Motor learning outcomes of handrim wheelchair propulsion during active spinal cord injury rehabilitation in comparison with experienced wheelchair users

Abstract

Purpose: To investigate changes in wheelchair propulsion technique and mechanical efficiency across first five weeks of active inpatient spinal cord injury rehabilitation and to compare the outcomes at discharge with experienced wheelchair users with spinal cord injury. Methods: Eight individuals with recent spinal cord injury performed six weekly submaximal exercise tests. The first and last measurement additionally contained a wheelchair circuit and peak graded exercise test. Fifteen experienced individuals performed all above-mentioned tests on one occasion. Results: Mechanical efficiency and propulsion technique did not change during the five weeks of inpatient rehabilitation. Peak power output during peak graded test and performance time on the wheelchair circuit improved between the first and the last week. No difference in propulsion technique, peak power output, and performance time was found between the persons with a recent injury and the experienced group. Mechanical efficiency was higher after the correction for the difference in relative power output in the experienced group. Conclusion: The group with a recent injury did not improve mechanical efficiency and propulsion technique over the period of active rehabilitation, despite significant improvements on the wheelchair circuit and in work capacity. The only significant difference between the groups was found in mechanical efficiency. ä IMPLICATIONS FOR REHABILITATION The lack of time-dependent changes in mechanical efficiency and propulsion technique in the group with a recent spinal cord injury, combined with the lack of differences in technique, work capacity and on the wheelchair circuit between the groups, suggest that important adaptations of motor learning may happen even earlier in rehabilitation and emphasize that the group in active rehabilitation was relatively skilled. Standardized observational analyses of handrim wheelchair propulsion abilities during early spinal cord injury rehabilitation provide detailed understanding of wheelchair technique, skill as well as wheelchair propulsion capacity. Measurement of external power output is critical to interpretation of gross efficiency, propulsion technique, and capacity. Wheelchair quality and body weightnext to wheelchair fitness and skillrequire careful consideration both in early rehabilitation as well as in the chronic phase of spinal cord injury.

Steering Does Affect Biophysical Responses in Asynchronous, but Not Synchronous Submaximal Handcycle Ergometry in Able-Bodied Men

“…The current experiment asks for novices, as experience in one of the conditions may affect the performance. It is difficult to ask individuals who are in the process of early rehabilitation to volunteer in an experiment, as they already go through a stressful time (Leving et al, 2019 ). In order to simulate novice handcycle users however, a block was placed in front of the stool to prevent the participant from pushing off the ground with their feet.…”

Learning of Wheelchair Racing Propulsion Skills Over Three Weeks of Wheeling Practice on an Instrumented Ergometer in Able-Bodied Novices

“…This practice load was shown to be sufficient to achieve a learning effect in regular handrim wheelchair propulsion ( 6 , 20 , 25 ). They received no advice on propulsion technique prior to the experiment and no feedback during the sessions, resulting in a “natural” learning process ( 26 ). Before the start of an exercise block, the sole instruction was to propel at a required speed of 2.78 m/s (10 km/h) and to hit/push the handrim with the soft hand gloves.…”

“…The acquisition of daily wheelchair propulsion skill has been extensively studied for regular handrim wheelchairs in wheelchair users (12) and (novice) able-bodied participants (6)(7)(8). These studies generally examined steady-state submaximal performance at low speeds, using gross mechanical efficiency as the primary outcome measure (13).…”

“…This is in line with the framework of Sparrow and Newel ( 14 , 15 ) and Almåsbakk et al ( 16 ), where cyclic movement patters are thought to emerge through the interaction of different constraints, with metabolic energy as an optimization parameter. The increase in mechanical efficiency can be due to improvements in propulsion skill and/or physiological adaptation ( 12 ). A high mechanical efficiency in wheelchair propulsion was linked to increased wheeling proficiency, expressed as greater contact angles and a decreased push frequency, which is especially beneficial as this is thought to improve mobility and reduce risk of injury ( 17 , 18 ).…”

The Effect of External Power Output and Its Reliability on Propulsion Technique Variables in Wheelchair Users With Spinal Cord Injury

“…The protocol, regarding velocity, slope and test duration, was similar to the protocol that was used in previous studies to assess propulsion technique in people with SCI [13,14]. Participants first practiced propulsion at 0.56, 0.83 and 1.11 m•s -1 to familiarize themselves with treadmill propulsion and to choose one of these speeds for testing.…”