Impact of rear wheel axle position on upper limb kinematics and electromyography during manual wheelchair use

Abstract

Manual wheelchair propulsion is an important form of mobility for people with lower limb disabilities. Changes in the wheelchair configuration can affect, range of motion (ROM) of the upper limb joints, muscle actions and system stability. The purpose of this study is to investigate the impact of adjusting wheelchair configurations on upper body joints kinematics and muscle recruitment for able-bodied non experienced manual wheelchair users through applying a marker-based 3D motion analysis technique. Ten healthy male subjects were characterised for three wheelchair configurations, set by adjusting the horizontal axle position of both rear wheels by (3 cm) and (6 cm) posteriorly from the original position set by the manufacturer. Selected 3D kinematic and surface electromyography (sEMG) parameters of the upper body joints and shoulder muscles were measured in the Cardiff University Motion Analysis Laboratory. During the propulsion trials, trunk flexion/extension, lateral bending and axial rotation were evaluated within the average range of (7.50°±1.4°), (5.91°±1.23°) and (7.01°±3.91°), respectively. Dominant shoulder abduction/adduction, flexion/extension and internal/external rotation were evaluated within the average range of (24.63°±6.38°), (17.31°±4.27°) and (40.02°±12.35°), respectively. Dominant elbow pronation/supination and flexion/extension were evaluated within the range of (15.49°±7.70°) and (34.37°±8.38°), respectively. Dominant wrist radial/ ulnar deviation and flexion/ extension were evaluated within the average range of (29.82°±8.97°) and (53.59°±9.65°), respectively. With normalising the muscle EMG to the percentage of MVC activity, posterior deltoid had the highest average EMG muscle activity (11.43 ± 5.33) during the propulsion trials and at the three wheel adjustments relative to the other dominant shoulder muscles. Other average muscles activities were evaluated as (6.99 ± 2.37) for upper trapezius, (6.89 ± 2.51) for triceps brachii, (5.39 ± 2.95) for anterior deltoid, (3.26 ± 1.00) for biceps brachii and (3.14 ± 1.26) for pectoralis major as the lowest average activity. The findings of this study indicate that changing rear wheel axle position posteriorly is correlated with increasing the kinematic ROMs of the trunk and dominant upper limb and the sEMG activities of the muscles predominantly involved with the recovery phase of propulsion which could be linked with higher risks of musculoskeletal disorders. This knowledge may help professionals when designing and prescribing wheelchairs that are more proper to users' functional characteristics, accordingly profiting them improved quality of life.

How Was Studied the Effect of Manual Wheelchair Configuration on Propulsion Biomechanics: A Systematic Review on Methodologies

“…Methods: Six articles used overground propulsion and involved experienced MWC users ( 37 , 47 ), novice AB participants ( 19 , 32 , 43 ) or older people with no information on their MWC experience ( 60 ). One article focused on MWC rugby athletes ( 37 ).…”

“…One article focused on MWC rugby athletes ( 37 ). Participants were asked to propel at a comfortable self-selected speed either for at least 4 cycles on a linear path on 4 different surfaces ( 60 ), for 10 m ( 32 ), for 20 m ( 47 ) or for 30 cycles ( 43 ); to perform a combination of 5 m sprints, Illinois agility test and a specific “skill” test ( 37 ), or a combination of a 15 m straight line sprint and a slalom course ( 19 ).…”

“…The six studies used a single MWC for all their participants. The initial configuration was either described through MWC brand, rear-wheel diameter, tire type, handrim diameter, front wheel type, seat width and depth and camber angle ( 47 ); through brand, mass, seat width, depth, height and inclination, cushion thickness and type, side guards material, rear and caster wheel types and diameters, handrim material and camber ( 60 ); through brand and seat height ( 32 ); through fore-aft seat position ( 19 ); through seat height, angle, and tire pressure ( 37 ) or not described ( 43 ). All articles except one ( 43 ) used an adjustable MWC, but only three reported a MWC adaptation to each participant ( 37 , 47 , 60 ), and Kotajarvi et al ( 47 ) specified this adaptation to be the reproduction of the participant's backrest and footrest heights.…”

“…The total amplitude of variation varied between 3 cm ( 37 ) and 8 cm ( 47 , 60 ). Four studies specified that some or all the other settings were maintained constant and/or controlled between configurations ( 32 , 37 , 47 , 60 ).…”

“…Materials: Regarding measurement devices, the experiments used optoelectronic motion capture systems ( 32 , 47 ), video cameras ( 37 ), instrumented wheels ( 47 , 60 ), IMUs or accelerometers ( 37 , 43 ), and EMG electrodes ( 19 , 32 ).…”