Manual wheelchairs: Research and innovation in rehabilitation, sports, daily life and health

Submaximal physical strain and peak performance in handcycling versus handrim wheelchair propulsion

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This publication of the Center for International Rehabilitation Research Information and Exchange is supported by funds received from the National Institute on Disability and Rehabilitation Research of the U.S. Department of Education under grant number H133A050008. The opinions contained in this publication are those of the authors and do not necessarily reflect those of CIRRIE or the Department of Education.

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International Encyclopedia of Rehabilitation

Optimizing mobility performance in wheelchair court sports (basketball, rugby and tennis) is dependent on a combination of factors associated with the user, the wheelchair and the interfacing between the two. Substantial research has been attributed to the wheelchair athlete yet very little has focused on the role of the wheelchair and the wheelchair-user combination. This article aims to review relevant scientific literature that has investigated the effects of wheelchair configuration on aspects of mobility performance from an ergonomics perspective. Optimizing performance from an ergonomics perspective requires a multidisciplinary approach. This has resulted in laboratory-based investigations incorporating a combination of physiological and biomechanical analyses to assess the efficiency, health/safety and comfort of various wheelchair configurations. To a lesser extent, field-based testing has also been incorporated to determine the effects of wheelchair configuration on aspects of mobility performance specific to the wheelchair court sports. The available literature has demonstrated that areas of seat positioning, rear wheel camber, wheel size and hand-rim configurations can all influence the ergonomics of wheelchair performance. Certain configurations have been found to elevate the physiological demand of wheelchair propulsion, others have been associated with an increased risk of injury and some have demonstrated favourable performance on court. A consideration of all these factors is required to identify optimal wheelchair configurations. Unfortunately, a wide variety of different methodologies have immerged between studies, many of which are accompanied by limitations, thus making the identification of optimal configurations problematic. When investigating an area of wheelchair configuration, many studies have failed to adequately standardize other areas, which has prevented reliable cause and effect relationships being established. In addition, a large number of studies have explored the effects of wheelchair configuration in either able-bodied populations or in daily life or racing wheelchairs. As such, the findings are not specific and transferable to athletes competing in the wheelchair court sports. This review presents evidence about the effects of wheelchair configuration on aspects of mobility performance specific to the wheelchair court sports to better inform athletes, coaches and manufacturers about the consequences of their selections. It also provides researchers with guidance on the design of future investigations into areas of wheelchair configuration, which are essential.

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The Ergonomics of Wheelchair Configuration for Optimal Performance in the Wheelchair Court Sports

Background: Regular physical activity is important for people with tetraplegia to maintain fitness but may not always be easily integrated into daily life. In many countries, hand cycling has become a serious option for daily mobility in people with tetraplegia. However, little information exists regarding the suitability of this exercise mode for this population.

Objective: The purpose of this study was to evaluate the effects of a structured hand cycle training program in individuals with chronic tetraplegia.

Design: Pretraining and posttraining outcome measurements of physical capacity were compared.

Setting: Structured hand cycle interval training was conducted at home or in a rehabilitation center in the Netherlands.

Participants: Twenty-two patients with tetraplegia (American Spinal Injury Association Impairment Scale classification A-D) at least 2 years since injury participated.

Intervention: The intervention was an 8- to 12-week hand cycle interval training program.

Measures: Primary outcomes of physical capacity were: peak power output (POpeak) and peak oxygen uptake (Vo2peak), as determined in hand cycle peak exercise tests on a motor-driven treadmill. Secondary outcome measures were: peak muscle strength (force-generating capacity) of the upper extremities (as assessed by handheld dynamometry), respiratory function (forced vital capacity and peak expiratory flow) and participant-reported shoulder pain.

Results: Significant improvements following a mean of 19 (SD=3) sessions of hand cycle training were found in POpeak (from 42.5 W [SD=21.9] to 50.8 W [SD=25.4]), Vo2peak (from 1.32 L·min−1 [SD=0.40] to 1.43 L·min−1 [SD=0.43]), and mechanical efficiency, as reflected by a decrease in submaximal oxygen uptake. Except for shoulder abduction strength, no significant effects were found on the secondary outcomes.

Limitations: Common health complications, such as urinary tract infections, bowel problems, and pressure sores, led to dropout and nonadherence.

Conclusion: Patients with tetraplegia were able to improve their physical capacity through regular hand cycle interval training, without participant-reported shoulder-arm pain or discomfort.

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L.A Rozendaal

Papers

Biomechanics and physiology in active manual wheelchair propulsion