Physiological parameters depending on two different types of manual wheelchair propulsion

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

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.

Biomechanical Relationships Between Manual Wheelchair Steering and the Position of the Human Body's Center of Gravity

The purpose of this investigation was to analyze the impact of differential steering of a wheelchair with a pushrim on changes in the position of the body's center of gravity. The method assumed measuring the wheelchair trajectory and the body's center of gravity and determining the transverse relocation of the measured body's center of gravity in relation to a point on the wheelchair trajectory. Twenty-seven measurement tests which demonstrated various wheelchair trajectories were carried out within the investigation. The trajectories were 10 to 15 m long and involved moving forward (test 2), reversing (test 3), turning left (test 1) and right (test 4). The factor of deviation of the center of gravity of human body from the wheelchair trajectory was determined for selected characteristic turning maneuvers. The measured values ranged from 51 to 192 mm. The impact of the wheelchair trajectory on the position of the body's center of gravity was demonstrated as a result of this investigation. Consequently, a trajectory deviation factor for relocation of the human body weight on one side of the wheelchair has been demonstrated.

Reliability and normative values of the Wheelchair Propulsion Test: A preliminary investigation

BACKGROUND

Normative data for the equivalent of gait speed via the Wheelchair Propulsion Test (WPT) do not exist for wheelchair users.

OBJECTIVE

The purposes of the current study were to: 1) determine the reliability of the WPT, 2) propose and compare normative values for the WPT for young adult males and females utilizing three different propulsion techniques, and 3) compare how different wheelchair types affect performance on the WPT.

METHODS

50 young adults (25 of each sex) performed the WPT using three different propulsion techniques in three different types of wheelchairs. Participants were asked to propel a wheelchair over 10 m at a comfortable speed. Time and number of pushes were recorded for three trials for each propulsion technique in each type of wheelchair.

RESULTS

All of the ICC(2,2) values were >0.83 for speed and number of pushes. Normative values for speed, number of pushes, push frequency and effectiveness categorized by propulsion technique, sex and wheelchair type were developed.

CONCLUSIONS

Preliminary normative values have been established for young adults performing the WPT. This study highlights the need to maintain consistency of the wheelchair type and propulsion technique between trials in order for the WPT to be reliable.

Effects of the performance parameters of a wheelchair on the changes in the position of the centre of gravity of the human body in dynamic condition

PURPOSE

The aim of this research is to establish whether, and to what extent, the tilt angle, gear ratio of the propulsion system and propulsion frequency of a wheelchair influence the position of the centre of gravity. Furthermore, it verifies the usefulness of such research using an original test stand.

MATERIALS AND METHODS

The article presents the effects of three operational parameters of a wheelchair on the position of the centre of gravity of the human body. The study included 27 wheelchair propulsion tests of a wheelchair with pushrim propulsion using the following variable parameters: gear ratio of the propulsion system, propulsion frequency and wheelchair tilt angle. The position of the centre of gravity of the human body was measured in dynamic conditions at 100 Hz. The results were represented with ellipses defining the region of variability of the position of the centre of gravity of the human body. The coordinates of the centre of gravity were measured in relation to the reference system, with the start point at the centre of the axis of rotation of the rear wheelchair wheels. The measurements were taken in a horizontal plane in relation to the base on which the test stand was positioned.

RESULTS

The research carried out shows that the inclination angle of the wheelchair has the greatest influence on position of the ellipse describing the position of the centre of gravity of the human body. By controlling the change in the inclination angle value in the range from 0° to 5.4°, the standard deviation of the length of the horizontal half-axis of the ellipse (SD a) equal to 31.2 mm was obtained. For comparison, by changing the frequency of pushes (40 to 50 pushes per minute) of the wheelchair at a constant inclination angle, the standard deviation of the horizontal half-axis length (SD a) equal to 8 mm was recorded. The results of the study show a change in the position of the centre of gravity of the human body in dynamic conditions. They are relative to the contact points of the wheelchair wheels with the ground. Using the dimensions of the plotted ellipses, one can determine the values of pressure that affect the wheelchair's individual wheels. Conclusions-Increasing the value of each aforementioned parameter resulted in the increase of strength required by the operator to propel the wheelchair. It directly influenced the position of the centre of gravity during the test.