title: The influence of verbal training and visual feedback on manual wheelchair propulsion.
abstract: OBJECTIVE
  To determine if verbal training with visual feedback improved manual wheelchair propulsion; to examine propulsion differences between an individual with paraplegia and an individual with tetraplegia.
  
  
  METHODS
  Quasi-experimental study: Nine manual wheelchair-using adults participated in propulsion assessments and training. Baseline propulsion performance was measured on several tasks on different surfaces. Participants were trained on a wheelchair treadmill with verbal and visual feedback to increase push length, reduce push frequency and to modify propulsion pattern. Handrim biomechanics were measured with an instrumented wheel. Changes in propulsion were assessed. Differences in propulsion characteristics between a participant with paraplegia and a participant with tetraplegia were examined.
  
  
  RESULTS
  Push length increased (p < 0.05), push frequency decreased (p < 0.01) and peak (p < 0.05) and average (p < 0.01) forces increased immediately after training. These changes were not sustained over time. Graphic representations showed differences in propulsion characteristics between a participant with paraplegia and a participant with tetraplegia.
  
  
  CONCLUSIONS
  Verbal training may produce changes in push biomechanics of manual wheelchair users. Longer training periods may be needed to sustain propulsion changes. Findings from this study support other studies that have shown propulsion differences between people with tetraplegia and paraplegia. Propulsion training for populations with upper-extremity impairments warrants further study.
authors.affiliation: Program in Occupational Therapy, Washington University in St. Louis, St. Louis, Missouri 63108, USA.
authors.forename: Keri K
authors.initials: KK
authors.lastname: DeGroot
authors.forename: Holly H
authors.initials: HH
authors.lastname: Hollingsworth
authors.forename: Kerri A
authors.initials: KA
authors.lastname: Morgan
authors.forename: Carrie L
authors.initials: CL
authors.lastname: Morris
authors.forename: David B
authors.initials: DB
authors.lastname: Gray
mesh_terms: D000054:Acceleration; D000328:Adult; D015331:Cohort Studies; D004867:Equipment Design; D005246:Feedback; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D018763:Muscle Fatigue; D010264:Paraplegia / Q000534:rehabilitation; D010364:Pattern Recognition, Visual; D011782:Quadriplegia / Q000534:rehabilitation; D012046:Rehabilitation / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000534:rehabilitation*; D013647:Task Performance and Analysis; D034941:Upper Extremity / Q000502:physiology; D014706:Verbal Learning; D014910:Wheelchairs