Simulated effect of reaction force redirection on the upper extremity mechanical demand imposed during manual wheelchair propulsion

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

doi:10.1016/j.clinbiomech.2011.10.001

Cited by 13 publications

(6 citation statements)

References 27 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: 92%

“…As found previously, we expect that RF magnitude, shoulder net joint force (NJF), and shoulder NJM during WCP would increase whereas contact duration would decrease with increases in speed (Kulig et al, 1998 ; Koontz et al, 2002 ; Veeger et al, 2002 ). Consistent with that found in other impulse generating tasks (McNitt-Gray et al, 2001 ; Mathiyakom et al, 2005 ) and experimental-based model simulations of WCP (Munaretto et al, 2012 ), we hypothesized that the orientation of RF relative to the forearm and upper arm would affect the mechanical demand imposed on the upper extremity with increases in WCP speed. We anticipated that individuals with paraplegia would use different WCP techniques to accommodate the need to increase WCP speed.…”

Section: Introductionsupporting

confidence: 69%

“…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: 92%

Section: Introductionsupporting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Modifications in Wheelchair Propulsion Technique with Speed

Russell

Raina

Requejo

et al. 2015

Front. Bioeng. Biotechnol.

Self Cite

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“…A direct link between MSD and shoulder load has been established (Mercer et al, 2006). In most biomechanical studies on shoulder load during MWC propulsion, pushrim kinetics is assessed only on one side and perfect symmetry is assumed (Desroches et al, 2008;Bregman et al, 2009;Rankin et al, 2010;Munaretto et al, 2012). However, it is unclear whether MWC propulsion is a symmetric activity or not.…”

Section: Introductionmentioning

confidence: 99%

Proposing a new index to quantify instantaneous symmetry during manual wheelchair propulsion

Chénier

Malbequi

Gagnon

2017

Journal of Biomechanics

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Propelling a manual wheelchair (MWC) is a strenuous task that causes upper limb musculoskeletal disorders (MSD) in a large proportion of MWC users. Although most studies on MWC propulsion biomechanics assume that MWC propulsion is a relatively symmetric task, recent literature suggests that this is the case only when the assessed outcome measures are averaged over long periods of time, and not over short periods (i.e., instantaneously). No method is currently available to assess instantaneous symmetry. In this work, we present the Instantaneous Symmetry Index (ISI), a new method that quantifies how a variable has been instantaneously asymmetric during a selected time period. Thirteen experienced MWC users propelled on different cross slopes of 0%, 2%, 4%, 6% and 8%. As the cross slope is increased, the upper hand produced less propulsive moments and the lower hand produced more propulsive movements. This has been reflected in the ISI, which increased from 0.20 (0% slope) to 0.84 (8% slope) with a Spearman׳s coefficient of 0.90. The ISI has great potential to evaluate the ability of a user to propel symmetrically and synchronously, and will be a relevant measure to include in future studies on the impact of MWC propulsion asymmetry on MSD risk.

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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%