Article

PURPOSE: To test the hypothesis that movement of the head and trunk increases as
a consequence of speed during manual wheelchair propulsion over the ground in
individuals with tetraplegia. METHODS: Seven adult participants with tetraplegia
who used manual wheelchairs (5 men and 2 women, aged 33.0 +/- 10.2) were selected
for the study. Participants propelled over the ground at three different speeds
while video motion capture methods collected kinematic data. Variables
investigated were forward flexion, lateral flexion and axial rotation for both
the head and trunk. Repeated measures ANOVA were used to determine effects of
speed on head and trunk movements. RESULTS: Both neck and trunk forward flexion
significantly increased as a result of speed (p = 0.034, p = 0.031), with a large
effect size (r = 0.6, r = 0.6) between slow and fast speeds. Lateral flexion and
axial rotation were minimal for the neck and trunk and did not significantly
increase with speed. CONCLUSIONS: Results suggest that manual wheelchair users
with tetraplegia compensate for trunk muscle weakness by flexing the upper trunk
and neck forward during manual wheelchair propulsion and that these movements
increase with speed. Further studies should examine if these movements relate to
overuse injuries and interventions that focus on improving manual wheelchair
biomechanics of individuals with tetraplegia. IMPLICATIONS FOR REHABILITATION:
Individuals who use manual wheelchairs utilize their upper extremities almost
exclusively for both everyday mobility and participation in daily life activities
which can often lead to overuse injuries and pain. Despite having a lack of trunk
muscle innervation, manual wheelchair users with tetraplegia are able to
compensate for this weakness by using the upper trunk and neck. The way in which
force is translated from the trunk through the upper extremities to the pushrim
may impact propulsion biomechanics, and ultimately the extent in which upper
extremity pain and injury develops. A better understanding of how individuals
with trunk impairments propel a manual wheelchair will help clinicians determine
optimal wheelchair positioning and training during rehabilitation for individuals
with tetraplegia. Clinicians can determine ways in which they can support manual
wheelchair users to allow for most efficient biomechanics.

Langue : ANGLAIS