daily living. Wheelchair users are frequently affected by shoulder problems. With previous musculoskeletal shoulder models, shoulder joint loading was mostly calculated during well-defined activities like forward flexion or abduction. For complex movements of everyday living or wheelchair propulsion, the reported loads vary considerably. METHODS Shoulder joint forces and moments were measured with telemeterized implants in 6 subjects. Data were captured on a treadmill at defined speeds and inclinations. Additional measurements were taken in 1 subject when lifting the body from the wheelchair, using his arms only, and in 2 subjects when rapidly accelerating and stopping the wheelchair. The influence of the floor material on shoulder joint loading was accessed in 2 subjects. In general, the maximum shoulder loads did not exceed those during daily living but the time courses and magnitudes of the loads intra-individually varied much. FINDINGS The highest forces acted during maximum acceleration and lifting from the wheelchair (128% and 188% of body weight). Grass was the only surface which led to a general load increase, compared to a smooth floor. INTERPRETATION The increased incidence of overuse injuries in wheelchair users are probably not caused by excessive load magnitudes during regular propulsion. The high number of repetitions is assumed to be more decisive.
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Abstract
With progress of modern technology, manually-propelled wheelchairs are still of importance for individuals with mobility impairments. The repeated wheelchair propulsion and strenuous daily activities cause high loads and thus injuries on the upper extremity joints. Over the past few years, a considerable number of studies have been made on biomechanical analysis of wheelchair propulsion and wheelchair-related activities. Thorough investigation of biomechanics during wheelchair propulsion enhances comprehension of mechanism of injuries and provides information to improve wheelchair design and fitting. Numerous investigations have been made to demonstrate factors which cause low effectiveness of force application and inefficiency of movements. Emphasis was also placed on developing analytical models to simulate wheelchair propulsion.
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Affiliation(s)
- CHIEN-JU LIN
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - PO-CHOU LIN
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - FONG-CHIN SU
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - KAI-NAN AN
- Orthopaedic Biomechanics Lab, Mayo Clinic, Rochester, MN, USA
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Medola FO, Fortulan CA, Purquerio BDM, Elui VMC. A new design for an old concept of wheelchair pushrim. Disabil Rehabil Assist Technol 2011; 7:234-41. [PMID: 22066518 DOI: 10.3109/17483107.2011.629327] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Report on the development of an ergonomic manual wheelchair pushrim and evaluate the user's perception of the quality of the device. METHOD Based on anthropometric features and ergonomic concepts, a new wheelchair pushrim was designed, and a prototype was manufactured in polyurethane, using the rapid prototyping technique and serial production of parts by molding. The prototype was tested by a sample of wheelchair users, who rated the perceived quality of the device after testing both the new and conventional pushrims in a wheelchair propulsion experimental protocol. RESULTS The new ergonomic pushrim was found to be, in general, better than the conventional round tube pushrim. Specifically, experienced wheelchair users found the new wheelchair pushrim better in terms of easy and comfortable propulsion, braking and maneuvering of the wheelchair, and appearance. CONCLUSIONS The new wheelchair pushrim provides a proper fit for the hands due to its ergonomic design and its polyurethane composition, making wheelchair propulsion easier and more comfortable than the conventional wheelchair pushrim. Assistive technology devices should be design based on ergonomic concepts that involve less effort and offer greater comfort for the user. [Box: see text].
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Affiliation(s)
- Fausto Orsi Medola
- Programme of Post-graduation Interunits in Bioengineering, University of Sao Paulo, Sao Carlos, Brazil.
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Prediction of applied forces in handrim wheelchair propulsion. J Biomech 2011; 44:455-60. [DOI: 10.1016/j.jbiomech.2010.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 09/04/2010] [Accepted: 09/27/2010] [Indexed: 11/20/2022]
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Chow JW, Levy CE. Wheelchair propulsion biomechanics and wheelers' quality of life: an exploratory review. Disabil Rehabil Assist Technol 2010; 6:365-77. [DOI: 10.3109/17483107.2010.525290] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rankin JW, Kwarciak AM, Mark Richter W, Neptune RR. The influence of altering push force effectiveness on upper extremity demand during wheelchair propulsion. J Biomech 2010; 43:2771-9. [PMID: 20674921 DOI: 10.1016/j.jbiomech.2010.06.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 05/28/2010] [Accepted: 06/03/2010] [Indexed: 11/19/2022]
Abstract
Manual wheelchair propulsion has been linked to a high incidence of overuse injury and pain in the upper extremity, which may be caused by the high load requirements and low mechanical efficiency of the task. Previous studies have suggested that poor mechanical efficiency may be due to a low effective handrim force (i.e. applied force that is not directed tangential to the handrim). As a result, studies attempting to reduce upper extremity demand have used various measures of force effectiveness (e.g., fraction effective force, FEF) as a guide for modifying propulsion technique, developing rehabilitation programs and configuring wheelchairs. However, the relationship between FEF and upper extremity demand is not well understood. The purpose of this study was to use forward dynamics simulations of wheelchair propulsion to determine the influence of FEF on upper extremity demand by quantifying individual muscle stress, work and handrim force contributions at different values of FEF. Simulations maximizing and minimizing FEF resulted in higher average muscle stresses (23% and 112%) and total muscle work (28% and 71%) compared to a nominal FEF simulation. The maximal FEF simulation also shifted muscle use from muscles crossing the elbow to those at the shoulder (e.g., rotator cuff muscles), placing greater demand on shoulder muscles during propulsion. The optimal FEF value appears to represent a balance between increasing push force effectiveness to increase mechanical efficiency and minimize upper extremity demand. Thus, care should be taken in using force effectiveness as a metric to reduce upper extremity demand.
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Affiliation(s)
- Jeffery W Rankin
- Department of Mechanical Engineering, The University of Texas at Austin, 1 University Station C2200, Austin, TX 78712, USA
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Desroches G, Dumas R, Pradon D, Vaslin P, Lepoutre FX, Chèze L. Upper limb joint dynamics during manual wheelchair propulsion. Clin Biomech (Bristol, Avon) 2010; 25:299-306. [PMID: 20106573 DOI: 10.1016/j.clinbiomech.2009.12.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 12/18/2009] [Accepted: 12/22/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inverse dynamic methods have been widely used to estimate joint loads during manual wheelchair propulsion. However, the interpretation of 3D net joint moments and powers is not always straightforward. It has been suggested to use joint coordinate systems (expression of joint moment on anatomical axes) and the 3D angle between joint moment and angular velocity vectors (propulsion, resistance or stabilization joint configuration) for a better understanding of joint dynamics. METHODS Nine spinal cord injured subjects equipped with reflective markers propelled in a wheelchair with an instrumented wheel. Inverse dynamic results were interpreted using joint coordinate systems, 3D joint power and the 3D angle between the joint moment and joint angular velocity vectors at the three upper limb joints. The 3D angle was used to determine if the joints were predominantly driven (angle close to 0 or 180 degrees) or stabilized (angle close to 90 degrees ). FINDINGS The wrist and elbow joints are mainly in a stabilization configuration (angle close to 90 degrees ) with a combination of extension and ulnar deviation moments and an adduction moment respectively. The shoulder is in a propulsion configuration, but close to stabilization (angle hardly below 60 degrees ) with a combination of flexion and internal rotation moments. INTERPRETATION Stabilization configuration at the joints could partly explain the low mechanical efficiency of manual wheelchair propulsion and could give insight about injury risk at the wrist, elbow and shoulder joints.
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Howarth SJ, Polgar JM, Dickerson CR, Callaghan JP. Trunk Muscle Activity During Wheelchair Ramp Ascent and the Influence of a Geared Wheel on the Demands of Postural Control. Arch Phys Med Rehabil 2010; 91:436-42. [DOI: 10.1016/j.apmr.2009.10.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 10/15/2009] [Accepted: 10/19/2009] [Indexed: 12/01/2022]
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