An Investigation of Bilateral Symmetry During Manual Wheelchair Propulsion

Abstract

Studies of manual wheelchair propulsion often assume bilateral symmetry to simplify data collection, processing, and analysis. However, the validity of this assumption is unclear. Most investigations of wheelchair propulsion symmetry have been limited by a relatively small sample size and a focus on a single propulsion condition (e.g., level propulsion at self-selected speed). The purpose of this study was to evaluate bilateral symmetry during manual wheelchair propulsion in a large group of subjects across different propulsion conditions. Three-dimensional kinematics and handrim kinetics along with spatiotemporal variables were collected and processed from 80 subjects with paraplegia while propelling their wheelchairs on a stationary ergometer during three different conditions: level propulsion at their self-selected speed (free), level propulsion at their fastest comfortable speed (fast), and propulsion on an 8% grade at their level, self-selected speed (graded). All kinematic variables had significant side-to-side differences, primarily in the graded condition. Push angle was the only spatiotemporal variable with a significant side-to-side difference, and only during the graded condition. No kinetic variables had significant side-to-side differences. The magnitudes of the kinematic differences were low, with only one difference exceeding 5°. With differences of such small magnitude, the bilateral symmetry assumption appears to be reasonable during manual wheelchair propulsion in subjects without significant upper-extremity pain or impairment. However, larger asymmetries may exist in individuals with secondary injuries and pain in their upper extremity and different etiologies of their neurological impairment.

Relationship between shoulder pain and skin temperature measured by infrared thermography in a wheelchair propulsion test

“…It is also known that dominant side has a higher capacity to loss temperature and better thermoregulation [65], getting cold in response to the onset of the activity because of the vasoconstriction effect. This is not reflected in our results and it can be due to the bilateral propulsion of the wheelchair that may compensate this asymmetry in WCUs [66]. Finally, Shin-ichi et al [26] found a nonuniform distribution of the temperature in the bust rising heterogeneously during both wheelchair exercise and recovery, which is consistent with our lack of pattern in DT sk after exercise.…”

Sprint performance and propulsion asymmetries on an ergometer in trained high‐ and low‐point wheelchair rugby players

“…That said, the side‐to‐side differences in PO warrant future study with respect to whether this occurred at the start of the sprint (eg, problems with hand‐to‐tire coupling) or toward the end of the sprint (eg, fatigue effects); whether the symmetry noted was due to the type of health condition (eg, SCI vs non‐SCI); and/or whether there was asymmetric dynamic loading of the rollers. Nevertheless, the results of this study highlight the need to gather information on bilateral symmetry particularly if there are issues with secondary injury or pain . It is also unknown at present whether WCR players would be at a higher risk of shoulder pain from these side‐to‐side asymmetries on the court or even whether these asymmetries exist during daily ambulation in day‐chair wheelchair‐user combinations.…”

“…Nevertheless, the results of this study highlight the need to gather information on bilateral symmetry particularly if there are issues with secondary injury or pain. 12,23 It is also unknown at present whether WCR players would be at a higher risk of shoulder pain from these side-to-side asymmetries on the court or even whether these asymmetries exist during daily ambulation in day-chair wheelchair-user combinations. Consequently, these results are of interest to strength and conditioning practitioners as training regimes must address these side-to-side asymmetries alongside the tailored programs that are often prescribed to develop the posterior muscle groups.…”

The influence of wheelchair propulsion hand pattern on upper extremity muscle power and stress

“…Experimental data was previously collected from 223 individuals with complete motor paraplegia while they propelled their wheelchair at a self-selected speed on a stationary ergometer that simulated level propulsion over a tile surface (e.g., Soltau et al, 2015). The subjects were recruited from outpatient clinics throughout the Rancho Los Amigos National Rehabilitation Center, and informed written consent was obtained in accordance with the governing Institutional Review Board.…”