title: Shoulder kinetics during start-up and propulsion with a manual wheelchair within the initial phase of uninstructed training.
abstract: Wheelchair locomotion is constraining for the upper limbs and involves a set of motor tasks that need to be learnt by a novice user. To understand this integration process, we investigated the evolution of shoulder kinetics during start-up and propulsion within the initial phase of low-intensity uninstructed training.
  
  
  
  Seventeen novice able-bodied subjects performed a 120-min uninstructed practice distributed over 4 weeks. During the initial and final sessions, upper limbs kinematics and hand-rim kinetics were continuously collected. Inverse kinematics and dynamics coupled to a three-dimensional linked-segment model were used to compute shoulder net moments.
  
  
  
  Participants increased the speed of the wheelchair with practice. In average, an increase of shoulder net moments and mechanical work during the push phase was observed. Conversely, during the recovery phase, participants slightly increased shoulder power but maintained a similar level of shoulder loading. However, individual evolutions allowed the definition of two groups defined as: "increasers", who increased shoulder loading and mechanical work versus "decreasers", who managed to limit shoulder loading while improving the wheelchair speed.
  
  
  
  These findings underline that individual adaptation strategies are essential to take into account when designing a rehabilitation protocol for wheelchair users. Implications for Rehabilitation The learning process of manual wheelchair locomotion is essential for the assimilation of motor tasks leading individuals to select their propulsion technique. Novice users display different learning strategies: some people increase shoulder loading very early but others spontaneously manage to increase the wheelchair speed while maintaining a constant level of shoulder loading. Wheelchair rehabilitation programs should be individualized to take into account the subject-specific learning strategy.
authors.affiliation: a Arts et Me´tiers ParisTech , Institut de Biome´canique Humaine Georges Charpak , Paris , France.|b Centre d'Etudes et de Recherche pour l'Appareillage des Handicapés, Institution Nationale des Invalides , Woippy , France.
authors.forename: Samuel
authors.identifier: 0000-0003-3838-2860
authors.initials: S
authors.lastname: Hybois
authors.affiliation: a Arts et Me´tiers ParisTech , Institut de Biome´canique Humaine Georges Charpak , Paris , France.|b Centre d'Etudes et de Recherche pour l'Appareillage des Handicapés, Institution Nationale des Invalides , Woippy , France.
authors.forename: Alice
authors.initials: A
authors.lastname: Siegel
authors.affiliation: a Arts et Me´tiers ParisTech , Institut de Biome´canique Humaine Georges Charpak , Paris , France.|b Centre d'Etudes et de Recherche pour l'Appareillage des Handicapés, Institution Nationale des Invalides , Woippy , France.
authors.forename: Joseph
authors.identifier: 0000-0001-5290-8158
authors.initials: J
authors.lastname: Bascou
authors.affiliation: a Arts et Me´tiers ParisTech , Institut de Biome´canique Humaine Georges Charpak , Paris , France.|b Centre d'Etudes et de Recherche pour l'Appareillage des Handicapés, Institution Nationale des Invalides , Woippy , France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Eydieux
authors.affiliation: c Laboratoire d'Informatique, de Modélisation et d'Optimisation des Systèmes, Clermont Université , Clermont-Ferrand , France.|d Laboratoire d'Informatique, de Modélisation et d'Optimisation des Systèmes, Centre National de la Recherche Scientifique , Aubière , France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Vaslin
authors.affiliation: a Arts et Me´tiers ParisTech , Institut de Biome´canique Humaine Georges Charpak , Paris , France.
authors.forename: Hélène
authors.identifier: 0000-0002-0263-5910
authors.initials: H
authors.lastname: Pillet
authors.affiliation: b Centre d'Etudes et de Recherche pour l'Appareillage des Handicapés, Institution Nationale des Invalides , Woippy , France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Fodé
authors.affiliation: a Arts et Me´tiers ParisTech , Institut de Biome´canique Humaine Georges Charpak , Paris , France.
authors.forename: Christophe
authors.identifier: 0000-0002-6196-2698
authors.initials: C
authors.lastname: Sauret
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D026741:Physical Therapy Modalities; D012782:Shoulder / Q000502:physiology*; D062211:Spatio-Temporal Analysis; D034941:Upper Extremity / Q000502:physiology; D014910:Wheelchairs / Q000706:statistics & numerical data*
keywords: Biomechanics; kinetics; rehabilitation; shoulder; wheelchair