Manual Wheelchair Propulsion Training

Manual wheelchair users are at high risk of developing upper limb pain and injury. While much has been published identifying the prevalence of upper limb pain, very little has been published on its treatment and prevention. Consequently, a propulsion training system was developed based on biomechanical, ergonomic, and motor learning theory principles. Three groups were compared: a control group (CG) that received no training, an instruction only group (IO) that reviewed a multi media instructional presentation (MMP), and a feedback group (FB) that reviewed the MMP and received additional real time feedback (RTF). The purpose of this study was to 1) Develop propulsion-training programs that minimized injurious biomechanics; 2) Test if the training programs can cause lasting changes; 3) Investigate if resultant forces and moments at the shoulder can be reduced and 4) To determine if one treatment (MMP) was superior to the other (RTF) in achieving these goals. First, the RTF systems' design was completed and tested on a pilot subject (chapter 2). Next the training systems were tested over ground (chapter 3) and on a dynamometer where shoulder forces were modeled (chapter 4) (N=27). Results showed baseline pain measures to be extremely low and did not increase significantly. In addition, the effects of training were not influenced by surface type or speed condition (presence or absence of a target speed). In chapter 2, the FB group who received RTF and MMP displayed larger increases in contact angle(CA)(angle along the arc of the hand rim) and greater decreases in rate of rise of peak resultant force (rorFr) than the IO group who received the MMP alone.5While both training groups decreased stroke frequency (SF), the IO group displayed a larger reduction than the FB group. Furthermore, both treatment groups showed a short term increase in peak resultant force (maxFr) however their long term values were not significantly greater than baseline and their shoulder forces did not increase significantly. Finally, the CG showed a long term increase in maxFr at the hand rim (p<.05), however their shoulder forces did not increase