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Cordes CMA, Leonardis JM, Samet J, Schnorenberg AJ, England M, Mukherjee S, Vogel LC, Seitz AL, Slavens BA. Handrim kinetics and quantitative ultrasound parameters for assessment of subacromial impingement in wheelchair users with pediatric-onset spinal cord injury. Gait Posture 2024; 113:561-569. [PMID: 39182433 DOI: 10.1016/j.gaitpost.2024.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Most manual wheelchair users with pediatric-onset spinal cord injury (SCI) will experience shoulder pain or pathology at some point in their life. However, guidelines for preservation of the upper limb in children with SCI are limited. RESEARCH QUESTION What are the relationships between manual wheelchair handrim kinetics and quantitative ultrasound parameters related to subacromial impingement in individuals with pediatric-onset SCI? METHODS Subacromial impingement risk factors including supraspinatus tendon thickness (SST), acromiohumeral distance (AHD), and occupation ratio (OR; SST/AHD) were measured with ultrasound in 11 manual wheelchair users with pediatric-onset SCI. Handrim kinetics were acquired during the stroke cycle, including peak resultant force (FR), peak rate of rise of resultant force (ROR) and fractional effective force (FEF). Variability of handrim kinetics was computed using the coefficient of variation and linear regression was performed to assess correlations between handrim metrics and quantitative ultrasound parameters. RESULTS Peak resultant force significantly increased 1.4 % and variability of FEF significantly decreased 8.0 % for every 0.1 cm increase in AHD. FEF decreased 3.5 % for every 0.1 cm increase in SST. Variability of peak resultant force significantly increased 3.6 % and variability of peak ROR of resultant force significantly increased 7.3 % for every 0.1 cm increase in SST. FEF variability significantly decreased 11.6 % for every 0.1 cm increase in SST. Peak ROR significantly decreased 1.54 % with every 10 % increase in OR. FEF variability significantly decreased 1.5 % with every 10 % increase in OR. SIGNIFICANCE This is the first study to investigate relationships among handrim kinetics and shoulder structure in manual wheelchair users with pediatric-onset SCI. Associations were identified between subacromial impingement risk factors and magnitude and variability of wheelchair handrim kinetics. These results indicate the critical need to further explore the relationships among wheelchair handrim kinetics, shoulder joint dynamics, and shoulder pathology in manual wheelchair users with pediatric-onset SCI.
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Affiliation(s)
- Caleb M A Cordes
- University of Wisconsin-Milwaukee, Department of Rehabilitation Sciences and Technology, Milwaukee, WI 53211, USA; University of Wisconsin-Milwaukee, Department of Mechanical Engineering, Milwaukee, WI 53211, USA.
| | - Joshua M Leonardis
- University of Wisconsin-Milwaukee, Department of Rehabilitation Sciences and Technology, Milwaukee, WI 53211, USA; University of Illinois Urbana-Champaign, College of Applied Health Sciences, Urbana, IL 61801, USA; University of Illinois Urbana-Champaign, Beckman Institute for Advanced Science and Technology, Urbana, IL 61801, USA
| | - Jonathan Samet
- Ann and Robert H. Lurie Children's Hospital, Department of Medical Imaging, Chicago, IL 60611, USA; Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Alyssa J Schnorenberg
- University of Wisconsin-Milwaukee, Department of Mechanical Engineering, Milwaukee, WI 53211, USA
| | - Mark England
- Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Shubhra Mukherjee
- Shriners Children's Chicago, Chicago, IL 60707, USA; Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | | | - Amee L Seitz
- Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Brooke A Slavens
- University of Wisconsin-Milwaukee, Department of Rehabilitation Sciences and Technology, Milwaukee, WI 53211, USA; University of Wisconsin-Milwaukee, Department of Mechanical Engineering, Milwaukee, WI 53211, USA
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Flemmer CL, Flemmer RC. Reinventing the wheel for a manual wheelchair. Disabil Rehabil Assist Technol 2024; 19:2166-2177. [PMID: 37916314 DOI: 10.1080/17483107.2023.2272851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 08/22/2023] [Accepted: 10/13/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE Standard manual wheelchairs (MWCs) are inefficient and pushrim propulsion may cause progressive damage and pain to the user's arms. We describe a wheel for a MWC with a novel propulsion mechanism. METHODS The wheel has two modes of operation called "Standard" mode and "Run" mode. In Run mode, the wheelchair is propelled forward by pushing a compliant handle forward and then pulling it back, both strokes contributing to forward propulsion. We report the propulsive force and preliminary testing on a rough outdoor circuit by three able-bodied participants. RESULTS In Run mode, the peak applied force is reduced to 30% and the maximum force gradient is reduced to 10% of that for standard pushrim propulsion, for the same work output. The travel time for the 1.06 km outdoor circuit is about 60% of that for a brisk walk and about 40% of that for pushrim propulsion. At a propulsion speed of 1 m/s, the cardiovascular effort in Run mode is 56% of that for pushrim propulsion. Automatic hill-hold in Run mode improves safety when ascending slopes. The mechanism has three gears so that it can be used by people with widely varying strength and fitness. Folding the handle away converts the operation to Standard mode with the conventional pushrim propulsion, supplemented by three gears. CONCLUSIONS Despite the increased weight, width and friction, the bimodal geared wheels facilitate wheelchair travel on challenging paths. This may bring significant improvement to the quality of life of MWC users.
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Affiliation(s)
- Claire L Flemmer
- School of Built Environment, Massey University, Palmerston North, New Zealand
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Leonardis JM, Schnorenberg AJ, Vogel LC, Harris GF, Slavens BA. Sex-Related Differences in Shoulder Complex Joint Dynamics Variability During Pediatric Manual Wheelchair Propulsion. J Appl Biomech 2024; 40:112-121. [PMID: 37984356 DOI: 10.1123/jab.2022-0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 09/08/2023] [Accepted: 10/13/2023] [Indexed: 11/22/2023]
Abstract
More than 80% of adult manual wheelchair users with spinal cord injuries will experience shoulder pain. Females and those with decreased shoulder dynamics variability are more likely to experience pain in adulthood. Sex-related differences in shoulder dynamics variability during pediatric manual wheelchair propulsion may influence the lifetime risk of pain. We evaluated the influence of sex on 3-dimensional shoulder complex joint dynamics variability in 25 (12 females and 13 males) pediatric manual wheelchair users with spinal cord injury. Within-subject variability was quantified using the coefficient of variation. Permutation tests evaluated sex-related differences in variability using an adjusted critical alpha of P = .001. No sex-related differences in sternoclavicular or acromioclavicular joint kinematics or glenohumeral joint dynamics variability were observed (all P ≥ .042). Variability in motion, forces, and moments are considered important components of healthy joint function, as reduced variability may increase the likelihood of repetitive strain injury and pain. While further work is needed to generalize our results to other manual wheelchair user populations across the life span, our findings suggest that sex does not influence joint dynamics variability in pediatric manual wheelchair users with spinal cord injury.
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Affiliation(s)
- Joshua M Leonardis
- Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Alyssa J Schnorenberg
- Department of Mechanical Engineering, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | - Gerald F Harris
- Shriners Children's, Chicago, IL, USA
- Department of Biomedical Engineering, Orthopaedic & Rehabilitation Center, Marquette University, Milwaukee, WI, USA
| | - Brooke A Slavens
- Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
- Department of Mechanical Engineering, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
- Shriners Children's, Chicago, IL, USA
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Grindle D, Untaroiu C. Computational Seated Pedestrian Impact Design of Experiments with Ultralight Wheelchair. Ann Biomed Eng 2023; 51:1523-1534. [PMID: 36795241 DOI: 10.1007/s10439-023-03157-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/29/2023] [Indexed: 02/17/2023]
Abstract
Pedestrians who use wheelchairs (seated pedestrians) report higher mortality rates than standing pedestrians in vehicle-to-pedestrian collisions but the cause of this mortality is poorly understood. This study investigated the cause of seated pedestrian serious injuries (AIS 3+) and the effect of various pre-collision variables using finite element (FE) simulations. An ultralight manual wheelchair model was developed and tested to meet ISO standards. The GHBMC 50th percentile male simplified occupant model and EuroNCAP family car (FCR) and sports utility vehicle (SUV) were used to simulate vehicle collisions. A full factorial design of experiments (n = 54) was run to explore the effect of pedestrian position relative to the vehicle bumper, pedestrian arm posture, and pedestrian orientation angle relative to the vehicle. The largest average injury risks were at the head (FCR: 0.48 SUV: 0.79) and brain (FCR: 0.42 SUV: 0.50). The abdomen (FCR: 0.20 SUV: 0.21), neck (FCR: 0.08 SUV: 0.14), and pelvis (FCR: 0.02 SUV: 0.02) reported smaller risks. 50/54 impacts reported no thorax injury risk, but 3 SUV impacts reported risks ≥ 0.99. Arm (gait) posture and pedestrian orientation angle had larger effects on most injury risks. The most dangerous arm posture examined was when the hand was off the wheelchair handrail after wheel propulsion and the two more dangerous orientations were when the pedestrian faced 90° and 110° away from the vehicle. Pedestrian position relative to the vehicle bumper played little role in injury outcomes. The findings of this study may inform future seated pedestrian safety testing procedures to narrow down the most concerning impact scenarios and design impact tests around them.
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Affiliation(s)
- Daniel Grindle
- Department of Biomedical Engineering and Mechanics, Center for Injury Biomechanics, Virginia Tech, Collegiate Square Innovation Place (0151), 460 Turner St NW, Suite 304, Blacksburg, VA, 24060-3325, USA
| | - Costin Untaroiu
- Department of Biomedical Engineering and Mechanics, Center for Injury Biomechanics, Virginia Tech, Collegiate Square Innovation Place (0151), 460 Turner St NW, Suite 304, Blacksburg, VA, 24060-3325, USA.
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Leonardis JM, Schnorenberg AJ, Vogel LC, Harris GF, Slavens BA. The Influence of Age at Pediatric-Onset Spinal Cord Injury and Years of Wheelchair Use on Shoulder Complex Joint Dynamics During Manual Wheelchair Propulsion. Arch Rehabil Res Clin Transl 2022; 4:100235. [PMID: 36545526 PMCID: PMC9761265 DOI: 10.1016/j.arrct.2022.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To assess the association of age at pediatric-onset spinal cord injury (SCI) and years of manual wheelchair use with shoulder dynamics. Design Upper extremity kinematics and hand-rim kinetics were obtained during manual wheelchair propulsion. An inverse dynamics model computed three-dimensional acromioclavicular, sternoclavicular, and glenohumeral joint dynamics. Linear mixed effects models evaluated the association of age at injury onset and years of wheelchair use with shoulder dynamics. Setting Motion laboratory within a children's hospital. Participants Seventeen manual wheelchair users (N=17; 6 female, 11 male; mean age: 17.2 years, mean age at SCI onset: 11.5 years) with pediatric-onset SCI (levels: C4-T11) and International Standards for Neurological Classification of SCI grades: A (11), B (3), C (2), and N/A (2). Interventions Not applicable. Main Outcome Measures Acromioclavicular, sternoclavicular, and glenohumeral angles and ranges of motion, and glenohumeral forces and moments. Results We observed a decrease in maximum acromioclavicular upward rotation (ß [95% confidence interval {CI}]=3.02 [0.15,5.89], P=.039) and an increase in acromioclavicular downward/upward rotation range of motion (ß [95% CI]=0.44 [0.08,0.80], P=.016) with increasing age at SCI onset. We found interactions between age at onset and years of use for maximum glenohumeral abduction (ß [95% CI]=0.16 [0.03,0.29], P=.017), acromioclavicular downward/upward rotation range of motion (ß [95% CI]=-0.05 [-0.09,-0.01], P=.008), minimum acromioclavicular upward rotation (ß [95% CI]=-0.34 [-0.64,-0.04], P=.026). A decrease in glenohumeral internal rotation moment (ß [95% CI]=-0.09 [-0.17,-0.009], P=.029) with increasing years of use was found. Conclusions Age at injury and the years of wheelchair use are associated with shoulder complex biomechanics during wheelchair propulsion. These results are noteworthy, as both age at SCI onset and years of wheelchair use are considered important factors in the incidence of shoulder pain. These results suggest that investigations of biomechanical changes over the lifespan are critical.
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Affiliation(s)
- Joshua M. Leonardis
- Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Alyssa J. Schnorenberg
- Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI
| | | | - Gerald F. Harris
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI
| | - Brooke A. Slavens
- Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI
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Jahanian O, Gaglio A, Cho CC, Muqeet V, Smith R, Morrow MMB, Hsiao-Wecksler ET, Slavens BA. Hand-rim biomechanics during geared manual wheelchair propulsion over different ground conditions in individuals with spinal cord injury. J Biomech 2022; 142:111235. [PMID: 35947887 PMCID: PMC10765479 DOI: 10.1016/j.jbiomech.2022.111235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 06/29/2022] [Accepted: 07/21/2022] [Indexed: 11/29/2022]
Abstract
Geared manual wheelchair wheels, a recently developed alternative propulsion mechanism, have the potential to alleviate the high upper extremity demands required for wheelchair propulsion and help decrease the risk of secondary injuries in manual wheelchair users. The objective of this study was to investigate the effects of using geared manual wheelchairs on hand-rim biomechanics of wheelchair propulsion in individuals with spinal cord injury (SCI). Seven manual wheelchair users with SCI propelled their wheelchairs equipped with geared wheels over tile, carpet, and up a ramp in low gear (gear ratio 1.5:1) and standard gear (gear ratio 1:1) conditions. Hand-rim kinetics and stroke cycle characteristics were measured using a custom instrumented geared wheel. Using the geared wheels in the low gear condition, propulsion speed (P = 0.013), peak resultant force (P = 0.005), peak propulsive moment (P < 0.006), and peak rate of rise of the resultant force (P = 0.035) decreased significantly in comparison with the standard gear condition. The significant increase in the number of stroke cycles when normalized to distance (P = 0.004) and decrease in the normalized integrated moment (P = 0.030) indicated that although a higher number of stroke cycles are required for travelling a given distance in the low gear than the standard gear condition, the low gear condition might be less demanding for the upper extremity. These results suggest that geared wheels could be a useful technology for manual wheelchair users to independently accomplish strenuous propulsion tasks including mobility on carpeted floors and ramp ascension, while reducing the risk factors contributing to the incidence of secondary upper extremity injuries.
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Affiliation(s)
- Omid Jahanian
- Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA; Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Alan Gaglio
- Department of Mechanical Science & Engineering, University of Illinois at Urbana-Champaign, IL, USA
| | - Chris C Cho
- College of Health Science, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Vaishnavi Muqeet
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Roger Smith
- Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Melissa M B Morrow
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Brooke A Slavens
- Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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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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Rotation sequence and marker tracking method affects the humerothoracic kinematics of manual wheelchair propulsion. J Biomech 2022; 141:111212. [PMID: 35780696 DOI: 10.1016/j.jbiomech.2022.111212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/21/2022]
Abstract
The literature on shoulder (humerothoracic) kinematics in manual wheelchair propulsion is growing. Inconsistencies in the reporting of which rotation sequence is used to compute three-dimensional (3D) angles complicates the interpretation and comparison between studies. The purpose of this study was to compare the effects of three often used and recommended rotation sequences (ZXY, XZY, and YXY) and two tracking methods (anatomical and cluster only) on the humerothoracic kinematics of manual wheelchair propulsion. Fourteen able-bodied participants performed manual wheelchair propulsion on a treadmill, while a motion capture system recorded the movements at 120 Hz. Humeral and thoracic segment coordinate systems were constructed according to ISB recommendations. Humerothoracic angles were calculated using each of the three rotation sequences. The ZXY and XZY sequences yielded similar angles in terms of both shape and amplitude, but, perhaps unsurprisingly, these differed substantially from the YXY sequence. Anatomical tracking showed neither gimbal locks nor phase angle discontinuities for any rotation sequence, while cluster tracking yielded phase angle discontinuities for the ZXY and YXY rotation sequences. The two tracking methods yielded similar joint angles for all sequences except for internal/external rotation, and the cluster-only method had larger variability than the anatomical method. These results highlight the importance of reporting which rotation sequence and tracking method are used when calculating humerothoracic angles in order to allow for straightforward interpretation of results and comparison across studies.
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Chénier F, Alberca I, Gagnon DH, Faupin A. Impact of Sprinting and Dribbling on Shoulder Joint and Pushrim Kinetics in Wheelchair Basketball Athletes. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:863093. [PMID: 36189044 PMCID: PMC9397776 DOI: 10.3389/fresc.2022.863093] [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: 01/26/2022] [Accepted: 05/10/2022] [Indexed: 11/18/2022]
Abstract
Background While wheelchair basketball is one of the most popular Paralympic sports, it eventually causes shoulder problems and pain in many athletes. However, shoulder kinetics has never been assessed during propulsion in wheelchair basketball. This study analyzes the impact of sprinting and dribbling on pushrim and shoulder kinetics in terms of external forces and net muscular moments. Methods A group of 10 experienced wheelchair basketball athletes with various classifications performed four, 9-m sprints on a basketball court using classic synchronous propulsion, and four sprints while dribbling forward. Pushrim and shoulder kinetics were calculated by inverse dynamics, using a motion capture device and instrumented wheels. Findings Sprinting was associated to peak shoulder load from 13 to 346% higher than in previous studies on standard wheelchair propulsion in most force/moment components. Compared to sprinting without a ball, dribbling reduced the speed, the peak external forces in the anterior and medial direction at the shoulder, and the peak net shoulder moment of internal rotation. Interpretation The high shoulder load calculated during both sprinting and dribbling should be considered during training sessions to avoid overloading the shoulder. Dribbling generally reduced the shoulder load, which suggests that propelling while dribbling does not put the shoulder at more risk of musculoskeletal disorders than sprinting.
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Affiliation(s)
- Félix Chénier
- Mobility and Adaptive Sports Research Lab, Department of Physical Activity Science, Université du Québec à Montréal (UQAM), Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- *Correspondence: Félix Chénier
| | - Ilona Alberca
- Université de Toulon, Impact de l'Activité Physique sur la Santé (UR IAPS n°201723207F), Campus de La Garde, Toulon, France
| | - Dany H. Gagnon
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- School of Rehabilitation, Université de Montréal, Faculty of Medicine, Montreal, QC, Canada
| | - Arnaud Faupin
- Université de Toulon, Impact de l'Activité Physique sur la Santé (UR IAPS n°201723207F), Campus de La Garde, Toulon, France
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A novel push-pull central-lever mechanism reduces peak forces and energy-cost compared to hand-rim wheelchair propulsion during a controlled lab-based experiment. J Neuroeng Rehabil 2022; 19:30. [PMID: 35300710 PMCID: PMC8932120 DOI: 10.1186/s12984-022-01007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background Hand-rim wheelchair propulsion is straining and mechanically inefficient, often leading to upper limb complaints. Previous push–pull lever propulsion mechanisms have shown to perform better or equal in efficiency and physiological strain. Propulsion biomechanics have not been evaluated thus far. A novel push–pull central-lever propulsion mechanism is compared to conventional hand-rim wheelchair propulsion, using both physiological and biomechanical outcomes under low-intensity steady-state conditions on a motor driven treadmill. Methods In this 5 day (distributed over a maximum of 21 days) between-group experiment, 30 able-bodied novices performed 60 min (5 × 3 × 4 min) of practice in either the push–pull central lever wheelchair (n = 15) or the hand-rim wheelchair (n = 15). At the first and final sessions cardiopulmonary strain, propulsion kinematics and force production were determined in both instrumented propulsion mechanisms. Repeated measures ANOVA evaluated between (propulsion mechanism type), within (over practice) and interaction effects. Results Over practice, both groups significantly improved on all outcome measures. After practice the peak forces during the push and pull phase of lever propulsion were considerably lower compared to those in the handrim push phase (42 ± 10 & 46 ± 10 vs 63 ± 21N). Concomitantly, energy expenditure was found to be lower as well (263 ± 45 vs 298 ± 59W), on the other hand gross mechanical efficiency (6.4 ± 1.5 vs 5.9 ± 1.3%), heart-rate (97 ± 10 vs 98 ± 10 bpm) and perceived exertion (9 ± 2 vs 10 ± 1) were not significantly different between modes. Conclusion The current study shows the potential benefits of the newly designed push–pull central-lever propulsion mechanism over regular hand rim wheelchair propulsion. The much lower forces and energy expenditure might help to reduce the strain on the upper extremities and thus prevent the development of overuse injury. This proof of concept in a controlled laboratory experiment warrants continued experimental research in wheelchair-users during daily life.
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Effectiveness of Rehabilitation through Kinematic Analysis of Upper Limb Functioning in Wheelchair Basketball Athletes: A Pilot Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12062929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Wheelchair basketball is one of the most popular Paralympic sports, including players with different diagnoses. To date, there is scarce evidence on shoulder functionality in wheelchair basketball players, and there is no consensus on a shoulder injury prevention program in these athletes. Therefore, in the present pilot study, we aimed to evaluate the effects of a comprehensive rehabilitative approach on shoulder ROM, muscle activity, and functioning in wheelchair basketball athletes. We included adult wheelchair basketball athletes playing in the Italian Second League who completed an 8-week comprehensive rehabilitative program, based on education to avoid upper limb pain injuries, preventive exercises, and improvement of ergonomics through kinematic analysis. We administered the Wheelchair User’s Shoulder Pain Index (WUSPI) and the Kerlan-Jobe Orthopaedic Clinic (KJOC) questionnaire to evaluate pain experienced during functional activities, and used kinematic analysis integrated with sEMG to evaluate shoulder function and propulsion pattern. A sample of 10 wheelchair athletes (33.75 ± 6.42 years) were assessed. After the intervention there was a significant (p < 0.05) difference in WUSPI score (27.0 ± 18.5 vs. 25.0 ± 21.5) and in KJOC score (89.3 ± 10.4 to 95.4 ± 9.1). Moreover, there was a significant improvement in scapular upward rotation, abduction, and extra-rotation of the glenohumeral joint. Propulsion techniques improved in pattern and acceleration. This approach played a key role in improving upper limb function, reducing the incidence of pain and cumulative trauma disorders. However, the small sample size could affect the generalizability of results. In conclusion, healthcare professionals should monitor wheelchair athletes, assessing the patient’s function, ergonomics, equipment, and level of pain, and introducing specific exercises to prevent upper limb injuries.
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Leonardis JM, Schnorenberg AJ, Vogel LC, Harris GF, Slavens BA. Biological Sex-Related Differences in Glenohumeral Dynamics Variability during Pediatric 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 2021; 2021:4619-4622. [PMID: 34892243 DOI: 10.1109/embc46164.2021.9630865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Shoulder pain and pathology are extremely common in adult manual wheelchair users with spinal cord injury (SCI). Within this population, biological sex and variability in shoulder joint dynamics have been shown to be important contributors to both shoulder pain and pathology. Sex-related differences in shoulder dynamics variability during pediatric manual wheelchair propulsion may influence a user's lifetime risk of shoulder pain and pathology. The purpose of this study was to assess the influence of biological sex on variability in three-dimensional (3-D) glenohumeral joint dynamics in pediatric manual wheelchair users with SCI. An inverse dynamics model computed 3-D glenohumeral joint angles, forces, and moments of 20 pediatric manual wheelchair users. Levene's tests assessed biological sex-related differences in variability. Females exhibited less variability in glenohumeral joint kinematics and forces, but greater variability in joint moments than males. Evaluation of glenohumeral joint dynamics with consideration for biological sex and variability strengthens our interpretation of the relationships among shoulder function, pain, and pathology in pediatric manual wheelchair users.Clinical Relevance- Female pediatric manual wheelchair users may be at an increased risk of shoulder repetitive strain injuries due to decreased glenohumeral joint motion and force variability during propulsion. This work establishes quantitative methods for determining the effects of biological sex on the variability of shoulder joint dynamics.
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Bailey SN, Foglyano KM, Bean NF, Triolo RJ. Effect of Context-Dependent Modulation of Trunk Muscle Activity on Manual Wheelchair Propulsion. Am J Phys Med Rehabil 2021; 100:983-989. [PMID: 33443856 DOI: 10.1097/phm.0000000000001691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aims of the study were to reliably determine the two main phases of manual wheelchair propulsion via a simple wearable sensor and to evaluate the effects of modulated trunk and hip stimulation on manual wheelchair propulsion during the challenging tasks of ramp assent and level sprint. DESIGN An offline tool was created to identify common features between wrist acceleration signals for all subjects who corresponded to the transitions between the contact and recovery phases of manual wheelchair propulsion. For one individual, the acceleration rules and thresholds were implemented for real-time phase-change event detection and modulation of stimulation. RESULTS When pushing with phase-dependent modulated stimulation, there was a significant (P < 0.05) increase in the primary speed variable (5%-6%) and the subject rated pushing as "moderately or very easy." In the offline analysis, the average phase-change event detection success rate was 79% at the end of contact and 71% at the end of recovery across the group. CONCLUSIONS Signals from simple, wrist-mounted accelerometers can detect the phase transitions during manual wheelchair propulsion instead of elaborate and expensive, instrumented systems. Appropriately timing changes in muscle activation with the propulsion cycle can result in a significant increase in speed, and the system was consistently perceived to be significantly easier to use.
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Affiliation(s)
- Stephanie Nogan Bailey
- From the Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio (SNB, KMF, NFB, RJT); Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio (NFB, RJT); and Department of Orthopaedics, Case Western Reserve University, Cleveland, Ohio (RJT)
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Hanks MM, Leonardis JM, Schnorenberg AJ, Krzak JJ, Graf A, Vogel LC, Harris GF, Slavens BA. The Influence of Sex on Upper Extremity Joint Dynamics in Pediatric Manual Wheelchair Users With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 27:26-37. [PMID: 34456544 PMCID: PMC8370704 DOI: 10.46292/sci20-00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Manual wheelchair propulsion is a physically demanding task associated with upper extremity pain and pathology. Shoulder pain is reported in over 25% of pediatric manual wheelchairs users, and this number rises over the lifespan. Upper extremity biomechanics in adults has been associated with shoulder pain and pathology; however, few studies have investigated upper extremity joint dynamics in children. Furthermore, sex may be a critical factor that is currently unexplored with regard to pediatric wheelchair mobility. OBJECTIVES To investigate differences in upper extremity joint dynamics between pediatric male and female manual wheelchair users with spinal cord injury (SCI) during wheelchair propulsion. METHODS Novel instrumented wheelchair hand-rims synchronized with optical motion capture were used to acquire upper extremity joint dynamics of 20 pediatric manual wheelchair users with SCI (11 males, 9 females). Thorax, sternoclavicular, acromioclavicular, glenohumeral, elbow, and wrist joint kinematics and kinetics were calculated during wheelchair propulsion. Linear mixed models were used to assess differences between sexes. RESULTS Females exhibited significantly greater peak forearm pronation (p = .007), normalized wrist lateral force (p = .03), and normalized elbow posterior force (p = .04) than males. Males exhibited significantly greater peak sternoclavicular joint retraction (p < .001) than females. No significant differences between males and females were observed for the glenohumeral joint (p > .012). CONCLUSION This study found significant differences in upper extremity joint dynamics between sexes during manual wheelchair propulsion. Our results underscore the importance of considering sex when evaluating pediatric wheelchair mobility and developing comprehensive wheelchair training interventions for early detection and prevention of upper extremity pain and pathology.
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Affiliation(s)
- Matthew M. Hanks
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Joshua M. Leonardis
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Alyssa J. Schnorenberg
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Joseph J. Krzak
- Shriners Hospitals for Children, Chicago, Illinois
- Department of Physical Therapy, Midwestern University, Downers Grove, Illinois
| | - Adam Graf
- Shriners Hospitals for Children, Chicago, Illinois
| | | | - Gerald F. Harris
- Shriners Hospitals for Children, Chicago, Illinois
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brooke A. Slavens
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
- Shriners Hospitals for Children, Chicago, Illinois
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Beirens BJH, Bossuyt FM, Arnet U, van der Woude LHV, de Vries WHK. Shoulder Pain Is Associated With Rate of Rise and Jerk of the Applied Forces During Wheelchair Propulsion in Individuals With Paraplegic Spinal Cord Injury. Arch Phys Med Rehabil 2020; 102:856-864. [PMID: 33161010 DOI: 10.1016/j.apmr.2020.10.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 09/17/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the association between propulsion biomechanics, including variables that describe smoothness of the applied forces, and shoulder pain in individuals with spinal cord injury (SCI). DESIGN Cross-sectional, observational study. SETTING Non-university research institution. PARTICIPANTS Community dwelling, wheelchair dependent participants (N=30) with chronic paraplegia between T2 and L1, with and without shoulder pain (age, 48.6±9.3y; 83% men). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Rate of rise and jerk of applied forces during wheelchair propulsion. Participants were stratified in groups with low, moderate, and high pain based on their Wheelchair User Shoulder Pain Index score on the day of measurement. RESULTS A mixed-effect multilevel analysis showed that wheelchair users in the high pain group propelled with a significantly greater rate of rise and jerk, measures that describe smoothness of the applied forces, compared with individuals with less or no pain, when controlling for all covariables. CONCLUSIONS Individuals with severe shoulder pain propelled with less smooth strokes compared to individuals with less or no pain. This supports a possible association between shoulder pain and rate of rise and jerk of the applied forces during wheelchair propulsion.
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Affiliation(s)
| | - Fransiska M Bossuyt
- Swiss Paraplegic Research, Nottwil, Switzerland; Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Ursina Arnet
- Swiss Paraplegic Research, Nottwil, Switzerland; Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Lucas H V van der Woude
- Centre for Human Movement Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands; Centre for Rehabilitation, Department of Rehabilitation Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Wiebe H K de Vries
- Swiss Paraplegic Research, Nottwil, Switzerland; Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.
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Eydieux N, Hybois S, Siegel A, Bascou J, Vaslin P, Pillet H, Fodé P, Sauret C. Changes in wheelchair biomechanics within the first 120 minutes of practice: spatiotemporal parameters, handrim forces, motor force, rolling resistance and fore-aft stability. Disabil Rehabil Assist Technol 2019; 15:305-313. [PMID: 30786787 DOI: 10.1080/17483107.2019.1571117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: During manual wheelchair (MWC) skill acquisition, users adapt their propulsion technique through changes in biomechanical parameters. This evolution is assumed to be driven towards a more efficient behavior. However, when no specific training protocol is provided to users, little is known about how they spontaneously adapt during overground MWC locomotion. For that purpose, we investigated this biomechanical spontaneous adaptation within the initial phase of low-intensity uninstructed training.Materials and methods: Eighteen novice able-bodied subjects were enrolled to perform 120 min of uninstructed practice with a field MWC, distributed over 4 weeks. Subjects were tested during the very first minutes of the program, and after completion of the entire training protocol. Spatiotemporal parameters, handrim forces, motor force, rolling resistance and fore-aft stability were investigated using an instrumented field wheelchair.Results: Participants rapidly increased linear velocity of the MWC, thanks to a higher propulsive force. This was achieved thanks to higher handrim forces, combined with an improved fraction of effective force for startup but not for propulsion. Despite changes in mechanical actions exerted by the user on the MWC, rolling resistance remained constant but the stability index was noticeably altered.Conclusion: Even if no indication is given, novice MWC users rapidly change their propulsion technique and increase their linear speed. Such improvements in MWC mobility are allowed by a mastering of the whole range of stability offered by the MWC, which raises the issue of safety on the MWC.Implications for rehabilitationThe learning process of manual wheelchair locomotion induces adaptations for novice users, who change their propulsion technique to improve their mobility.Several wheelchair biomechanical parameters change during the learning process, especially wheelchair speed, handrim forces, motor force, rolling resistance and fore-aft stability.Fore-aft stability on the wheelchair rapidly reached the tipping limits for users. Technical solutions that preserve stability but do not hinder mobility have to beimplemented, for instance by adding anti-tipping wheels rather than moving the seat forwards with respect to the rear wheels axle.
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Affiliation(s)
- Nicolas Eydieux
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.,Centre d'Études et de Recherche sur l'Appareillage des Handicapés Institution Nationale des Invalides, Woippy, France
| | - Samuel Hybois
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.,Centre d'Études et de Recherche sur l'Appareillage des Handicapés Institution Nationale des Invalides, Woippy, France
| | - Alice Siegel
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.,Centre d'Études et de Recherche sur l'Appareillage des Handicapés Institution Nationale des Invalides, Woippy, France
| | - Joseph Bascou
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.,Centre d'Études et de Recherche sur l'Appareillage des Handicapés Institution Nationale des Invalides, Woippy, France
| | - Philippe Vaslin
- Laboratoire d'Informatique, de Modélisation et d'Optimisation des Systèmes, Université Clermont Auvergne (UCA), Clermont-Ferrand, France
| | - Hélène Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Pascale Fodé
- Centre d'Études et de Recherche sur l'Appareillage des Handicapés Institution Nationale des Invalides, Woippy, France
| | - Christophe Sauret
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
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Leving MT, Vegter RJK, de Vries WHK, de Groot S, van der Woude LHV. Changes in propulsion technique and shoulder complex loading following low-intensity wheelchair practice in novices. PLoS One 2018; 13:e0207291. [PMID: 30412627 PMCID: PMC6226177 DOI: 10.1371/journal.pone.0207291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/29/2018] [Indexed: 11/18/2022] Open
Abstract
Background Up to 80% of wheelchair users are affected by shoulder pain. The Clinical Practice Guidelines for preservation of upper limb function following spinal cord injury suggest that using a proper wheelchair propulsion technique could minimize the shoulder injury risk. Yet, the exact relationship between the wheelchair propulsion technique and shoulder load is not well understood. Objective This study aimed to examine the changes in shoulder loading accompanying the typical changes in propulsion technique following 80 min of low-intensity wheelchair practice distributed over 3 weeks. Methods Seven able-bodied participants performed the pre- and the post-test and 56 min of visual feedback-based low-intensity wheelchair propulsion practice. Kinematics and kinetics of propulsion technique were recorded during the pre- and the post-test. A musculoskeletal model was used to calculate muscle force and glenohumeral reaction force. Results Participants decreased push frequency (51→36 pushes/min, p = 0.04) and increased contact angle (68→94°, p = 0.02) between the pre- and the post-test. The excursion of the upper arm increased, approaching significance (297→342 mm, p = 0.06). Range of motion of the hand, trunk and shoulder remained unchanged. The mean glenohumeral reaction force per cycle decreased by 13%, approaching significance (268→232 N, p = 0.06). Conclusions Despite homogenous changes in propulsion technique, the kinematic solution to the task varied among the participants. Participants exhibited two glenohumeral reaction force distribution patterns: 1) Two individuals developed high force at the onset of the push, leading to increased peak and mean glenohumeral forces 2) Five individuals distributed the force more evenly over the cycle, lowering both peak and mean glenohumeral forces.
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Affiliation(s)
- Marika T. Leving
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Riemer J. K. Vegter
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Sonja de Groot
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands
| | - Lucas H. V. van der Woude
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Babu Rajendra Kurup N, Puchinger M, Gföhler M. Forward dynamic optimization of handle path and muscle activity for handle based isokinetic wheelchair propulsion: A simulation study. Comput Methods Biomech Biomed Engin 2018; 22:55-63. [PMID: 30398368 PMCID: PMC6457274 DOI: 10.1080/10255842.2018.1527321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Push-rim wheelchair propulsion is biomechanically inefficient and physiologically stressful to the musculoskeletal structure of human body. This study focuses to obtain a new, optimized propulsion shape for wheelchair users, which is within the ergonomic ranges of joint motion, thus reducing the probability of injuries. To identify the propulsion movement, forward dynamic optimization was performed on a 3D human musculoskeletal model linked to a handle based propulsion mechanism, having shape and muscle excitations as optimization variables. The optimization resulted in a handle path shape with a circularity ratio of 0.95, and produced a net propulsion power of 34.7 watts for an isokinetic propulsion cycle at 50 rpm. Compared to push-rim propulsion, the compact design of the new propulsion mechanism along with the ergonomically optimized propulsion shape may help to reduce the risk of injuries and thus improve the quality of life for wheelchair users.
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Affiliation(s)
| | - Markus Puchinger
- a Research Division for Biomechanics and Rehabilitation Engineering , TU Wien , Vienna , Austria
| | - Margit Gföhler
- a Research Division for Biomechanics and Rehabilitation Engineering , TU Wien , Vienna , Austria
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Gagnon DH, Jouval C, Chénier F. Estimating pushrim temporal and kinetic measures using an instrumented treadmill during wheelchair propulsion: A concurrent validity study. J Biomech 2016; 49:1976-1982. [DOI: 10.1016/j.jbiomech.2016.04.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 04/23/2016] [Accepted: 04/27/2016] [Indexed: 01/22/2023]
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Slowik JS, Requejo PS, Mulroy SJ, Neptune RR. The influence of wheelchair propulsion hand pattern on upper extremity muscle power and stress. J Biomech 2016; 49:1554-1561. [PMID: 27062591 DOI: 10.1016/j.jbiomech.2016.03.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 03/16/2016] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
Abstract
The hand pattern (i.e., full-cycle hand path) used during manual wheelchair propulsion is frequently classified as one of four distinct hand pattern types: arc, single loop, double loop or semicircular. Current clinical guidelines recommend the use of the semicircular pattern, which is based on advantageous levels of broad biomechanical metrics implicitly related to the demand placed on the upper extremity (e.g., lower cadence). However, an understanding of the influence of hand pattern on specific measures of upper extremity muscle demand (e.g., muscle power and stress) is needed to help make such recommendations, but these quantities are difficult and impractical to measure experimentally. The purpose of this study was to use musculoskeletal modeling and forward dynamics simulations to investigate the influence of the hand pattern used on specific measures of upper extremity muscle demand. The simulation results suggest that the double loop and semicircular patterns produce the most favorable levels of overall muscle stress and total muscle power. The double loop pattern had the lowest full-cycle and recovery-phase upper extremity demand but required high levels of muscle power during the relatively short contact phase. The semicircular pattern had the second-lowest full-cycle levels of overall muscle stress and total muscle power, and demand was more evenly distributed between the contact and recovery phases. These results suggest that in order to decrease upper extremity demand, manual wheelchair users should consider using either the double loop or semicircular pattern when propelling their wheelchairs at a self-selected speed on level ground.
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Affiliation(s)
- Jonathan S Slowik
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Philip S Requejo
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA; Rehabilitation Engineering, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Sara J Mulroy
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Richard R Neptune
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA.
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Slowik JS, Requejo PS, Mulroy SJ, Neptune RR. The influence of speed and grade on wheelchair propulsion hand pattern. Clin Biomech (Bristol, Avon) 2015; 30:927-32. [PMID: 26228706 PMCID: PMC4631660 DOI: 10.1016/j.clinbiomech.2015.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/10/2015] [Accepted: 07/13/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The hand pattern used during manual wheelchair propulsion (i.e., full-cycle hand path) can provide insight into an individual's propulsion technique. However, previous analyses of hand patterns have been limited by their focus on a single propulsion condition and reliance on subjective qualitative characterization methods. The purpose of this study was to develop a set of objective quantitative parameters to characterize hand patterns and determine the influence of propulsion speed and grade of incline on the patterns preferred by manual wheelchair users. METHODS Kinematic and kinetic data were collected from 170 experienced manual wheelchair users on an ergometer during three conditions: level propulsion at their self-selected speed, level propulsion at their fastest comfortable speed and graded propulsion (8%) at their level self-selected speed. Hand patterns were quantified using a set of objective parameters, and differences across conditions were identified. FINDINGS Increased propulsion speed resulted in a shift away from under-rim hand patterns. Increased grade of incline resulted in the hand remaining near the handrim throughout the cycle. INTERPRETATION Manual wheelchair users change their hand pattern based on task-specific constraints and goals. Further work is needed to investigate how differences between hand patterns influence upper extremity demand and potentially lead to the development of overuse injuries and pain.
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Affiliation(s)
- Jonathan S. Slowik
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Philip S. Requejo
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA,Rehabilitation Engineering, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Sara J. Mulroy
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Richard R. Neptune
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
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Slavens BA, Schnorenberg AJ, Aurit CM, Tarima S, Vogel LC, Harris GF. Biomechanics of Pediatric Manual Wheelchair Mobility. Front Bioeng Biotechnol 2015; 3:137. [PMID: 26442251 PMCID: PMC4564732 DOI: 10.3389/fbioe.2015.00137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/26/2015] [Indexed: 12/02/2022] Open
Abstract
Currently, there is limited research of the biomechanics of pediatric manual wheelchair mobility. Specifically, the biomechanics of functional tasks and their relationship to joint pain and health is not well understood. To contribute to this knowledge gap, a quantitative rehabilitation approach was applied for characterizing upper extremity biomechanics of manual wheelchair mobility in children and adolescents during propulsion, starting, and stopping tasks. A Vicon motion analysis system captured movement, while a SmartWheel simultaneously collected three-dimensional forces and moments occurring at the handrim. A custom pediatric inverse dynamics model was used to evaluate three-dimensional upper extremity joint motions, forces, and moments of 14 children with spinal cord injury (SCI) during the functional tasks. Additionally, pain and health-related quality of life outcomes were assessed. This research found that joint demands are significantly different amongst functional tasks, with greatest demands placed on the shoulder during the starting task. Propulsion was significantly different from starting and stopping at all joints. We identified multiple stroke patterns used by the children, some of which are not standard in adults. One subject reported average daily pain, which was minimal. Lower than normal physical health and higher than normal mental health was found in this population. It can be concluded that functional tasks should be considered in addition to propulsion for rehabilitation and SCI treatment planning. This research provides wheelchair users and clinicians with a comprehensive, biomechanical, mobility assessment approach for wheelchair prescription, training, and long-term care of children with SCI.
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Affiliation(s)
- Brooke A Slavens
- Movement Analysis for Biomedical Innovation & Technology (Mobility) Laboratory, Department of Occupational Science and Technology, University of Wisconsin-Milwaukee , Milwaukee, WI , USA ; Shriners Hospitals for Children - Chicago , Chicago, IL , USA ; Orthopaedic and Rehabilitation Engineering Center (OREC), Medical College of Wisconsin and Marquette University , Milwaukee, WI , USA
| | - Alyssa J Schnorenberg
- Movement Analysis for Biomedical Innovation & Technology (Mobility) Laboratory, Department of Occupational Science and Technology, University of Wisconsin-Milwaukee , Milwaukee, WI , USA
| | - Christine M Aurit
- Movement Analysis for Biomedical Innovation & Technology (Mobility) Laboratory, Department of Occupational Science and Technology, University of Wisconsin-Milwaukee , Milwaukee, WI , USA
| | - Sergey Tarima
- Department of Biostatistics, Medical College of Wisconsin , Milwaukee, WI , USA
| | | | - Gerald F Harris
- Shriners Hospitals for Children - Chicago , Chicago, IL , USA ; Orthopaedic and Rehabilitation Engineering Center (OREC), Medical College of Wisconsin and Marquette University , Milwaukee, WI , USA
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Evaluation of pediatric manual wheelchair mobility using advanced biomechanical methods. BIOMED RESEARCH INTERNATIONAL 2015; 2015:634768. [PMID: 25802860 PMCID: PMC4352734 DOI: 10.1155/2015/634768] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/03/2014] [Accepted: 07/21/2014] [Indexed: 11/17/2022]
Abstract
There is minimal research of upper extremity joint dynamics during pediatric wheelchair mobility despite the large number of children using manual wheelchairs. Special concern arises with the pediatric population, particularly in regard to the longer duration of wheelchair use, joint integrity, participation and community integration, and transitional care into adulthood. This study seeks to provide evaluation methods for characterizing the biomechanics of wheelchair use by children with spinal cord injury (SCI). Twelve subjects with SCI underwent motion analysis while they propelled their wheelchair at a self-selected speed and propulsion pattern. Upper extremity joint kinematics, forces, and moments were computed using inverse dynamics methods with our custom model. The glenohumeral joint displayed the largest average range of motion (ROM) at 47.1° in the sagittal plane and the largest average superiorly and anteriorly directed joint forces of 6.1% BW and 6.5% BW, respectively. The largest joint moments were 1.4% body weight times height (BW × H) of elbow flexion and 1.2% BW × H of glenohumeral joint extension. Pediatric manual wheelchair users demonstrating these high joint demands may be at risk for pain and upper limb injuries. These evaluation methods may be a useful tool for clinicians and therapists for pediatric wheelchair prescription and training.
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Schnorenberg AJ, Slavens BA, Graf A, Krzak J, Vogel L, Harris GF. Upper extremity biomechanics of children with spinal cord injury during wheelchair mobility. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:4338-41. [PMID: 25570952 DOI: 10.1109/embc.2014.6944584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
While much work is being done evaluating the upper extremity joint dynamics of adult manual wheelchair propulsion, limited work has examined the pediatric population of manual wheelchair users. Our group used a custom pediatric biomechanical model to characterize the upper extremity joint dynamics of 12 children and adolescents with spinal cord injury (SCI) during wheelchair propulsion. Results show that loading appears to agree with that of adult manual wheelchair users, with the highest loading primarily seen at the glenohumeral joint. This is concerning due to the increased time of wheelchair use in the pediatric population and the impact of this loading during developmental years. This research may assist clinicians with improved mobility assessment methods, wheelchair prescription, training, and long-term care of children with orthopaedic disabilities.
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Gagnon DH, Babineau AC, Champagne A, Desroches G, Aissaoui R. Pushrim biomechanical changes with progressive increases in slope during motorized treadmill manual wheelchair propulsion in individuals with spinal cord injury. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2014; 51:789-802. [PMID: 25357244 DOI: 10.1682/jrrd.2013.07.0168] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 01/08/2014] [Indexed: 11/05/2022]
Abstract
The purpose of this study was to quantify the effects of five distinct slopes on spatiotemporal and pushrim kinetic measures at the nondominant upper limb during manual wheelchair (MWC) propulsion on a motorized treadmill in individuals with spinal cord injury (SCI). Eighteen participants with SCI propelled their MWC at a self-selected natural speed on a treadmill at different slopes (0, 2.7, 3.6, 4.8, and 7.1 degrees). Spatiotemporal parameters along with total force and tangential components of the force applied to the pushrim, including mechanical effective force, were calculated using an instrumented wheel. The duration of the recovery phase was 54% to 70% faster as the slope increased, whereas the duration of the push phase remained similar. The initial contact angles migrated forward on the pushrim, while the final and total contact angles remained similar as the slope increased. As the slope increased, the mean total force was 93% to 201% higher and the mean tangential component of the force was 96% to 176% higher than propulsion with no slope. Measures were similar for the 2.7 and 3.6 degrees slopes. Overall, the recovery phase became shorter and the forces applied at the pushrim became greater as the slope of the treadmill increased during motorized treadmill MWC propulsion.
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Affiliation(s)
- Dany H Gagnon
- School of Rehabilitation, Université de Montréal, Montreal, Canada; and Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut de Réadaptation Gingras-Lindsay-de-Montréal, Montreal, Canada
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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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Askari S, Kirby RL, Parker K, Thompson K, O'Neill J. Wheelchair Propulsion Test: Development and Measurement Properties of a New Test for Manual Wheelchair Users. Arch Phys Med Rehabil 2013; 94:1690-8. [DOI: 10.1016/j.apmr.2013.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/05/2013] [Accepted: 03/05/2013] [Indexed: 10/27/2022]
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Triolo RJ, Bailey SN, Lombardo LM, Miller ME, Foglyano K, Audu ML. Effects of intramuscular trunk stimulation on manual wheelchair propulsion mechanics in 6 subjects with spinal cord injury. Arch Phys Med Rehabil 2013; 94:1997-2005. [PMID: 23628377 DOI: 10.1016/j.apmr.2013.04.010] [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] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 04/12/2013] [Accepted: 04/13/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To quantify the effects of stabilizing the paralyzed trunk and pelvis with electrical stimulation on manual wheelchair propulsion. DESIGN Single-subject design case series with subjects acting as their own concurrent controls. SETTING Hospital-based clinical biomechanics laboratory. PARTICIPANTS Individuals (N=6; 4 men, 2 women; mean age ± SD, 46 ± 10.8y) who were long-time users (6.1 ± 3.9y) of implanted neuroprostheses for lower extremity function and had chronic (8.6 ± 2.8y) midcervical- or thoracic-level injuries (C6-T10). INTERVENTIONS Continuous low-level stimulation to the hip (gluteus maximus, posterior adductor, or hamstrings) and trunk extensor (lumbar erector spinae and/or quadratus lumborum) muscles with implanted intramuscular electrodes. MAIN OUTCOME MEASURES Pushrim kinetics (peak resultant force, fraction effective force), kinematics (cadence, stroke length, maximum forward lean), and peak shoulder moment at preferred speed over 10-m level surface; speed, pushrim kinetics, and subjective ratings of effort for level 100-m sprints and up a 30.5-m ramp of approximately 5% grade. RESULTS Three of 5 subjects demonstrated reduced peak resultant pushrim forces (P≤.014) and improved efficiency (P≤.048) with stimulation during self-paced level propulsion. Peak sagittal shoulder moment remained unchanged in 3 subjects and increased in 2 others (P<.001). Maximal forward trunk lean also increased by 19% to 26% (P<.001) with stimulation in these 3 subjects. Stroke lengths were unchanged by stimulation in all subjects, and 2 showed extremely small (5%) but statistically significant increases in cadence (P≤.021). Performance measures for sprints and inclines were generally unchanged with stimulation; however, subjects consistently rated propulsion with stimulation to be easier for both surfaces. CONCLUSIONS Stabilizing the pelvis and trunk with low levels of continuous electrical stimulation to the lumbar trunk and hip extensors can positively impact the mechanics of manual wheelchair propulsion and reduce both perceived and physical measures of effort.
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Affiliation(s)
- Ronald J Triolo
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH; Case Western Reserve University, Cleveland, OH.
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Vegter RJK, Lamoth CJ, de Groot S, Veeger DHEJ, van der Woude LHV. Variability in bimanual wheelchair propulsion: consistency of two instrumented wheels during handrim wheelchair propulsion on a motor driven treadmill. J Neuroeng Rehabil 2013; 10:9. [PMID: 23360756 PMCID: PMC3614450 DOI: 10.1186/1743-0003-10-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 01/24/2013] [Indexed: 11/30/2022] Open
Abstract
Background Handrim wheelchair propulsion is a complex bimanual motor task. The bimanually applied forces on the rims determine the speed and direction of locomotion. Measurements of forces and torques on the handrim are important to study status and change of propulsion technique (and consequently mechanical strain) due to processes of learning, training or the wheelchair configuration. The purpose of this study was to compare the simultaneous outcomes of two different measurement-wheels attached to the different sides of the wheelchair, to determine measurement consistency within and between these wheels given the expected inter- and intra-limb variability as a consequence of motor control. Methods Nine able-bodied subjects received a three-week low-intensity handrim wheelchair practice intervention. They then performed three four-minute trials of wheelchair propulsion in an instrumented hand rim wheelchair on a motor-driven treadmill at a fixed belt speed. The two measurement-wheels on each side of the wheelchair measured forces and torques of one of the two upper limbs, which simultaneously perform the push action over time. The resulting data were compared as direct output using cross-correlation on the torque around the wheel-axle. Calculated push characteristics such as power production and speed were compared using an intra-class correlation. Results Measured torque around the wheel axle of the two measurement-wheels had a high average cross-correlation of 0.98 (std=0.01). Unilateral mean power output over a minute was found to have an intra-class correlation of 0.89 between the wheels. Although the difference over the pushes between left and right power output had a high variability, the mean difference between the measurement-wheels was low at 0.03 W (std=1.60). Other push characteristics showed even higher ICC’s (>0.9). Conclusions A good agreement between both measurement-wheels was found at the level of the power output. This indicates a high comparability of the measurement-wheels for the different propulsion parameters. Data from both wheels seem suitable to be used together or interchangeably in experiments on motor control and wheelchair propulsion performance. A high variability in forces and timing between the left and right side were found during the execution of this bimanual task, reflecting the human motor control process.
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Affiliation(s)
- Riemer J K Vegter
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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The influence of wheelchair propulsion technique on upper extremity muscle demand: a simulation study. Clin Biomech (Bristol, Avon) 2012; 27:879-86. [PMID: 22835860 PMCID: PMC3444526 DOI: 10.1016/j.clinbiomech.2012.07.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 05/16/2012] [Accepted: 07/05/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The majority of manual wheelchair users will experience upper extremity injuries or pain, in part due to the high force requirements, repetitive motion and extreme joint postures associated with wheelchair propulsion. Recent studies have identified cadence, contact angle and peak force as important factors for reducing upper extremity demand during propulsion. However, studies often make comparisons between populations (e.g., able-bodied vs. paraplegic) or do not investigate specific measures of upper extremity demand. The purpose of this study was to use a musculoskeletal model and forward dynamics simulations of wheelchair propulsion to investigate how altering cadence, peak force and contact angle influence individual muscle demand. METHODS Forward dynamics simulations of wheelchair propulsion were generated to emulate group-averaged experimental data during four conditions: 1) self-selected propulsion technique, and while 2) minimizing cadence, 3) maximizing contact angle, and 4) minimizing peak force using biofeedback. Simulations were used to determine individual muscle mechanical power and stress as measures of muscle demand. RESULTS Minimizing peak force and cadence had the lowest muscle power requirements. However, minimizing peak force increased cadence and recovery power, while minimizing cadence increased average muscle stress. Maximizing contact angle increased muscle stress and had the highest muscle power requirements. INTERPRETATION Minimizing cadence appears to have the most potential for reducing muscle demand and fatigue, which could decrease upper extremity injuries and pain. However, altering any of these variables to extreme values appears to be less effective; instead small to moderate changes may better reduce overall muscle demand.
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Desroches G, Vermette M, Gourdou P, Gagnon D. Development of an automated method to detect sitting pivot transfer phases using biomechanical variables: toward a standardized method. J Neuroeng Rehabil 2012; 9:7. [PMID: 22305052 PMCID: PMC3298704 DOI: 10.1186/1743-0003-9-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 02/03/2012] [Indexed: 01/18/2023] Open
Abstract
Background Sitting pivot transfer (SPT) is one of the most important, but at the same time strenuous at the upper extremity, functional task for spinal cord injured individuals. In order to better teach this task to those individuals and to improve performance, a better biomechanical understanding during the different SPT phases is a prerequisite. However, no consensus has yet been reached on how to depict the different phases of the SPT. The definition of the phases of the SPT, along with the events characterizing these phases, will facilitate the interpretation of biomechanical outcome measures related to the performance of SPTs as well as strengthen the evidence generated across studies. Methods Thirty-five individuals with a spinal cord injury performed two SPTs between seats of similar height using their usual SPT technique. Kinematics and kinetics were recorded using an instrumented transfer assessment system. Based on kinetic and kinematic measurements, a relative threshold-based algorithm was developed to identify four distinct phases: pre-lift, upper arm loading, lift-pivot and post-lift phases. To determine the stability of the algorithm between the two SPTs, Student t-tests for dependent samples were performed on the absolute duration of each phase. Results The mean total duration of the SPT was 2.00 ± 0.49 s. The mean duration of the pre-lift, upper arm loading, lift-pivot and post-lift phases were 0.74 ± 0.29 s, 0.28 ± 0.13 s, 0.72 ± 0.24 s, 0.27 ± 0.14 s whereas their relative contributions represented approximately 35%, 15%, 35% and 15% of the overall SPT cycle, respectively. No significant differences were found between the trials (p = 0.480-0.891). Conclusion The relative threshold-based algorithm used to automatically detect the four distinct phases of the SPT, is rapid, accurate and repeatable. A quantitative and thorough description of the precise phases of the SPT is prerequisite to better interpret biomechanical findings and measure task performance. The algorithm could also become clinically useful to refine the assessment and training of SPTs.
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Kwarciak AM, Turner JT, Guo L, Richter WM. The effects of four different stroke patterns on manual wheelchair propulsion and upper limb muscle strain. Disabil Rehabil Assist Technol 2012; 7:459-63. [PMID: 22295946 DOI: 10.3109/17483107.2011.650781] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the effects of stroke pattern on handrim biomechanics and upper limb electromyography (EMG) in experienced wheelchair users. METHOD Subjects propelled their own wheelchair on a level, motor-driven treadmill using each of four identified stroke patterns: arcing, double loop (DL), semi-circular (SC) and single loop (SL). Upper limb EMG and measurements taken from an instrumented wheelchair wheel were compared for each pattern. A one-way ANOVA with Bonferroni correction (p < 0.05) was used to check for significant differences. RESULTS The DL and SC patterns produced the best overall results. The DL pattern led to a significantly longer contact angle and significantly less braking moment than the SL and arcing patterns, and a significantly lower cadence than the SL pattern. The SC pattern led to a significantly longer contact angle than the SL pattern and the lowest peak force and impact of any pattern. There were no significant differences in integrated EMG (IEMG); however, the DL and arcing patterns produced lower combined IEMG values. CONCLUSIONS When traversing level terrain, wheelchair users should push with either the DL or SC patterns. Between the two, the DL pattern required less muscle activity and may be a better choice for experienced wheelchair users.
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Validation of a biofeedback system for wheelchair propulsion training. Rehabil Res Pract 2011; 2011:590780. [PMID: 22110977 PMCID: PMC3196933 DOI: 10.1155/2011/590780] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Accepted: 07/02/2011] [Indexed: 11/18/2022] Open
Abstract
This paper describes the design and validation of the OptiPush Biofeedback System, a commercially available, instrumented wheel system that records handrim biomechanics and provides stroke-by-stroke biofeedback and targeting for 11 propulsion variables. Testing of the system revealed accurate measurement of wheel angle (0.02% error), wheel speed (0.06% error), and handrim loads. The maximum errors in static force and torque measurements were 3.80% and 2.05%, respectively. Measured forces were also found to be highly linear (0.985 < slope < 1.011) and highly correlated to the reference forces (r2 > .998). Dynamic measurements of planar forces (Fx and Fy) and axle torque also had low error (−0.96 N to 0.83 N for force and 0.10 Nm to 0.14 Nm for torque) and were highly correlated (r > .986) with expected force and torque values. Overall, the OptiPush Biofeedback System provides accurate measurement of wheel dynamics and handrim biomechanics and may be a useful tool for improving manual wheelchair propulsion.
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Abstract
Laboratory-based simulators afford many advantages for studying physiology and biomechanics; however, they may not perfectly mimic wheelchair propulsion over natural surfaces. The goal of this study was to compare kinetic and temporal parameters between propulsion overground on a tile surface and on a dynamometer. Twenty-four experienced manual wheelchair users propelled at a self-selected speed on smooth, level tile and a dynamometer while kinetic data were collected using an instrumented wheel. A Pearson correlation test was used to examine the relationship between propulsion variables obtained on the dynamometer and the overground condition. Ensemble resultant force and moment curves were compared using cross-correlation and qualitative analysis of curve shape. User biomechanics were correlated (R ranging from 0.41 to 0.83) between surfaces. Overall, findings suggest that although the dynamometer does not perfectly emulate overground propulsion, wheelchair users were consistent with the direction and amount of force applied, the time peak force was reached, push angle, and their stroke frequency between conditions.
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Richter WM, Kwarciak AM, Guo L, Turner JT. Effects of Single-Variable Biofeedback on Wheelchair Handrim Biomechanics. Arch Phys Med Rehabil 2011; 92:572-7. [PMID: 21440701 DOI: 10.1016/j.apmr.2010.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 11/01/2010] [Accepted: 11/02/2010] [Indexed: 11/15/2022]
Affiliation(s)
- W Mark Richter
- Biomechanics Laboratory, MAX Mobility, LLC, Antioch, TN, USA.
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Rankin JW, Richter WM, Neptune RR. Individual muscle contributions to push and recovery subtasks during wheelchair propulsion. J Biomech 2011; 44:1246-52. [PMID: 21397232 DOI: 10.1016/j.jbiomech.2011.02.073] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 02/17/2011] [Accepted: 02/18/2011] [Indexed: 11/25/2022]
Abstract
Manual wheelchair propulsion places considerable physical demand on the upper extremity and is one of the primary activities associated with the high prevalence of upper extremity overuse injuries and pain among wheelchair users. As a result, recent effort has focused on determining how various propulsion techniques influence upper extremity demand during wheelchair propulsion. However, an important prerequisite for identifying the relationships between propulsion techniques and upper extremity demand is to understand how individual muscles contribute to the mechanical energetics of wheelchair propulsion. The purpose of this study was to use a forward dynamics simulation of wheelchair propulsion to quantify how individual muscles deliver, absorb and/or transfer mechanical power during propulsion. The analysis showed that muscles contribute to either push (i.e., deliver mechanical power to the handrim) or recovery (i.e., reposition the arm) subtasks, with the shoulder flexors being the primary contributors to the push and the shoulder extensors being the primary contributors to the recovery. In addition, significant activity from the shoulder muscles was required during the transition between push and recovery, which resulted in increased co-contraction and upper extremity demand. Thus, strengthening the shoulder flexors and promoting propulsion techniques that improve transition mechanics have much potential to reduce upper extremity demand and improve rehabilitation outcomes.
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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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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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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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Manual Wheelchair Propulsion Patterns on Natural Surfaces During Start-Up Propulsion. Arch Phys Med Rehabil 2009; 90:1916-23. [DOI: 10.1016/j.apmr.2009.05.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 04/22/2009] [Accepted: 05/22/2009] [Indexed: 11/21/2022]
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