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de Vries WHK, van der Slikke RMA, van Dijk MP, Arnet U. Real-Life Wheelchair Mobility Metrics from IMUs. SENSORS (BASEL, SWITZERLAND) 2023; 23:7174. [PMID: 37631711 PMCID: PMC10458841 DOI: 10.3390/s23167174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023]
Abstract
Daily wheelchair ambulation is seen as a risk factor for shoulder problems, which are prevalent in manual wheelchair users. To examine the long-term effect of shoulder load from daily wheelchair ambulation on shoulder problems, quantification is required in real-life settings. In this study, we describe and validate a comprehensive and unobtrusive methodology to derive clinically relevant wheelchair mobility metrics (WCMMs) from inertial measurement systems (IMUs) placed on the wheelchair frame and wheel in real-life settings. The set of WCMMs includes distance covered by the wheelchair, linear velocity of the wheelchair, number and duration of pushes, number and magnitude of turns and inclination of the wheelchair when on a slope. Data are collected from ten able-bodied participants, trained in wheelchair-related activities, who followed a 40 min course over the campus. The IMU-derived WCMMs are validated against accepted reference methods such as Smartwheel and video analysis. Intraclass correlation (ICC) is applied to test the reliability of the IMU method. IMU-derived push duration appeared to be less comparable with Smartwheel estimates, as it measures the effect of all energy applied to the wheelchair (including thorax and upper extremity movements), whereas the Smartwheel only measures forces and torques applied by the hand at the rim. All other WCMMs can be reliably estimated from real-life IMU data, with small errors and high ICCs, which opens the way to further examine real-life behavior in wheelchair ambulation with respect to shoulder loading. Moreover, WCMMs can be applied to other applications, including health tracking for individual interest or in therapy settings.
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Affiliation(s)
| | - Rienk M. A. van der Slikke
- Department of Biomechanical Engineering, Delft University of Technology, 2628 Delft, The Netherlands; (R.M.A.v.d.S.); (M.P.v.D.)
- Human Kinetic Technology, The Hague University of Applied Sciences, 2521 The Hague, The Netherlands
| | - Marit P. van Dijk
- Department of Biomechanical Engineering, Delft University of Technology, 2628 Delft, The Netherlands; (R.M.A.v.d.S.); (M.P.v.D.)
| | - Ursina Arnet
- Swiss Paraplegic Research, Guido A. Zächstrasse 4, 6207 Nottwil, Switzerland;
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Qi L, Guan S, Zhang L, Liu HL, Sun CK, Ferguson-Pell M. The Effect of Fatigue on Wheelchair Users' Upper Limb Muscle Coordination Patterns in Time-Frequency and Principal Component Analysis. IEEE Trans Neural Syst Rehabil Eng 2021; 29:2096-2102. [PMID: 34633931 DOI: 10.1109/tnsre.2021.3119359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An assessment of shoulder muscle coordination patterns is important to gain insight into muscle fatigue during wheelchair propulsion. The objective of the present study was to quantify muscle coordination changes over time during fatiguing wheelchair propulsion, as the muscles go through distinct levels of fatigue, a) non-fatigued, b) transiting to fatigue and c) fatigued to exhaustion. We recorded surface electromyography (sEMG) signals of the anterior deltoid (AD), middle deltoid (MD), posterior deltoid (PD), infraspinatus (IS), upper trapezius (UT), sternal head of the pectoralis major (PM), biceps brachii (BB), and triceps brachii (TB) during a wheelchair incremental exercise test. Nine wheelchair users with a diagnosis of spina bifida or T6-T12 spinal cord injury volunteered for the study. Oxygen uptake and SmartWheel kinetic parameters were also recorded during the test. EMG signals were processed by wavelet and principal component analysis (PCA), allowing for an assessment of how wheelchair users modify their muscle coordination patterns over time. Analyses of covariance (ANCOVA) were conducted to identify the main effect of fatigue levels on muscle coordination patterns by controlling for the effect of increased workload as covariate. A significant effect of fatigue levels on the PC1 and PC3 loading scores was found after controlling for the effect of increasing workloads (with both cases). In addition, PC3 reflects the most dominant fatigue effect on muscle coordination patterns which are not affected by increased ergometer workload. PC3 indicates muscle imbalance when muscles are fully fatigued and muscle co-contraction when muscles are beginning to fatigue. We conclude that fatigue-related changes in neuromuscular activity during wheelchair propulsion contribute to muscle imbalance and reflect a strategy of stiffening the shoulder joint.
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The longitudinal relationship between shoulder pain and altered wheelchair propulsion biomechanics of manual wheelchair users. J Biomech 2021; 126:110626. [PMID: 34329882 DOI: 10.1016/j.jbiomech.2021.110626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/25/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to investigate the longitudinal association between within-subject changes in shoulder pain and alterations in wheelchair propulsion biomechanics in manual wheelchair users. Eighteen (age 33 ± 11 years) manual wheelchair users propelled their own daily living wheelchair at 1.11 m.s-1 for three minutes on a dual-roller ergometer during two laboratory visits (T1 and T2) between 4 and 6 months apart. Shoulder pain was assessed using the Performance Corrected Wheelchair User's Shoulder Pain Index (PC-WUSPI). Between visits mean PC-WUSPI scores increased by 5.4 points and varied from - 13.5 to + 20.9 points. Of the eighteen participants, nine (50%) experienced increased shoulder pain, seven (39%) no change in pain, and two (11%) decreased pain. Increasing shoulder pain severity correlated with increased contact angle (r = 0.59, P = 0.010), thorax range of motion (r = 0.60, P = 0.009) and kinetic and kinematic variability. Additionally, increasing shoulder pain was associated with reductions in peak torque (r = -0.56, P = 0.016), peak glenohumeral abduction (r = -0.69, P = 0.002), peak scapular downward rotation (r = -0.68, P = 0.002), and range of motion in glenohumeral flexion/extension and scapular angles. Group comparisons revealed that these biomechanical alterations were exhibited by individuals who experienced increased shoulder pain, whereas, propulsion biomechanics of those with no change/decreased pain remained unaltered. These findings indicate that wheelchair users exhibit a protective short-term wheelchair propulsion biomechanical response to increases in shoulder pain which may temporarily help maintain functional independence.
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Rice I, Jayaraman C, Pohlig RT. The short-term influence of rear wheel axle position and training on manual wheelchair propulsion technique in novice able-bodied participants during steady-state treadmill propulsion, a pilot study. Assist Technol 2020; 32:136-143. [DOI: 10.1080/10400435.2018.1504834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Ian Rice
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Chandrasekaran Jayaraman
- Max Näder Lab for Rehabilitation and outcomes Center for Bionic Medicine Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Ryan T. Pohlig
- Biostatistics Core Facility, College of Health Sciences, University of Delaware, Newark, DE, USA
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Briley SJ, Vegter RJ, Tolfrey VL, Mason BS. Propulsion biomechanics do not differ between athletic and nonathletic manual wheelchair users in their daily wheelchairs. J Biomech 2020; 104:109725. [DOI: 10.1016/j.jbiomech.2020.109725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 11/25/2022]
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Compensation Strategies in Response to Fatiguing Propulsion in Wheelchair Users. Am J Phys Med Rehabil 2019; 99:91-98. [DOI: 10.1097/phm.0000000000001267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Bickelhaupt B, Oyama S, Benfield J, Burau K, Lee S, Trbovich M. Effect of Wheelchair Stroke Pattern on Upper Extremity Muscle Fatigue. PM R 2018; 10:1004-1011. [PMID: 29627608 DOI: 10.1016/j.pmrj.2018.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/12/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Shoulder dysfunction is common in persons with spinal cord injury (SCI) with an incidence of up to 63%. Dysfunction is a result of muscle imbalances, specifically denervated rotator cuff muscles that are repetitively used during manual wheelchair propulsion. OBJECTIVE To determine which arm stroke technique, pump (P) or semicircular (SC), is most energy efficient for long periods of propulsion. DESIGN A randomized study with repeated measures observations. SETTING The study was performed at an institutional gait analysis laboratory. PARTICIPANTS 18 able-bodied (AB) male participants were studied and randomized into one of 2 conditions, SC or P. METHODS Shoulder muscle fatigue was measured by changes in Borg CR10 Rate of Perceived Exertion (Borg RPE) and upper extremity strength via a handheld dynamometer. Participants were studied and assigned into one of 2 conditions of wheelchair arm propulsion patterns, SC or P group, and propelled on a wheelchair treadmill for 10 minutes. MAIN OUTCOME MEASURES The primary outcomes included recordings of Borg RPE scale during continuous wheelchair propulsion and pre- and post-test dynamometer testing means for bilateral elbow and shoulder extension. Analysis of covariance, t-tests, and Kruskal-Wallis tests were used in analyzing data. RESULTS Although not significant (P = .23), the Borg RPE scores for the SC condition were consistently higher than the scores for the P condition. In addition, the dynamometer pre- and post-test readings demonstrated a larger decrease for the SC condition participants than for the P condition participants, but were not statistically significant. CONCLUSIONS These data demonstrate that the SC wheelchair propulsion pattern appears to be more fatiguing to shoulder muscles than the P propulsion pattern. However, more data would need to be collected to find a significant difference. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Brittany Bickelhaupt
- Department of Rehabilitation Medicine, University of Texas Health Science Center of San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229
| | - Sakiko Oyama
- Department of Kinesiology, Health, and Nutrition, University of Texas at San Antonio, San Antonio, TX
| | - Jonathan Benfield
- Department of Rehabilitation Medicine, University of Texas Health Science Center of San Antonio, San Antonio, TX
| | - Keith Burau
- Department of Rehabilitation Medicine, University of Texas Health Science Center of San Antonio, San Antonio, TX; and Spinal Cord Injury Center, Audie L. Murphy Memorial Hospital, San Antonio, TX
| | - Shuko Lee
- Research and Development, Audie L. Murphy Memorial Hospital, San Antonio, TX
| | - Michelle Trbovich
- University of Texas Health Science Center of San Antonio, San Antonio, TX; Spinal Cord Injury Center, Audie L. Murphy Memorial Hospital, San Antonio, TX
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Relationship between linear velocity and tangential push force while turning to change the direction of the manual wheelchair. BIOMED ENG-BIOMED TE 2017; 62:439-445. [DOI: 10.1515/bmt-2015-0173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 07/27/2016] [Indexed: 11/15/2022]
Abstract
AbstractWheelchair propulsion is a major cause of upper limb pain and injuries for manual wheelchair users with spinal cord injuries (SCIs). Few studies have investigated wheelchair turning biomechanics on natural ground surfaces. The purpose of this study was to investigate the relationship between tangential push force and linear velocity of the wheelchair during the turning portions of propulsion. Using an instrumented handrim, velocity and push force data were recorded for 25 subjects while they propel their own wheelchairs on a concrete floor along a figure-eight-shaped course at a maximum velocity. The braking force (1.03 N) of the inside wheel while turning was the largest of all other push forces (p<0.05). Larger changes in squared velocity while turning were significantly correlated with higher propulsive and braking forces used at the pre-turning, turning, and post-turning phases (p<0.05). Subjects with less change of velocity while turning needed less braking force to maneuver themselves successfully and safely around the turns. Considering the magnitude and direction of tangential force applied to the wheel, it seems that there are higher risks of injury and instability for upper limb joints when braking the inside wheel to turn. The results provide insight into wheelchair setup and mobility skills training for wheelchair users.
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MacGillivray MK, Lam T, Klimstra M, Zehr EP, Sawatzky BJ. Exploring the ecological validity and variability of a 10-min bout of wheeling. Disabil Rehabil Assist Technol 2017; 13:287-292. [PMID: 28485185 DOI: 10.1080/17483107.2017.1323965] [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: 10/19/2022]
Abstract
PURPOSE To determine the ecological validity of using able-bodied participants to perform a 10-min wheeling trial by (1) evaluating changes in biomechanics over the trial in manual wheelchair users and able-bodied participants naïve to wheeling and (2) describing differences in changes and variability between groups. MATERIALS AND METHODS Manual wheelchair users (n = 7, 2-27 years' experience) and able-bodied participants (n = 11) wheeled for 10 min. Kinetic and temporal variables were collected and averaged over each minute, while wheeling strategy (movement pattern) was categorized at minutes 1 and 10. RESULTS There was a main effect of time for push angle, and a main effect of group for average push angle, tangential force and total force. Manual wheelchair users used larger push angles and forces compared to able-bodied participants. Surprisingly, intercycle variability did not differ between groups. CONCLUSION Using able-bodied participants to represent manual wheelchair users performing a 10-min wheeling trial is not ecologically valid and caution should be used when interpreting push angle and forces applied to the pushrim. Considering that push angle was the only variable that demonstrated a main effect of time, long durations (e.g., 10 min) of wheeling may be appropriate for use in study designs acknowledging potential changes in wheeling strategy and push angle. Implications for Rehabilitation Some experienced wheelchair users and non-wheelchair users modify their movement pattern from an arc to a circular pattern within a 10-min wheeling trial. There are clear biomechanical differences in push angle and forces applied to the pushrim between wheelchair users with experience and able-bodied non-wheelchair users. Able-bodied participants who have no prior manual wheeling experience are no more variable than long-term wheelchair users. Variability may play an important role in wheelchair propulsion.
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Affiliation(s)
- Megan K MacGillivray
- a International Collaboration on Repair Discoveries , Vancouver , Canada.,b Rehabilitation Sciences, University of British Columbia , Vancouver , Canada
| | - Tania Lam
- a International Collaboration on Repair Discoveries , Vancouver , Canada.,c School of Kinesiology , University of British Columbia , Vancouver , Canada
| | - Marc Klimstra
- d School of Exercise Science, Physical and Health Education , University of Victoria , Victoria , Canada
| | - E Paul Zehr
- a International Collaboration on Repair Discoveries , Vancouver , Canada.,d School of Exercise Science, Physical and Health Education , University of Victoria , Victoria , Canada
| | - Bonita J Sawatzky
- a International Collaboration on Repair Discoveries , Vancouver , Canada.,e Department of Orthopedics , University of British Columbia , Vancouver , Canada
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Slowik JS, McNitt-Gray JL, Requejo PS, Mulroy SJ, Neptune RR. Compensatory strategies during manual wheelchair propulsion in response to weakness in individual muscle groups: A simulation study. Clin Biomech (Bristol, Avon) 2016; 33:34-41. [PMID: 26945719 PMCID: PMC4821704 DOI: 10.1016/j.clinbiomech.2016.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 02/06/2016] [Accepted: 02/11/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The considerable physical demand placed on the upper extremity during manual wheelchair propulsion is distributed among individual muscles. The strategy used to distribute the workload is likely influenced by the relative force-generating capacities of individual muscles, and some strategies may be associated with a higher injury risk than others. The objective of this study was to use forward dynamics simulations of manual wheelchair propulsion to identify compensatory strategies that can be used to overcome weakness in individual muscle groups and identify specific strategies that may increase injury risk. Identifying these strategies can provide rationale for the design of targeted rehabilitation programs aimed at preventing the development of pain and injury in manual wheelchair users. METHODS Muscle-actuated forward dynamics simulations of manual wheelchair propulsion were analyzed to identify compensatory strategies in response to individual muscle group weakness using individual muscle mechanical power and stress as measures of upper extremity demand. FINDINGS The simulation analyses found the upper extremity to be robust to weakness in any single muscle group as the remaining groups were able to compensate and restore normal propulsion mechanics. The rotator cuff muscles experienced relatively high muscle stress levels and exhibited compensatory relationships with the deltoid muscles. INTERPRETATION These results underline the importance of strengthening the rotator cuff muscles and supporting muscles whose contributions do not increase the potential for impingement (i.e., the thoracohumeral depressors) and minimize the risk of upper extremity injury in manual wheelchair users.
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Affiliation(s)
- Jonathan S. Slowik
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Jill L. McNitt-Gray
- Department of Biomedical Engineering, The University of Southern California, Los Angeles, CA, USA,Department of Biological Sciences, The University of Southern California, Los Angeles, CA, 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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Low-Intensity Wheelchair Training in Inactive People with Long-Term Spinal Cord Injury. Am J Phys Med Rehabil 2015; 94:975-86. [DOI: 10.1097/phm.0000000000000289] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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The Need for Updated Clinical Practice Guidelines for Preservation of Upper Extremities in Manual Wheelchair Users. Am J Phys Med Rehabil 2015; 94:313-24. [DOI: 10.1097/phm.0000000000000203] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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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Effect of workload setting on propulsion technique in handrim wheelchair propulsion. Med Eng Phys 2012; 35:283-8. [PMID: 22910103 DOI: 10.1016/j.medengphy.2012.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 04/11/2012] [Accepted: 04/28/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the influence of workload setting (speed at constant power, method to impose power) on the propulsion technique (i.e. force and timing characteristics) in handrim wheelchair propulsion. METHOD Twelve able-bodied men participated in this study. External forces were measured during handrim wheelchair propulsion on a motor driven treadmill at different velocities and constant power output (to test the forced effect of speed) and at power outputs imposed by incline vs. pulley system (to test the effect of method to impose power). Outcome measures were the force and timing variables of the propulsion technique. RESULTS FEF and timing variables showed significant differences between the speed conditions when propelling at the same power output (p < 0.01). Push time was reduced while push angle increased. The method to impose power only showed slight differences in the timing variables, however not in the force variables. CONCLUSIONS Researchers and clinicians must be aware of testing and evaluation conditions that may differently affect propulsion technique parameters despite an overall constant power output.
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van der Scheer JW, de Groot S, Postema K, Veeger DHEJ, van der Woude LHV. Design of a randomized-controlled trial on low-intensity aerobic wheelchair exercise for inactive persons with chronic spinal cord injury. Disabil Rehabil 2012; 35:1119-26. [DOI: 10.3109/09638288.2012.709301] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sawatzky B, Rushton PW, Denison I, McDonald R. Wheelchair skills training programme for children: A pilot study. Aust Occup Ther J 2011; 59:2-9. [DOI: 10.1111/j.1440-1630.2011.00964.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chow JW, Levy CE. Wheelchair propulsion biomechanics and wheelers' quality of life: an exploratory review. Disabil Rehabil Assist Technol 2010; 6:365-77. [DOI: 10.3109/17483107.2010.525290] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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