title: Hand rim wheelchair propulsion training using biomechanical real-time visual feedback based on motor learning theory principles.
abstract: OBJECTIVE
  As considerable progress has been made in laboratory-based assessment of manual wheelchair propulsion biomechanics, the necessity to translate this knowledge into new clinical tools and treatment programs becomes imperative. The objective of this study was to describe the development of a manual wheelchair propulsion training program aimed to promote the development of an efficient propulsion technique among long-term manual wheelchair users.
  
  
  METHODS
  Motor learning theory principles were applied to the design of biomechanical feedback-based learning software, which allows for random discontinuous real-time visual presentation of key spatiotemporal and kinetic parameters. This software was used to train a long-term wheelchair user on a dynamometer during 3 low-intensity wheelchair propulsion training sessions over a 3-week period. Biomechanical measures were recorded with a SmartWheel during over ground propulsion on a 50-m level tile surface at baseline and 3 months after baseline.
  
  
  RESULTS
  Training software was refined and administered to a participant who was able to improve his propulsion technique by increasing contact angle while simultaneously reducing stroke cadence, mean resultant force, peak and mean moment out of plane, and peak rate of rise of force applied to the pushrim after training.
  
  
  CONCLUSIONS
  The proposed propulsion training protocol may lead to favorable changes in manual wheelchair propulsion technique. These changes could limit or prevent upper limb injuries among manual wheelchair users. In addition, many of the motor learning theory-based techniques examined in this study could be applied to training individuals in various stages of rehabilitation to optimize propulsion early on.
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Rice
authors.forename: Dany
authors.initials: D
authors.lastname: Gagnon
authors.forename: Jere
authors.initials: J
authors.lastname: Gallagher
authors.forename: Michael
authors.initials: M
authors.lastname: Boninger
mesh_terms: D001696:Biomechanical Phenomena / Q000502:physiology*; D004867:Equipment Design; D056228:Feedback, Sensory / Q000502:physiology*; D005260:Female; D006225:Hand / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011582:Psychological Theory; D011597:Psychomotor Performance; D016059:Range of Motion, Articular; D012985:Software Design; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D013997:Time Factors; D014910:Wheelchairs
references.citation: Percept Mot Skills. 1994 Jun;78(3 Pt 1):835-41
references.pmid: 8084699
references.citation: Arch Phys Med Rehabil. 1994 May;75(5):519-24
references.pmid: 8185443
references.citation: J Med Eng Technol. 2003 Nov-Dec;27(6):249-58
references.pmid: 14602516
references.citation: Clin Orthop Relat Res. 1988 Aug;(233):132-5
references.pmid: 3402118
references.citation: J Rehabil Res Dev. 2007;44(3):449-58
references.pmid: 18247241
references.citation: Paraplegia. 1988 Apr;26(2):101-6
references.pmid: 3412779
references.citation: J Rehabil Res Dev. 2003 Nov-Dec;40(6):501-10
references.pmid: 15077662
references.citation: J Rehabil Res Dev. 2005 May-Jun;42(3 Suppl 1):9-19
references.pmid: 16195959
references.citation: Percept Mot Skills. 1982 Aug;55(1):171-80
references.pmid: 7133898
references.citation: Paraplegia. 1991 Jan;29(1):17-24
references.pmid: 2023767
references.citation: Spinal Cord. 2003 Aug;41(8):451-6
references.pmid: 12883543
references.citation: J Biomech. 2003 Feb;36(2):239-47
references.pmid: 12547361
references.citation: Med Sci Sports Exerc. 1988 Feb;20(1):70-8
references.pmid: 2963939
references.citation: Arch Phys Med Rehabil. 2005 Mar;86(3):380-6
references.pmid: 15759215
references.citation: J Bone Joint Surg Am. 1987 Jun;69(5):676-8
references.pmid: 3597466
references.citation: Arch Phys Med Rehabil. 2006 Apr;87(4):510-5
references.pmid: 16571390
references.citation: J Hand Surg Am. 1988 Sep;13(5):716-9
references.pmid: 3241043
references.citation: Age Ageing. 1997 Jan;26(1):15-9
references.pmid: 9143432
references.citation: J Bone Joint Surg Am. 1988 Apr;70(4):517-9
references.pmid: 3356717
references.citation: Hum Factors. 1997 Dec;39(4):509-25
references.pmid: 9473972
references.citation: Med Sci Sports Exerc. 2002 May;34(5):756-66
references.pmid: 11984291
references.citation: Spinal Cord. 2002 Oct;40(10):513-8
references.pmid: 12235533
references.citation: Am J Phys Med Rehabil. 1996 Jul-Aug;75(4):292-9
references.pmid: 8777025
references.citation: Arch Phys Med Rehabil. 1999 Aug;80(8):910-5
references.pmid: 10453767
references.citation: J Spinal Cord Med. 2005;28(5):434-70
references.pmid: 16869091
references.citation: Am J Phys Med Rehabil. 2004 Aug;83(8):640-9
references.pmid: 15277966
references.citation: Paraplegia. 1995 May;33(5):290-3
references.pmid: 7630657
references.citation: Arch Phys Med Rehabil. 2004 Jul;85(7):1141-5
references.pmid: 15241765
references.citation: Paraplegia. 1991 Oct;29(8):521-30
references.pmid: 1775358
references.citation: Clin Biomech (Bristol, Avon). 2002 Mar;17(3):219-26
references.pmid: 11937260
references.citation: Res Q Exerc Sport. 1990 Jun;61(2):169-77
references.pmid: 2094928
references.citation: Am J Phys Med Rehabil. 1998 May-Jun;77(3):213-21
references.pmid: 9635556
references.citation: Arch Phys Med Rehabil. 1992 Jan;73(1):44-8
references.pmid: 1729973
references.citation: J Mot Behav. 2002 Jun;34(2):171-82
references.pmid: 12057890
references.citation: Arch Phys Med Rehabil. 2002 May;83(5):718-23
references.pmid: 11994814
references.citation: Q J Exp Psychol A. 2001 Nov;54(4):1143-54
references.pmid: 11765737
references.citation: Paraplegia. 1994 Apr;32(4):219-24
references.pmid: 8022631
references.citation: Res Q Exerc Sport. 1991 Sep;62(3):285-92
references.pmid: 1925056
references.citation: Res Q Exerc Sport. 1999 Mar;70(1):33-40
references.pmid: 10100333
references.citation: Arch Phys Med Rehabil. 1993 Oct;74(10):1030-4
references.pmid: 8215852
references.citation: Clin Biomech (Bristol, Avon). 2008 May;23(4):434-41
references.pmid: 18077065
references.citation: Res Q Exerc Sport. 1999 Jun;70(2):120-6
references.pmid: 10380243
references.citation: J Rehabil Res Dev. 2001 Sep-Oct;38(5):505-11
references.pmid: 11732828
references.citation: Clin Orthop Relat Res. 1991 Nov;(272):141-5
references.pmid: 1934724
references.citation: J Exp Psychol Learn Mem Cogn. 1989 Mar;15(2):352-9
references.pmid: 2522520
references.citation: Hum Factors. 1998 Mar;40(1):79-91
references.pmid: 9579105
references.citation: IEEE Trans Biomed Eng. 1993 Dec;40(12):1320-4
references.pmid: 8125507
references.citation: Paraplegia. 1985 Jun;23(3):182-6
references.pmid: 4011294