Reconfiguration of the upper extremity relative to the pushrim affects load distribution during wheelchair propulsion

Munaretto, Joseph M.; McNitt-Gray, Jill L.; Flashner, Henryk; Requejo, Philip S.

doi:10.1016/j.medengphy.2012.12.002

Cited by 14 publications

(4 citation statements)

References 25 publications

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“…The experimental results of this study are consistent with the model simulation results (Munaretto et al, 2012 , 2013 ) that demonstrate at a particular WCP speed, increases in resultant pushrim RF can occur without comparable increase in shoulder NJM. The magnitude of the shoulder NJM is dependent on the proximal distal moments created by the NJFs at the elbow and shoulder and the elbow NJM (Figure 8 ).…”

Section: Discussionsupporting

confidence: 91%

“…Understanding how an individual can effectively interact with the pushrim to achieve required increases in WCP speed provides insights into how modifications in multijoint control of the upper limb can accommodate for increased mechanical demand imposed on the shoulder. Model simulation results indicate that modifications in RF orientation relative to the upper extremity segments can effectively redistribute load away from the shoulder while maintaining WCP speed (Munaretto et al, 2012 , 2013 ). To date, the techniques used by individuals with SCI to accomplish the changes in propulsion speeds have been difficult to discern from group mean data of peak NJMs reported during WCP (Kulig et al, 1998 , 2001 ; Koontz et al, 2002 ; Mercer et al, 2006 ).…”

Section: Introductionmentioning

confidence: 99%

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Modifications in Wheelchair Propulsion Technique with Speed

Russell

Raina

Requejo

et al. 2015

Front. Bioeng. Biotechnol.

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ObjectiveRepetitive loading of the upper limb joints during manual wheelchair (WC) propulsion (WCP) has been identified as a factor that contributes to shoulder pain, leading to loss of independence and decreased quality of life. The purpose of this study was to determine how individual manual WC users with paraplegia modify propulsion mechanics to accommodate expected increases in reaction forces (RFs) generated at the pushrim with self-selected increases in WCP speed.MethodsUpper extremity kinematics and pushrim RFs were measured for 40 experienced manual WC users with paraplegia while propelling on a stationary ergometer at self-selected free and fast propulsion speeds. Upper extremity kinematics and kinetics were compared within subject between propulsion speeds. Between group and within-subject differences were determined (α = 0.05).ResultsIncreased propulsion speed was accompanied by increases in RF magnitude (22 of 40, >10 N) and shoulder net joint moment (NJM, 15 of 40, >10 Nm) and decreases in pushrim contact duration. Within-subject comparison indicated that 27% of participants modified their WCP mechanics with increases in speed by regulating RF orientation relative to the upper extremity segments.ConclusionsReorientation of the RF relative to the upper extremity segments can be used as an effective strategy for mitigating rotational demands (NJM) imposed on the shoulder at increased propulsion speeds. Identification of propulsion strategies that individuals can use to effectively accommodate for increases in RFs is an important step toward preserving musculoskeletal health of the shoulder and improving health-related quality of life.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Modifications in Wheelchair Propulsion Technique with Speed

Russell

Raina

Requejo

et al. 2015

Front. Bioeng. Biotechnol.

Self Cite

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“…Another solution to avoid experimental limitations is to resort to numerical simulation. Some studies already embraced this approach based on simplified 2-D wheelchair propulsion models (14,(96)(97)(98)(99), or through 3-D musculoskeletal simulations (100). Still, all these techniques rely on experimental data to feed the model.…”

Section: Numerical Simulationsmentioning

confidence: 99%

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

Fritsch

Poulet

Bascou

et al. 2022

Front. Rehabilit. Sci.

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BackgroundFor both sports and everyday use, finding the optimal manual wheelchair (MWC) configuration can improve a user's propulsion biomechanics. Many studies have already investigated the effect of changes in MWC configuration but comparing their results is challenging due to the differences in experimental methodologies between articles.PurposeThe present systematic review aims at offering an in-depth analysis of the methodologies used to study the impact of MWC configuration on propulsion biomechanics, and ultimately providing the community with recommendations for future research.MethodsThe reviewing process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart on two databases (Scopus and PubMed) in March 2022.ResultsForty-five articles were included, and the results highlighted the multiplicity of methodologies regarding different experimental aspects, including propulsion environment, experimental task, or measurement systems, for example. More importantly, descriptions of MWC configurations and their modifications differed significantly between studies and led to a lack of critical information in many cases.DiscussionStudying the effect of MWC configuration on propulsion requires recommendations that must be clarified: (1) the formalism chosen to describe MWC configuration (absolute or relative) should be consistent with the type of study conducted and should be documented enough to allow for switching to the other formalism; (2) the tested MWC characteristics and initial configuration, allowing the reproduction or comparison in future studies, should be properly reported; (3) the bias induced by the experimental situation on the measured data must be considered when drawing conclusions and therefore experimental conditions such as propulsion speed or the effect of the instrumentation should be reported.ConclusionOverall, future studies will need standardization to be able to follow the listed recommendations, both to describe MWC configuration and mechanical properties in a clear way and to choose the experimental conditions best suited to their objectives.

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“…These include recommendations for reducing the mechanical loads and muscular demands through ergonomics, wheelchair selection and configuration, and environmental adaptations and personal factors for increasing the capacity to handle the daily mobility demands (Requejo et al, 2008 , 2015 ). By integrating up-to-date knowledge of the musculoskeletal system, individual’s capacity to generate and withstand external demands, preferred multijoint control strategies including propulsion technique, and repetitive load exposure through biomechanical modeling and simulations, feasible interventions can be identified and implemented (Munaretto et al, 2012 , 2013 ; Slowik et al, 2015 , 2016a , b ).…”

mentioning

confidence: 99%