Comparison of shoulder load during power-assisted and purely hand-rim wheelchair propulsion.
BACKGROUND
Repetitive forces and moments are among the work requirements of hand-rim wheelchair propulsion that are related to shoulder injuries. No previous research has been published about the influence of power-assisted wheelchair propulsion on these work requirements. The purpose of our study was therefore to determine the influence of power-assisted propulsion on shoulder biomechanics and muscle activation patterns. We also explored the theoretical framework for the effectiveness of power-assisted propulsion in preventing shoulder injuries by decreasing the work requirements of hand-rim wheelchair propulsion.


METHODS
Nine non-wheelchair users propelled a hand-rim wheelchair on a treadmill at 0.9 m/s. Shoulder biomechanics, and muscle activation patterns, were compared between propulsion with and without power-assist.


RESULTS
Propulsion frequency did not differ significantly between the two conditions (Wilcoxon Signed Rank test/significance level/effect size:4/.314/-.34). During power-assisted propulsion we found significantly decreased maximum shoulder flexion and internal rotation angles (1/.015/-.81 and 0/.008/-.89) and decreased peak force on the rim (0/.008/-.89). This resulted in decreased shoulder flexion, adduction and internal rotation moments (2/.021/-.77; 0/.008/-.89 and 1/.011/-.85) and decreased forces at the shoulder in the posterior, superior and lateral directions (2/.021/-.77; 2/.008/-.89 and 2/.024/-.75). Muscle activation in the pectoralis major, posterior deltoid and triceps brachii was also decreased (2/.038/-.69; 1/.015/-.81 and 1/.021/-.77).


CONCLUSIONS
Power-assist influenced the work requirements of hand-rim wheelchair propulsion by healthy subjects. It was primarily the kinetics at rim and shoulder which were influenced by power-assisted propulsion. Additional research with actual hand-rim wheelchair users is required before extrapolation to routine clinical practice.
Roessingh Research and Development, Enschede, The Netherlands.
Marieke G M
MG
Kloosterman
Hilde
H
Eising
Leendert
L
Schaake
Jaap H
JH
Buurke
Johan S
JS
Rietman
D004735:Energy Transfer / Q000502:physiology*; D006225:Hand / Q000502:physiology; D006801:Humans; D008297:Male; D009119:Muscle Contraction / Q000502:physiology*; D018482:Muscle, Skeletal / Q000502:physiology*; D016059:Range of Motion, Articular / Q000502:physiology*; D012785:Shoulder Joint / Q000502:physiology*; D013647:Task Performance and Analysis; D014910:Wheelchairs; D055815:Young Adult