title: Manual wheelchair propulsion by people with hemiplegia: within-participant comparisons of forward versus backward techniques.
abstract: OBJECTIVE
  To test the hypotheses that people with hemiplegia using arms and legs to propel their wheelchairs perform better backward than forward and prefer the backward direction.
  
  
  METHODS
  Within-participant cross-sectional design.
  
  
  METHODS
  Manual wheelchair users (N=18) with hemiplegia caused by stroke, a sample of convenience.
  
  
  METHODS
  Rehabilitation center.
  
  
  METHODS
  Participants each performed 9 skills from the Wheelchair Skills Test (WST 4.1)-4 low-rolling-resistance skills (rolls 10m, turns 90° while moving, rolls 2m across 5° side slope, descends 5cm level change) and 5 high-rolling-resistance skills (ascends 5° incline, rolls 2m on soft surface, gets over 15-cm pothole, gets over 2-cm threshold, ascends 5cm level change)-in both the forward and backward directions, in random order.
  
  
  METHODS
  Total percentage capacity scores from the modified WST 4.1, success rates for individual skills, and responses from an orally administered questionnaire regarding direction preferences.
  
  
  RESULTS
  The mean ± SD total WST 4.1 capacity scores were 53%±26% in the forward direction and 76%±30% in the backward direction (P<.001). For the 4 low-rolling-resistance skills, there were no clinically significant differences (≥20%) between forward and backward success rates. For the 5 high-rolling-resistance skills, the success rates were 33% to 50% higher in the backward direction. Participants preferred the forward direction for low-rolling-resistance skills and the backward direction for high-rolling-resistance skills.
  
  
  CONCLUSIONS
  Wheelchair skills that involve high rolling resistance are performed more successfully in the backward than the forward direction, and participants prefer the backward direction for such skills. These findings have implications for wheelchair selection and skills training.
authors.affiliation: Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Charbonneau
authors.forename: R Lee
authors.initials: RL
authors.lastname: Kirby
authors.forename: Kara
authors.initials: K
authors.lastname: Thompson
mesh_terms: D000368:Aged; D001132:Arm; D003430:Cross-Sectional Studies; D005260:Female; D006429:Hemiplegia / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D009048:Motor Skills; D026741:Physical Therapy Modalities; D012047:Rehabilitation Centers; D020521:Stroke / Q000150:complications; D013647:Task Performance and Analysis; D014910:Wheelchairs
keywords: Hemiplegia; Rehabilitation; WST; Wheelchair Skills Test; Wheelchairs