title: Pushrim kinetics during advanced wheelchair skills in manual wheelchair users with spinal cord injury.
abstract: OBJECTIVE
  To assess the peak force during wheelchair propulsion of individuals with spinal cord injury propelling over obstacles from the Wheelchair Skills Test.
  
  
  METHODS
  Twenty-three individuals with spinal cord injury (SCI) who are full-time manual wheelchair users were included in this prospective study. A SmartWheel (Three Rivers Holdings, LLC) was used to analyze each push while subjects negotiated standardized obstacles used in the Wheelchair Skills Test, including tile, carpet, soft surface, 5° and 10° ramps, 2 cm, 5 cm, and 15 cm curbs.
  
  
  RESULTS
  When the peak forces of the advanced skills were compared to level 10 m tile/10 m carpet, there was a statistically significant increase in all peak forces (P value ranged from .0001 to .0268).
  
  
  CONCLUSIONS
  It is well documented that a large number of individuals with SCI develop upper limb pain. One of the recommendations to preserve the upper limb is to minimize force during repetitive tasks.
  
  
  CONCLUSIONS
  Advanced wheelchair skills require an increase in force to accomplish. The increase in forces ranged from 18% to 130% over that required for level 10 m tile/10 m carpet.
authors: MetroHealth Rehabilitation Institute of Ohio , Cleveland , Ohio.
authors: Jennifer
authors: J
authors: Nagy
authors: Amy
authors: A
authors: Winslow
authors: Jessica M
authors: JM
authors: Brown
authors: Lisa
authors: L
authors: Adams
authors: Kathleen
authors: K
authors: O'Brien
authors: Michael
authors: M
authors: Boninger
authors: Gregory
authors: G
authors: Nemunaitis
keywords: kinetics; manual wheelchair; peak force; propulsion; spinal cord injury; wheelchair skills test