Guillaume Desroches

Relationship Between Resultant Force at the Pushrim and the Net Shoulder Joint Moments During Manual Wheelchair Propulsion in Elderly Persons

OBJECTIVE To determine the relationship between the resultant force at the pushrim and the net shoulder joint moments during manual wheelchair propulsion in elderly persons. DESIGN Convenience sample. SETTING Motion analysis laboratory. PARTICIPANTS Older manual wheelchair users (N=14; age, 68.2+/-5.2y) were tested. INTERVENTIONS Kinematic and kinetic data were collected during manual wheelchair propulsion at a speed between 0.96 and 1.01m/s for 10 seconds and at a power output around 22.4W on a wheelchair ergometer. MAIN OUTCOME MEASURES Net shoulder joint moments were computed with an inverse dynamic model. The mechanical use of the forces at the pushrim and the mechanical fraction of effective force were measured during propulsion. RESULTS Mechanical use and mechanical fraction of effective force had a positive and significant correlation with the net internal (P<.05) and external (P<.001) shoulder rotation moment, the net flexion (P<.05), and extension (P<.001) moment in the sagittal plane, and the net flexion (P<.001) moment in the horizontal plane. CONCLUSIONS The results suggest that because the resultant force at the pushrim has a greater tangential component and a greater proportion of the maximal voluntary force, most of the net moments around the shoulder are higher. Thus the optimal way of propelling, from a mechanical point of view (ie, tangential), may not be advantageous for manual wheelchair users.

Effect of system tilt and seat-to-backrest angles on load sustained by shoulder during wheelchair propulsion

This study determined the effect of system tilt angle (STA) and seat-to-backrest angle (SBA) changes on the load sustained by the shoulder during manual wheelchair propulsion. Fourteen elderly participants (mean +/- standard deviation age 68.2 +/- 5.2 years) were recruited. Combinations of three STAs (0 degrees , 5 degrees , and 10 degrees ) and three SBAs (95 degrees , 100 degrees , and 105 degrees ) were randomly tested. The initial position of the wheel axle was held constant with respect to the participants shoulder position in each condition (horizontal: 4 cm forward of shoulder, vertical: 110 degrees to 120 degrees elbow extension). The shoulder load was estimated by the joint moments. The analysis did not reveal any significant differences between shoulder joint moments (average and peak) for the various STA and SBA combinations. Changing the seat angle while keeping the wheel-axle position constant maintained the shoulder load at the same level. Thus, seat angle can be determined with the goals of user comfort and pressure modulation at the seat interface for alleviating pressure ulcers without increasing risk of overuse shoulder injuries.

The Effect of Resultant Force at the Pushrim on Shoulder Kinetics During Manual Wheelchair Propulsion: A Simulation Study

The aim of this study was to determine, by simulation on real data, the effect of modifying the direction or effectiveness of a given force amplitude on the load sustained by the shoulder estimated by joint forces and moments. Kinematics and kinetics data were recorded on 14 manual wheelchair users (68.2plusmn5.2 years) for 10 s at sub-maximal speed (0.96-1.01 m/s). The simulation consisted in modifying force effectiveness at the pushrim while maintaining the same initial force amplitude. Shoulder kinetics were computed for simulated resultant forces from radial to tangent directions and also for initial force effectiveness. The results show that as the force was simulated tangent to the wheel, there was a significant increase in the average proximal and anterior shoulder joint forces. Also, significant increases in average internal rotation, flexion in the sagittal and horizontal plane moments were reported. Higher shoulder kinetics could accelerate the onset of fatigue and increase the risk of injury. A single-case analysis revealed an improvement window for force effectiveness (~10%) in which shoulder kinetics were not substantially increased. Our results provide useful information on what would happen to shoulder kinetics if we were able to teach manual wheelchair users to modify their force pattern at the pushrim. The results suggest that for an elderly population, it is not wise to aim at producing a mechanically optimal resultant force at the pushrim (i.e., tangent). Smaller increases of the initial force effectiveness would be preferable.

Pushrim biomechanical changes with progressive increases in slope during motorized treadmill manual wheelchair propulsion in individuals with spinal cord injury.

The purpose of this study was to quantify the effects of five distinct slopes on spatiotemporal and pushrim kinetic measures at the nondominant upper limb during manual wheelchair (MWC) propulsion on a motorized treadmill in individuals with spinal cord injury (SCI). Eighteen participants with SCI propelled their MWC at a self-selected natural speed on a treadmill at different slopes (0, 2.7, 3.6, 4.8, and 7.1 degrees). Spatiotemporal parameters along with total force and tangential components of the force applied to the pushrim, including mechanical effective force, were calculated using an instrumented wheel. The duration of the recovery phase was 54% to 70% faster as the slope increased, whereas the duration of the push phase remained similar. The initial contact angles migrated forward on the pushrim, while the final and total contact angles remained similar as the slope increased. As the slope increased, the mean total force was 93% to 201% higher and the mean tangential component of the force was 96% to 176% higher than propulsion with no slope. Measures were similar for the 2.7 and 3.6 degrees slopes. Overall, the recovery phase became shorter and the forces applied at the pushrim became greater as the slope of the treadmill increased during motorized treadmill MWC propulsion.

Stroke pattern classification during manual wheelchair propulsion in the elderly using fuzzy clustering

The purpose of this study was to analyse the kinematic pattern of elderly group during manual wheelchair propulsion. Fourteen elderly persons propelled manually in a wheelchair ergometer. A new objective method based on metrical and topological aspect of the contour of hand center of mass is proposed. A geometric mapping transforms the original time-hand trajectory to a normalized couple of features (R1 and R2). Fuzzy clustering was used to classify wheelchair propulsion pattern based on their features R1 and R2. Four classes were found in order to represent different propulsion pattern. Significant differences were found between classes for fraction of effective force and the biomechanical effectiveness. It was also found that classes are posture dependent and this can help in developing rehabilitation programmes for different groups of patients.

Trunk and Shoulder Kinematic and Kinetic and Electromyographic Adaptations to Slope Increase during Motorized Treadmill Propulsion among Manual Wheelchair Users with a Spinal Cord Injury

The main objective was to quantify the effects of five different slopes on trunk and shoulder kinematics as well as shoulder kinetic and muscular demands during manual wheelchair (MWC) propulsion on a motorized treadmill. Eighteen participants with spinal cord injury propelled their MWC at a self-selected constant speed on a motorized treadmill set at different slopes (0°, 2.7°, 3.6°, 4.8°, and 7.1°). Trunk and upper limb movements were recorded with a motion analysis system. Net shoulder joint moments were computed with the forces applied to the handrims measured with an instrumented wheel. To quantify muscular demand, the electromyographic activity (EMG) of the pectoralis major (clavicular and sternal portions) and deltoid (anterior and posterior fibers) was recorded during the experimental tasks and normalized against maximum EMG values obtained during static contractions. Overall, forward trunk flexion and shoulder flexion increased as the slope became steeper, whereas shoulder flexion, adduction, and internal rotation moments along with the muscular demand also increased as the slope became steeper. The results confirm that forward trunk flexion and shoulder flexion movement amplitudes, along with shoulder mechanical and muscular demands, generally increase when the slope of the treadmill increases despite some similarities between the 2.7° to 3.6° and 3.6° to 4.8° slope increments.

Upper Extremity Kinematics and Kinetics During the Performance of a Stationary Wheelie in Manual Wheelchair Users With a Spinal Cord Injury

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 participants 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.