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At least 19 recordsLinked to original sources
PubMed2006

Comparison between performance with a pushrim-activated power-assisted wheelchair and a manual wheelchair on the Wheelchair Skills Test.

PURPOSE: To test the hypothesis that people using a pushrim-activated power-assisted wheelchair (PAPAW) can accomplish a wider range of wheelchair skills than when using a manual wheelchair (MWC). METHODS: We studied 30 able-bodied participants, using within-participant comparisons. Participants used a manual wheelchair equipped with both PAPAW and regular MWC rear wheels, and rear anti-tip devices (Arc-RADs) that permitted wheelie-like function. We trained participants to perform the wheelchair skills of the Wheelchair Skills Training Program (WSTP, Version 2.4). From the Wheelchair Skills Test (WST, Version 2.4), we calculated pass-fail success rates for the 50 individual skills and a total percentage WST score. RESULTS: The mean (+/-SD) total WST scores were 89.3 (+/-7.0)% for the PAPAW and 88.8 (+/-8.4)% for the MWC, with a mean difference of 0.6 (+/-5.6)% (p = 0.59). Qualitative observations suggested that skills requiring a higher force on the pushrim (e.g., incline ascent) were performed more easily with the PAPAW, whereas skills requiring greater control of the wheelchair (e.g., wheelie-dependent skills) were performed more easily with the MWC. CONCLUSION: Overall wheelchair skill performance with the PAPAW is not superior to that when using the MWC. The PAPAW may be helpful for specific skills that require more wheel torque, but the additional torque appears to be disadvantageous when performing skills that require greater control.

Adult↗
PubMed2002

Wheelchair users are not necessarily wheelchair bound.

OBJECTIVES: To determine the patterns of wheelchair use in terms of locations of use, whether wheelchair use in one location was related to wheelchair use in other locations, and factors associated with wheelchair use in different locations. DESIGN: Longitudinal cohort study. SETTING: Patients prescribed wheelchairs by clinicians at one of two teaching hospitals (one Veterans Affairs hospital and one private hospital). PARTICIPANTS: One hundred fifty-three consecutive persons who were prescribed a new wheelchair, resided in the community, had a Short Portable Mental Status Questionnaire score of greater than six out of 10, and who could be interviewed within 7 to 21 days of receiving the wheelchair. MEASUREMENTS: Patient, wheelchair, and environmental characteristics and self-reported wheelchair use in life spaces. RESULTS: Wheelchair use in the 24 hours before the interview was inconsistent across life spaces. The correlation between wheelchair use in the bath and in the kitchen was 0.66, between locations near and far from home was -0.08, and between locations in the home and outside the home was 0.08. Predictors of wheelchair use in the home were using help from another person to propel the wheelchair (odds ratio (OR) = 0.14, 95% confidence interval (CI) = 0.04-0.45), the number of impairments (OR = 0.80, 95% CI = 0.67-0.96), a report that the wheelchair did not meet the subject's needs (OR = 3.71, 95% CI = 1.27-10.81), and having adapted the home to accommodate the wheelchair (OR = 3.75, 95% CI = 1.47-8.18). Having adapted the home was also positively associated with use of the wheelchair in areas near the home (OR = 4.77, 95% CI = 1.94-11.71). The only factor associated with wheelchair use in distant locations was older age (OR = 0.62, 95% CI = 0.46-0.83 per 10-year increment). CONCLUSIONS: Personal factors (e.g., using help to propel the wheelchair) and environmental factors (e.g., home adaptations to accommodate the wheelchair) influenced wheelchair use. In addition, wheelchair use, and the factors influencing wheelchair use, differed by location. Wheelchair users appear to use their wheelchairs selectively, depending on their physical needs and the constraints of their environment.

Aged↗
PubMed1995

Wheelchairs as mobility restraints: predictors of wheelchair activity in nonambulatory nursing home residents.

OBJECTIVE: The purpose of this paper is to describe factors affecting wheelchair mobility in nonambulatory nursing home (NH) residents. DESIGN: Prospective descriptive study of a convenience sample of nonambulatory NH residents. SETTING: Seven nursing homes. PARTICIPANTS: Sixty-five nonambulatory residents. MEASUREMENTS: One-minute, time-sampled observations of behavior for each resident were made every 15 minutes for 8 to 11 hours across 2 days, noting wheelchair propulsion activity for the dependent variable; independent variables included measures of wheelchair level of assistance, speed, endurance, handgrip strength, and balance. MAIN RESULTS: A stepwise Multiple Regression analysis found wheelchair speed to be the single best predictor of the percentage of time residents were behaviorally observed wheelchair propelling (Multiple r = .45, P < .02). Handgrip strength and wheelchair endurance measures were highly intercorrelated with wheelchair speed. Wheelchairs that were either dysfunctional or inappropriately fitted to the residents' size were a major barrier to wheelchair use, affecting 46% of residents using wheelchairs. CONCLUSION: Improving wheelchair skills with targeted intervention programs, along with making chairs more "user friendly" (e.g., grip extensions on brakes, foot pedals that one can move without bending over), could result in more wheelchair propulsion with resultant improvements in the NH resident's independence, freedom of movement, and quality of life.

Aged↗
PubMedDate not supplied

Wheelchair-related accidents caused by tips and falls among noninstitutionalized users of manually propelled wheelchairs in Nova Scotia.

The purpose of this study was to document what proportion of noninstitutionalized users of manually propelled wheelchairs are affected by wheelchair-related accidents caused by tips and falls, determine the nature and severity of the resulting injuries, and, by comparison with an unaffected group, identify factors associated with the risk of such accidents. We administered a postal questionnaire to as many as possible of the estimated 2055 members of the target population in the province of Nova Scotia. Among the 577 appropriate respondents, 57.4% reported they had completely tipped over or fallen from their wheelchairs at least once, and 66.0% reported having partially tipped. Of the falls and tips that were reported, 46.3% were forward in direction, 29.5% backward and 24.2% sideways. Many of the accidents occurred outdoors or on ramps. A total of 292 injuries were reported by 272 (47.1%) respondents. Most of the injuries (84.3%) were minor (e.g., abrasions, contusions, lacerations and sprains). Of the 15.8% of injuries that were serious, the most common were fractures (10.6%) and concussions (2.7%). Factors that appear to be associated with an increased risk of accidents and injuries included younger age, male gender, paraplegia or spina bifida as the reason for wheelchair use, having had a wheelchair prescribed, some wheelchair features (lightweight, camber, adjustable rear-axle positions, a knapsack), daily use of a wheelchair, propelling the chair with both hands, use of the wheelchair for recreation, use of a sideways transfer (without a transfer board) and doing repairs themselves or having them done by the dealer. Factors associated with a decreased risk include multiple sclerosis, stroke or arthritis as the reason for wheelchair use, attendant propulsion and the use of a one-person assist for transfers. The results of this study, that wheelchair-related accidents caused by tips and falls are very common, that serious injuries are not unusual and that there is a pattern of risk factors, should be useful to wheelchair users, clinicians, manufacturers and regulatory bodies.

Accidents↗
PubMed1993

The ANSI/RESNA wheelchair standards: sample evaluation and guide to interpreting test data for prescribing power wheelchairs.

This study is a joint project of ECRI and the National Rehabilitation Hospital, supported by a grant from the National Institute on Disability and Rehabilitation Research (NIDRR, U.S. Department of Education, Agreement No. H133E80016). ECRI is the first independent laboratory to test power wheelchairs according to the standards of the Rehabilitation Engineering Society of North America (RESNA), now known as the Association for the Advancement of Rehabilitation and Assistive Technology (AART); these standards will ultimately be distributed by the American National Standards Institute (ANSI). We tested 10 power wheelchairs, which are similar in size and configuration, from seven manufacturers; all units are intended for adult use. Our testing showed that none of the sample wheelchairs are ideal for all environments in which these devices are typically needed. Each unit has advantages that should be carefully considered when specifying a power wheelchair. Numerous factors are involved in prescribing power wheelchairs, and learning the subtle differences in features and performance of a particular model and how they will affect the user is difficult. In addition, acquiring objective information about power wheelchairs from manufacturers is not typically easy. Considering these factors, and because the standards on which we based our testing do not generally provide criteria for passing or failing models under test, we did not rate the units. The purpose of this article is to present the data collected in our study, using wheelchair performance characteristics based on some parts of the ANSI/RESNA wheelchair standards, as an example of what prescribers can expect to receive from manufacturers and to provide guidance in interpreting and applying the data in writing power wheelchair prescriptions. Thus, this article provides an overview of the types of problems faced by those who specify power wheelchairs for users, the problems faced by the users themselves, and the components that are most susceptible to damage during use.

Electric Power Supplies↗
PubMed2001

Wheelchair propulsion biomechanics: implications for wheelchair sports.

The aim of this article is to provide the reader with a state-of-the-art review on biomechanics in hand rim wheelchair propulsion, with special attention to sport-specific implications. Biomechanical studies in wheelchair sports mainly aim at optimising sport performance or preventing sport injuries. The sports performance optimisation question has been approached from an ergonomic, as well as a skill proficiency perspective. Sports medical issues have been addressed in wheelchair sports mainly because of the extremely high prevalence of repetitive strain injuries such as shoulder impingement and carpal tunnel syndrome. Sports performance as well as sports medical reflections are made throughout the review. Insight in the underlying musculoskeletal mechanisms of hand rim wheelchair propulsion has been achieved through a combination of experimental data collection under realistic conditions, with a more fundamental mathematical modelling approach. Through a synchronised analysis of the movement pattern, force generation pattern and muscular activity pattern, insight has been gained in the hand rim wheelchair propulsion dynamics of people with a disability, varying in level of physical activity and functional potential. The limiting environment of a laboratory, however, has hampered the drawing of sound conclusions. Through mathematical modelling, simulation and optimisation (minimising injury and maximising performance), insight in the underlying musculoskeletal mechanisms during wheelchair propulsion is sought. The surplus value of inverse and forward dynamic simulation of hand rim stroke dynamics is addressed. Implications for hand rim wheelchair sports are discussed. Wheelchair racing, basketball and rugby were chosen because of the significance and differences in sport-specific movement dynamics. Conclusions can easily be transferred to other wheelchair sports where movement dynamics are fundamental.

Arm↗
PubMed2004

The Wheelchair Circuit: Construct validity and responsiveness of a test to assess manual wheelchair mobility in persons with spinal cord injury.

OBJECTIVE: To assess the validity and responsiveness of the Wheelchair Circuit, a test to assess manual wheelchair mobility in persons with spinal cord injury (SCI). DESIGN: Longitudinal. Subjects performed the Wheelchair Circuit at the start (T1) and at the end (T3) of inpatient functional rehabilitation. Construct validity and responsiveness were assessed. SETTING: Eight rehabilitation centers in the Netherlands. PARTICIPANTS: Seventy-four subjects with SCI admitted for inpatient rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores: ability, performance time, and physical strain. The construct validity of the Wheelchair Circuit was assessed by testing whether the test scores were significantly related to the subjects' functional status, physical capacity, lesion level, motor completeness of the lesion, and age. To prove the test's responsiveness, it was assessed whether the test scores had significantly improved between T1 and T3. RESULTS: For construct validity, 4 of the 5 hypotheses were confirmed. For test responsiveness, all 3 test scores had significantly improved during rehabilitation, and the standardized response mean values ranged from 0.6 to 0.9. CONCLUSIONS: The Wheelchair Circuit is a valid and responsive instrument with which to measure manual wheelchair mobility in subjects with SCI.

Adolescent↗
PubMed1999

Thermoregulatory and physiological responses of wheelchair athletes to prolonged arm crank and wheelchair exercise.

Seven wheelchair athletes participated in this study. On separate occasions all athletes performed 60 min of arm crank ergometry and wheelchair ergometry at 60% of the ergometer specific VO2peak in cool conditions (21.5+/-1.3 degrees C; 54.2+/-6.3% relative humidity, 21.2+/-1.9 degrees C; 55.5+/-11.9% relative humidity, respectively). The order of testing was randomised. Aural and skin temperatures were continually measured throughout the 60 min test. Expired air was collected at 5, 15, 30, 45, and 60 min during the exercise period. Oxygen consumption was similar for both trials (1.09+/-0.21 and 1.16+/-0.331 x min-(-1), for the ACE and WCE trials, respectively). Heat storage was calculated at these time-points. Aural temperature was elevated from rest between 25 to 45 min of wheelchair ergometry (0.5+/-0.3 degrees C; P < 0.05) when compared to between 20 min of exercise and 5 min of recovery (0.6+/-0.3 degrees C; P<0.05) during the arm crank ergometry trial. On the cessation of arm crank ergometry, heat storage was elevated above values observed at 5 min of exercise (P < 0.05). On the cessation of wheelchair ergometry, heat storage was not elevated above values at 5 minutes of exercise. Upper arm skin temperature was cooler during wheelchair ergometry when compared to arm crank ergometry (P<0.05). All other skin temperature responses were similar during both exercise modes. The efficiency of arm crank ergometry was greater than wheelchair ergometry throughout the exercise period (18.5+/-3.5 % and 8.9+/-3.7% at 60 minutes of exercise, respectively; P < 0.05). The results of this study suggest that although ACE demonstrates greater efficiency than WCE prolonged arm crank ergometry elicited greater thermal and physiological strain when compared with prolonged wheelchair ergometry. The lower thermal strain during WCE was suggested to be related to the propulsion biomechanics which may result in some degree of local cooling, and consequently heat dissipation, when compared to ACE. Due to the greater thermal strain during arm crank ergometry, it is recommended that for studies examining the exercise responses of wheelchair users wheel-chair ergometry should be employed.

Adult↗
PubMedDate not supplied

Physical performance and cardiovascular and metabolic adaptation of elite female wheelchair basketball players in wheelchair ergometry and in competition.

Spinal cord injury leads to a pronounced reduction of cardiovascular, pulmonary, and metabolic ability. Physical activity, up to and including high-performance sports, has obtained importance in the course of rehabilitation and the postclinical phase. Thirteen elite female wheelchair basketball players from the German National Basketball Team and 10 female sedentary spinal cord-injured persons were examined in the study. Heart volume was measured by an echocardiography. All subjects underwent a graded exercise test on a wheelchair ergometer. Additionally, heart rate, lactate, and player points were measured during a competitive basketball game in wheelchair basketball players. Cardiac dimensions were larger for spinal cord-injured wheelchair basketball players (620.3 ml; 9.6 ml x kg(-1)) in comparison with spinal cord-injured persons (477.4 ml; 8.2 ml x kg(-1)) but did not exceed the heart volume of untrained nonhandicapped persons. In contrast, athletes with amputations or those having had poliomyelitis reached training-induced cardiac hypertrophy in relation to body mass (713.7 ml; 13.2 ml x kg(-1)), as observed in nonhandicapped athletes. During graded wheelchair ergometry, wheelchair basketball players showed a higher maximal work rate (59.9 v 45.5 W), maximal oxygen consumption (33.7 v 18.3 ml x min(-1) x kg(-1)), and maximal lactate (9.1 v 5.47 mmol x l(-1)) without a difference in maximal heart rate and workload at AT4 than did spinal cord-injured persons. The average heart rate during the wheelchair basketball game was 151 x min(-1), and the lactate concentration was 1.92 mmol x l(-1). Female athletes with a less severe handicap and higher maximal oxygen consumption during the graded exercise test reached a higher game level in the evaluation. During the competitive basketball game, high cardiovascular stress was observed, indicating a fast aerobic metabolism; the anaerobic lactic acid capacity played a subordinate role. Wheelchair basketball is an effective and suitable sport to enhance physical performance and to induce positive physiological adaptations.

Adult↗
PubMed2000

Development of a wheelchair occupant injury risk assessment method and its application in the investigation of wheelchair securement point influence on frontal crash safety.

To promote proper wheelchair securement in transportation, the proposed ANSI/RESNA Standard on Wheelchairs Used as Seats in Motor Vehicles will require that all transit wheelchairs be equipped with four securement points compatible with strap-type tiedowns. Through computer simulations, the location of these securement points has been found to influence wheelchair user response to a frontal crash. This study develops and employs an injury risk assessment method to compare the crashworthiness of various securement point configurations. The comparative injury risk assessment method is designed to predict the risk associated with internalized crash forces, as well as risk associated with secondary occupant impact with the vehicle interior. Injury criteria established by Federal Motor Vehicle Safety Standards and General Motors, along with excursion limitations set by the Society of Automotive Engineers (SAE) J2249 Wheelchair Tiedowns and Occupant Restraint Systems (WTORS) Standard were used as benchmarks for the risk assessment method. The simulation model subjected a secured commercial powerbase wheelchair with a seated 50th percentile male Hybrid III test dummy to a 20 g/30 mph crash. The occupant was restrained using pelvic and shoulder belts, and the wheelchair was secured with four strap-type tiedowns. Results indicated that securement points located 1.5 in to 2.5 in above the evaluated wheelchair's center of gravity provide the most effective occupant protection.

Abbreviated Injury Scale↗
PubMed1997

Wheelchair rider injuries: causes and consequences for wheelchair design and selection.

An understanding of adverse incidents and injuries sustained by active wheelchair riders, who live and work in the mainstream of society, is needed to improve safety via wheelchair design, selection, and configuration. We interviewed 109 riders who had experienced incidents, in order to identify the causes of incidents and injuries they suffered. Participants reported n = 253 incidents (53% in powered wheelchairs, 47% manual) occurring within a 5-year period, comprised of 106 (42%) "Tips and Falls," 84 (33%) "Component Failures," and 63 (25%) "Other" events. Sixty-eight (27%) of the incidents caused injuries requiring medical attention, including 13 hospitalizations. Direction of Tips and Falls was associated with wheelchair type (manual or powered) and with different riding surfaces. Aspects of wheelchair stability, particularly the effects of wheelchair configuration and of different riding surfaces, are important engineering issues affecting wheelchair safety. Interpretation of the results highlights wheelchair stability mechanics. Potential design improvements are discussed.

Accidental Falls↗
PubMed2005

Wheelchair skills training for community-based manual wheelchair users: a randomized controlled trial.

OBJECTIVE: To test the hypotheses that wheelchair skills training of community-based manual wheelchair users is efficacious, safe, and practical. DESIGN: Randomized controlled trial. SETTING: Rehabilitation center and community. PARTICIPANTS: Twenty community-based manual wheelchair users (15 men, 5 women; age range, 21-77 y), half with musculoskeletal and half with neurologic disorders. INTERVENTION: Participants were randomly allocated to the Wheelchair Skills Training Program (WSTP) or control groups. In 1-hour individualized sessions, the WSTP group participants received a mean +/- standard deviation of 4.5+/-0.7 hours of training. Caregivers participated whenever possible. In addition to training at the rehabilitation center, the trainer traveled to administer training in the community. MAIN OUTCOME MEASURES: Using the Wheelchair Skills Test (WST, version 3.1), an objective test of 57 skills, we calculated total and subtotal percentage scores (percentage number of skills passed of those possible) and individual skill success rates. RESULTS: The WSTP group's improvement in total WST score was significantly greater than the control group's (P<.005). The mean total WST score for the WSTP group increased from a pretraining value of 63.3%+/-6.0% to 78.5%+/-8.3% posttraining, a relative improvement of 24.0% (P=.002). The control group increased from a baseline value of 70.8%+/-14.0% to 74.2%+/-11.8% at follow-up, a relative improvement of 4.8% (P=.03). The WSTP group had clinically significant pre- and posttraining improvements (> or = 20%) in the success rates of 25 of the 57 individual WST skills, compared with only 5 skills for the control group. There were no adverse incidents, and the WSTP participants' comments were all positive. CONCLUSIONS: Wheelchair skills training of community-based manual wheelchair users is efficacious, safe, and practical. These findings have implications for the standard of rehabilitation care.

Adult↗
PubMed2004

Wheelchair skills training program: A randomized clinical trial of wheelchair users undergoing initial rehabilitation.

OBJECTIVE: To test the hypothesis that a brief, formalized period of additional wheelchair skills training is safe and results in significantly greater improvements in wheelchair skills performance than a standard rehabilitation program. DESIGN: Randomized controlled trial. SETTING: Rehabilitation center. PARTICIPANTS: Thirty-five wheelchair users (20 with musculoskeletal disorders, 15 with neurologic disorders) admitted for initial rehabilitation. Subjects' mean age +/- standard deviation (SD) was 59+/-18.3 years. INTERVENTION: Subjects randomly allocated to the treatment group participated in the Wheelchair Skills Training Program (WSTP), averaging 4.5+/-1.5 training sessions, each 30 minutes long. Subjects in the control group did not receive any wheelchair skills training beyond that given in a typical rehabilitation stay. MAIN OUTCOME MEASURES: Wheelchair Skills Test (WST), version 2.4, before and after training. Changes in total percentage WST score and individual skill scores were examined. RESULTS: There were no adverse incidents. The control group's mean percentage score +/- SD increased from 60.1%+/-14.4% to 64.9%+/-13.3%, an 8% improvement of the posttest relative to the pretest (P=.01). The WSTP group's mean score increased from 64.9%+/-9.4% to 80.9%+/-5.6%, a 25% improvement of the posttest relative to the pretest (P<.000). The WSTP group showed significantly greater improvements than the control group (P<.000). Among the specific skills, significantly greater improvements were seen in the WSTP group for the gravel and high-curb descent skills (P<.001). CONCLUSIONS: The WSTP is safe and practical and has a clinically significant effect on the independent wheeled mobility of new wheelchair users. These findings have implications for the standards of care in rehabilitation programs.

Adult↗
PubMed1997

Shoulder rotator torque and wheelchair dependence differences of National Wheelchair Basketball Association players.

OBJECTIVE: Shoulder rotator muscle imbalances can contribute to subacromial impingement. The forces and movement patterns of wheelchair locomotion may contribute to these imbalances. This study attempted to determine whether National Wheelchair Basketball Association players of differing classifications had significant differences (p < or = .05) in concentric isokinetic peak shoulder rotator torque and torque ratios, and wheelchair locomotion dependence. DESIGN: Fifty-seven (class 1 = 12, class 2 = 24, class 3 = 21) of 117 total tournament participants (class 1 = 25, class 2 = 49, class 3 = 43) served as the convenience sample of volunteers for the survey portion, and 33 of these subjects (class 1 = 11, class 2 = 12, class 3 = 10) also entered the isokinetic portion of this study. SETTING: National wheelchair basketball tournament. RESULTS: Class 1 and 2 players had greater wheelchair dependence than class 3 players (p < or = .05). Peak torque or torque ratios generally did not differ among player classifications or with other populations. Class 1 players had weaker nondominant shoulder external rotator torque production at 60 degrees/sec (p < or = .03) compared with other classes and at 180 degrees/sec compared with class 3 players (p = .02), suggesting an inability to develop the "attenuation of dominance" noted among other groups. Diminished torque-producing capacity at 60 degrees/sec related to greater wheelchair dependence among class 1 players (p = .034). CONCLUSIONS: Class 1 players failed to demonstrate the acquired shoulder external rotator torque symmetry evident among class 2 and 3 players (with specific weakness of the nondominant shoulder external rotators). This torque symmetry difference was related to their greater dependence on wheelchair locomotion.

Adult↗
PubMed1997

Kinematics of the elbow during wheelchair propulsion: a comparison of two wheelchairs and two stroking techniques.

OBJECTIVE: The kinematics of the elbow joint were studied for two types of wheelchairs and during two types of propulsive strokes. PARTICIPANTS: Ten serially selected healthy volunteers propelled a standard and a lightweight wheelchair on a roller system with both circular and pumping strokes. DESIGN: Kinematic data for the wheelchair and the upper extremity were collected by an optical tracking system. These kinematic descriptors were subsequently time-normalized with a spline algorithm to provide a graphic description of the wheelchair strokes. MAIN OUTCOME MEASURES: Thirteen discrete variables were compared for the two chairs and the two propulsive strokes. RESULTS: Total elbow motion ranged from 60.9 degrees of flexion to 5.2 degrees of extension. Maximal elbow flexion velocity ranged from 515.4 degrees to 572.8 degrees per second. Kinematic differences between the two wheelchairs were minimal, with a trend for 8.3 degrees to 5.2 degrees more elbow flexion in the lightweight wheelchair (p < .05), depending on the stroke used. With the use of any one chair, the style of the stroke had no significant effect on elbow kinematics, but the use of a pumping stroke did decrease propulsion arc by 12 degrees to 14 degrees (p < .05). CONCLUSION: No major differences regarding elbow kinematics were seen between the two types of wheelchairs. The pumping-stroke technique resulted in a shortened handrim contact arc.

Adult↗
PubMed1999

Oxygen uptake during peak graded exercise and single-stage fatigue tests of wheelchair propulsion in manual wheelchair users and the able-bodied.

OBJECTIVE: To determine if a single-stage, submaximal fatigue test on a wheelchair ergometer would result in higher than expected energy expenditure. DESIGN: An experimental survey design contrasting physiologic responses during peak graded exercise tests and fatigue tests. SETTING: A rehabilitation science laboratory that included a prototypical wheelchair ergometer, open-circuit spirometry system, and heart rate monitor. PARTICIPANTS: Nine able-bodied non-wheelchair users (the NWC group: 6 men and 3 women, mean +/- SD age 30 +/- 7yrs) and 15 manual wheelchair users (the WC group: 12 men and 3 women, age 40 +/- 9yrs, time in wheelchair 16 +/- 9yrs). No subject had any disease, medication regimen, or upper body neurologic, orthopedic, or other condition that would limit wheelchair exercise. MAIN OUTCOME MEASURES: Peak oxygen uptake (VO2) for graded exercise testing and during fatigue testing, using a power output corresponding to 75% peak aerobic capacity on graded exercise test. RESULTS: In the WC group, VO2 at 6 minutes of fatigue testing was not significantly different from peak VO2. In the NWC group, VO2 was similar to the expected level throughout fatigue testing. CONCLUSION: Energy expenditure was higher than expected in the WC group but not in the NWC group. Fatigue testing may provide a useful evaluation of cardiorespiratory status in manual wheelchair users.

Adult↗
PubMed1990

Physiological and biomechanical differences between wheelchair-dependent and able-bodied subjects during wheelchair ergometry.

The purpose of this study was to compare the physiological and biomechanical responses of wheelchair-dependent persons (WCD) to able-bodied persons (AB) during manual wheelchair ergometry. Five WCD and five AB performed a discontinuous wheelchair ergometer test starting at 12.8 W at 30 rev.min-1 (57 m.min-1) with increments of 7.0 W at 6-min intervals. Biomechanical data were collected 3.5 min into each stage followed by the collection of physiological data. After the fifth stage, peak oxygen consumption was determined by having the subject work against a resistance of 14.7-19.6 N at 30 rev.min-1. The WCD had significantly higher net mechanical efficiency at 26.7, 33.6 and 40.6 W in comparison to the AB. The WCD had significantly greater shoulder extension at the point of initial wheel contact as measured by the shoulder angle, while the AB had significantly greater shoulder range of motion at all work rates in comparison to the WCD. The results demonstrate that a significant physiological difference exists in the manner by which WCD and AB accomplish wheelchair ergometry. The biomechanical differences between AB and WCD were found to be a prominent factor contributing to the higher mechanical efficiency of WCD over AB. It was concluded that basic physiological and biomechanical differences exist between WCD and AB in manual wheelchair locomotion and that these differences are important considerations to the interpretation of data in wheelchair ergometry studies.

Adult↗
PubMed2003

Range of motion and stroke frequency differences between manual wheelchair propulsion and pushrim-activated power-assisted wheelchair propulsion.

BACKGROUND/OBJECTIVE: The objective of this study was to examine the use and efficacy of a pushrim-activated power-assist wheelchair (PAPAW) in the reduction of upper extremity range of motion (ROM) and stroke frequency in manual wheelchair users. METHODS: Ten manual wheelchair users were evaluated using a repeated-measures design with and without the use of a PAPAW for maximum ROM of shoulder flexion/extension, abduction/adduction, internal/external rotation, and horizontal flexion/extension; elbow flexion/extension; wrist flexion/extension, supination/pronation, and ulnar/radial deviation; and stroke frequency. Participants propelled a Quickie 2 manual wheelchair configured as a PAPAW and their own wheelchair on a computer-controlled dynamometer at 3 different resistance levels and 2 different speeds. RESULTS: The use of the PAPAW significantly (P < 0.05) decreased shoulder flexion/extension and horizontal flexion/extension, elbow flexion/extension, and wrist flexion/extension and ulnar/radial deviation for many speed and resistance combinations. Univariate analysis revealed that stroke frequency was unaltered in all cases. CONCLUSION: These findings provide the foundation for studying the utility of the PAPAW in reducing the risk of upper limb injury and neuropathy in the manual wheelchair user population.

Adult↗