Biomechanical evidence is needed to determine to what extent the use of a mobility assistance dog (ADMob) may minimize mechanical loads and muscular demands at the upper limbs among manual wheelchair users. This study quantified and compared upper limb efforts when propelling up a ramp with and without an ADMob among manual wheelchair users. Ten manual wheelchair users with a spinal cord injury who own an ADMob ascended a ramp with and without their ADMob. The movements of the wheelchair and upper limbs were captured and the forces applied at the pushrims were recorded to compute shoulder mechanical loading. Muscular demand of the pectoralis major, anterior deltoid, biceps, and the triceps was normalized against the maximum electromyographic values. The traction provided by the ADMob significantly reduced the total force applied at the pushrim and its tangential component while the mechanical effectiveness remained similar. The traction provided by the ADMob also resulted in a significant reduction in shoulder flexion, internal rotation, and adduction moments. The muscular demands of the anterior deltoid, pectoralis major, biceps, and triceps were significantly reduced by the traction provided by the ADMob. The use of ADMob represents a promising mobility assistive technology alternative to minimize upper limb mechanical loads and muscular demands and optimize performance during wheelchair ramp ascent.
Valérie Martin-Lemoyne, Dany H. Gagnon, François Routhier, Lise Poissant, Michel Tousignant, Hélène Corriveau and Claude Vincent
Mathieu Lalumiere, Dany H. Gagnon, François Routhier, Laurent Bouyer and Guillaume Desroches
No comprehensive biomechanical study has documented upper extremity (U/E) kinematics and kinetics during the performance of wheelchair wheelies among manual wheelchair users (MWUs). The aim of this study was to describe movement strategies (kinematics), mechanical loads (kinetics), and power at the nondominant U/E joints during a wheelie among MWUs with spinal cord injury (SCI). During a laboratory assessment, 16 MWUs with SCI completed four wheelie trials on a rigid surface. Each participant’s wheelchair was equipped with instrumented wheels to record handrim kinetics, while U/E and wheelchair kinematics were recorded with a 3D motion analysis system. The greatest mean and peak total net joint moments were generated by the shoulder flexors (mean = 7.2 ± 3.5 N·m; peak = 20.7 ± 12.9 N·m) and internal rotators (mean = 3.8 ± 2.2 N·m; peak = 11.4 ± 10.9 N·m) as well as by the elbow flexors (mean = 5.5 ± 2.5 N·m; peak = 14.1 ± 7.6 N·m) during the performance of wheelies. Shoulder flexor and internal rotator efforts predominantly generate the effort needed to lift the front wheels of the wheelchair, whereas the elbow flexor muscles control these shoulder efforts to reach a state of balance. In combination with a task-specific training program that remains essential to properly learn how to control wheelies among MWUs with SCI, rehabilitation professionals should also propose a shoulder flexor, internal rotator, and elbow flexor strengthening program.
Ricardo A. Tanhoffer, Aldre I. P. Tanhoffer, Jacqueline Raymond, Andrew P. Hills and Glen M Davis
The objective of this study was to verify the long-term effects of exercise on energy expenditure and body composition in individuals with spinal cord injury (SCI), as very little information is available on this population under free-living conditions.
Free-living energy expenditure and body composition using doubly labeled water (DLW) was measured in 13 individuals with SCI, subdivided in 2 groups: (1) sedentary (SED; N = 7) and (2) regularly engaged in any exercise program, for at least 150 min·wk−1 (EXE; N = 6).
The total daily energy expenditure (TDEE) was significantly higher in the EXE group (33 ± 4.5 kcal·kg−1·day−1) if compared with SED group (27 ± 4.3 kcal·kg−1·day−1). The percentage of body fat was significantly higher in SED group than in EXE group (38 ± 6% and 28 ± 9%).
Our findings revealed that, despite the severity of SCI, the actual ACSM’s guidelines for weight management for healthy adults exercise could significantly increase TDEE and BMR and improve body composition in individuals who regularly perform exercise. However, the EXE group still showed a high percentage of body fat, suggesting that a more specific approach might be considered (ie, increased intensity or volume, or combining with a diet program).
Ricardo A. Tanhoffer, Aldre I.P. Tanhoffer, Jacqueline Raymond, Nathan A. Johnson, Andrew P. Hills and Glen M. Davis
The objective of this study was to determine whether doubly labeled water (DLW) and a multi-sensor armband (SWA) could detect the variation in energy expenditure incurred by a period of increased exercise (EXE) versus a period of high sedentary activity (SED), in individuals with spinal cord injury (SCI).
Eight participants with SCI were submitted to 2 testing periods of energy expenditure assessment: 1) a 14-day phase during which sedentary living conditions were imposed and 2) a 14-day phase during which an exercise training intervention was employed. For each phase, total daily energy expenditure (TDEE) and physical activity energy expenditure (PAEE) were measured by DLW and SWA.
Mean TDEE assessed by DLW, was significantly higher during EXE versus SED (11,605 ± 2151 kJ·day-1 and 10,069 ± 2310 kJ·day-1). PAEE predicted by DLW was also significantly higher during EXE versus SED (5422 ± 2240 kJ·day-1 and 3855 ± 2496 kJ·day-1). SWA-predicted PAEE significantly underestimated PAEE measured by the DLW during SED and EXE.
DLW is sensitive to detect variation in within-individual energy expenditure during voluntary increase in physical activity in individuals with SCI. SWA failed to detect statistically significant variations in energy expenditure between periods of high versus low activity in SCI.
Aitor Iturricastillo, Cristina Granados, Raúl Reina, José Manuel Sarabia, Ander Romarate and Javier Yanci
factors related to wheelchair propulsion could have an influence, such as wheelchair–user interface, trunk function/activity, or propulsion technique, 10 and not only the upper-limb power output. Therefore, it might be interesting for coaches not only to train muscle strength with BP exercise but also to
Luc H.V. van der Woude, Dirk-Jan E.J. Veeger and Rients H. Rozendal
A review of wheelchair research within the scope of the wheelchair as a means of daily ambulation is presented. The relevance of a combined biomechanical and physiological research approach is advocated for enhancing the body of knowledge of wheelchair ergonomics, that is, the wheelchair/user interaction in relation to aspects of vehicle mechanics and the user’s physical condition. Results of experiments regarding variations in the wheelchair/user interface stress the possibilities of optimization in terms of wheelchair dimensions and user characteristics. Analysis of propulsion technique is aimed at the within-cycle characteristics and the time-dependent organization of technique.
Alicia M. Koontz, Lynn A. Worobey, Ian M. Rice, Jennifer L. Collinger and Michael L. Boninger
Laboratory-based simulators afford many advantages for studying physiology and biomechanics; however, they may not perfectly mimic wheelchair propulsion over natural surfaces. The goal of this study was to compare kinetic and temporal parameters between propulsion overground on a tile surface and on a dynamometer. Twenty-four experienced manual wheelchair users propelled at a self-selected speed on smooth, level tile and a dynamometer while kinetic data were collected using an instrumented wheel. A Pearson correlation test was used to examine the relationship between propulsion variables obtained on the dynamometer and the overground condition. Ensemble resultant force and moment curves were compared using cross-correlation and qualitative analysis of curve shape. User biomechanics were correlated (R ranging from 0.41 to 0.83) between surfaces. Overall, findings suggest that although the dynamometer does not perfectly emulate overground propulsion, wheelchair users were consistent with the direction and amount of force applied, the time peak force was reached, push angle, and their stroke frequency between conditions.
Fiona J. Connor-Kuntz, Gail M. Dummer and Michael J. Paciorek
Physical education and sport participation of 133 children and youth with myelomeningocele (MM), aged 7 to 16 years, was investigated with respect to age, level of MM, and ambulation. Results showed that 90.2% of subjects received physical education. Elementary-aged subjects were least likely to be excluded from physical education, as were full-time manual wheelchair users. Regular physical education placements were afforded to 51.7% of subjects, although individuals may have been placed according to their MM label rather than their ambulation ability. Sport participation was reported by 82.6% of subjects. Subjects with cervical MM, and those not receiving physical education, were least likely to have participated. Interestingly, children who walked without assistive devices were least likely to participate in nonschool sports. However, 9.2% of subjects, including almost 20% of the subjects with sacral MM, felt they could benefit from use of a wheelchair in the future, or from use of a wheelchair for sport.
øyvind F. Standal and Ejgil Jespersen
The purpose of this study was to investigate the learning that takes place when people with disabilities interact in a rehabilitation context. Data were generated through in-depth interviews and close observations in a 2½ week-long rehabilitation program, where the participants learned both wheelchair skills and adapted physical activities. The findings from the qualitative data analysis are discussed in the context of situated learning (Lave & Wenger, 1991; Wenger, 1998). The results indicate that peer learning extends beyond skills and techniques, to include ways for the participants to make sense of their situations as wheelchair users. Also, it was found that the community of practice established between the participants represented a critical corrective to instructions provided by rehabilitation professionals.
Yong Tai Wang, Randy Bernard, Clint Cope, Li-Shan Chang, Weerawat Limroongreungrat and Stephen Sprigle
This study examined time efficiency in wheelchair locomotive activities among four different wheelchairs propelled by elders with arms and/or legs. Sixteen elder manual wheelchair users propelled her/his own wheelchair and three wheelchairs (the main drive-axis wheels positioning in front, middle, and rear, respectively) in the test of seven wheelchair locomotive activities of daily living. A Mixed-Model ANOVA and Bonferroni post hoc test (p < .05) were employed to determine the time efficiency among four wheelchairs and three groups. The results demonstrated better time efficiency resulted from propelling the mid drive-axis and/or rear drive-axis wheelchairs; using arms and legs simultaneously propelling wheelchairs was more time efficient than using the arms or legs only in the selected locomotive activities.