Propulsion patterns and pushrim biomechanics in manual wheelchair propulsion.
OBJECTIVE
To classify stroke patterns of manual wheelchair users and to determine if different patterns of propulsion lead to different biomechanics.


METHODS
Case series.


METHODS
Biomechanics laboratory.


METHODS
Thirty-eight individuals with paraplegia who use manual wheelchairs for mobility.


METHODS
Subjects propelled their own wheelchair on a dynamometer at 2 different steady state speeds. Bilateral biomechanical data were obtained by using a force and moment sensing pushrim and a motion analysis system.


METHODS
The propulsive stroke of each participant for each speed and side was classified as following 1 of 4 patterns. These 4 patterns were then compared by using a mixed-model analysis of variance. The biomechanical variables that were compared were cadence, peak and rate of rise of the resultant force, mechanical effective force, push angle, and ratio of time spent pushing to time in recovery.


RESULTS
The most common propulsive stroke involved the user lifting the hand over the pushrim during the recovery phase. The stroke pattern was independent of axle position and varied from side to side and between speeds. After controlling for subject characteristics, significant differences were observed between stroke patterns in cadence and ratio of time spent pushing to time in recovery. A stroke pattern that involves using a semicircular motion with the hand below the pushrim during the recovery phase of the propulsion stroke was associated with a lower cadence and more time spent in the push phase relative to the recovery phase.


CONCLUSIONS
The semicircular motion of propulsion displayed characteristics consistent with reduced repetition and more efficient propulsion. Use of this propulsion style may reduce trauma to the upper extremities. Clinicians should consider training individuals in this propulsion style.
Boninger
Michael L
ML
Department of Physical Medicine and Rehabilitation, University of Pittsburgh, PA 15206, USA.
Souza
Aaron L
AL
Cooper
Rory A
RA
Fitzgerald
Shirley G
SG
Koontz
Alicia M
AM
Fay
Brian T
BT
D000328:Adult; D000368:Aged; D001132:Arm / Q000503:physiopathology*; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D008124:Locomotion / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000503:physiopathology*; D010364:Pattern Recognition, Visual / Q000145:classification* / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology; D014910:Wheelchairs