Upper extremity control and dynamics during manual wheelchair propulsion at different speeds and wheelchair configurations

2018-08-01This body of work aims to determine how upper extremity control and dynamics during manual wheelchair propulsion is affected by changes in speed and seating configuration. Due to the detrimental impact on mobility and the difficulty in treatment of shoulder pain, exploring upper extremity loading consequences of propulsion strategies are important to eventually improving patient outcomes. By determining how individual wheelchair users accommodate expected increases in mechanical demands we can begin to identify effective multijoint control strategies for achieving desired performance outcomes while mitigating detrimental mechanical loading of the shoulder. A detailed understanding of upper extremity demand during propulsion is necessary for describing an individual’s interaction with their wheelchair and identifying how to maintain shoulder health. However, the nature of the shoulder joint often lends to complex multi-planar movements that are difficult to fully describe anatomically. By using a novel method of parsing shoulder net joint moment, we aim to get a clearer understanding of the mechanical demand imposed on the shoulder during wheelchair propulsion. Clinical fitting visits for wheelchair users aim to reconfigure the wheelchair to address issues with posture, pressure, and stability. By comparing how individual wheelchair users modify technique during outdoor wheelchair propulsion following reconfiguration, we can explore the effect of wheelchair configuration on control and dynamics in a real-world setting. Finally, by analyzing propulsion mechanics on a stationary fixed ergometer apparatus and outside in a realistic setting we can begin to investigate the potential shifts in postural control as well as joint kinetics for differing wheelchair stability scenarios