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Abstract

An estimated 90% of all wheelchairs are hand-rim propelled, a physically straining form of ambulation that can lead to repetitive strain injuries in the arms and, eventually, to secondary impairments and disability. Further disability in wheelchair-dependent individuals can lead to a sedentary lifestyle and thereby create a greater risk for cardiovascular problems. Studies on lever-propelled and crank-propelled wheelchairs have shown that these propulsion mechanisms are less straining and more efficient than hand-rim-propelled wheelchairs. This article reviews these studies and substantiates that the frequent use of these alternative propulsion mechanisms may help prevent some of the secondary impairments that are seen among today's wheelchair-user population.

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... M anual wheelchair propulsion is the most favoured mode of propulsion adopted by a large percentage of wheelchair users: More than 90% of all selfpropelled wheelchairs are ambulated via push-rims by using the arms to apply force (1). Push-rim propulsion (PRP) is energetically inefficient, highly strenuous for the musculoskeletal system, and associated with high cardiopulmonary effort (1)(2)(3)(4)(5)(6). ...
... M anual wheelchair propulsion is the most favoured mode of propulsion adopted by a large percentage of wheelchair users: More than 90% of all selfpropelled wheelchairs are ambulated via push-rims by using the arms to apply force (1). Push-rim propulsion (PRP) is energetically inefficient, highly strenuous for the musculoskeletal system, and associated with high cardiopulmonary effort (1)(2)(3)(4)(5)(6). Furthermore, PRP often leads to severe upper limb injuries, especially at the shoulder and wrist joints (7)(8)(9). ...
... in the range 2-10% and rarely exceeds 10% (1,12). Despite similar power output conditions, reported values for GME vary widely, which may be explained by individual differences in the physical ability of wheelchair users and by the influence of propulsion speed and surface properties (1,12). ...
Article
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Objective: To investigate differences in metabolic cost and gross mechanical efficiency of a novel handlebased wheelchair propulsion device and to compare its performance with conventional push-rim propulsion. Design: Double-group comparative study between 2 different propulsion methods. Participants: Eight paraplegic individuals and 10 non-disabled persons. Methods: Participants performed the same exercise using a push-rim device and the novel handle-based device on a wheelchair- based test rig. The exercise consisted of a combined submaximal and maximal test. Power output, oxygen uptake, ventilation, respiratory exchange ratio and heart rate were recorded continuously during the tests. Analysis of variance was performed to determine the effects of group, mode and on power output. Results: Submaximal exercise resulted in a higher efficiency for the novel device and significant main effects of propulsion mode on all investigated parameters, except heart rate. On the respiratory exchange ratio, a significant interaction effect was found for both mode and group. The maximal exercise resulted in a higher peak power output and lower peak heart rate during propulsion using the handle-based device. A significant main effect on mode for mean peak power output, ventilation and heart rate was also observed. Conclusion: Wheelchair propulsion using the handlebased device resulted in lower physical responses and higher mechanical efficiency, suggesting that this novel design may be well suited for indoor use, thereby offering an attractive alternative to pushrim wheelchairs.
... Around 90% of manual wheelchairs users (MWUs) employ a hand-rim propelled wheelchairs (HRW) as primary mode of locomotion for daily living [1]. However, HRW propulsion is a straining and mechanically inefficient mode of transportation. ...
... The abovementioned factors suggest that any improvements in the propulsion mechanism and interfacing, may aid in reducing upper-body strains and complaints, while eventually promoting a physically active lifestyle [1,[13][14][15][16][17]. Apart from handcycling [17], few alternative propulsion mechanisms successfully entered and stayed in the marketplace. ...
... While bi-lever propulsion systems have been experimentally evaluated [1,13,14,18,19], a bi-manually driven single push-pull lever propulsion mechanism (PPLM) has very scarcely been tested on its physiological and biomechanical merit. The only studies that featured a design with a single lever originated in the 1970s and 1980s [15,20,21]. ...
Article
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Background Hand-rim wheelchair propulsion is straining and mechanically inefficient, often leading to upper limb complaints. Previous push–pull lever propulsion mechanisms have shown to perform better or equal in efficiency and physiological strain. Propulsion biomechanics have not been evaluated thus far. A novel push–pull central-lever propulsion mechanism is compared to conventional hand-rim wheelchair propulsion, using both physiological and biomechanical outcomes under low-intensity steady-state conditions on a motor driven treadmill. Methods In this 5 day (distributed over a maximum of 21 days) between-group experiment, 30 able-bodied novices performed 60 min (5 × 3 × 4 min) of practice in either the push–pull central lever wheelchair (n = 15) or the hand-rim wheelchair (n = 15). At the first and final sessions cardiopulmonary strain, propulsion kinematics and force production were determined in both instrumented propulsion mechanisms. Repeated measures ANOVA evaluated between (propulsion mechanism type), within (over practice) and interaction effects. Results Over practice, both groups significantly improved on all outcome measures. After practice the peak forces during the push and pull phase of lever propulsion were considerably lower compared to those in the handrim push phase (42 ± 10 & 46 ± 10 vs 63 ± 21N). Concomitantly, energy expenditure was found to be lower as well (263 ± 45 vs 298 ± 59W), on the other hand gross mechanical efficiency (6.4 ± 1.5 vs 5.9 ± 1.3%), heart-rate (97 ± 10 vs 98 ± 10 bpm) and perceived exertion (9 ± 2 vs 10 ± 1) were not significantly different between modes. Conclusion The current study shows the potential benefits of the newly designed push–pull central-lever propulsion mechanism over regular hand rim wheelchair propulsion. The much lower forces and energy expenditure might help to reduce the strain on the upper extremities and thus prevent the development of overuse injury. This proof of concept in a controlled laboratory experiment warrants continued experimental research in wheelchair-users during daily life.
... HE wheelchair is an important aid for the mobility of physically disabled and injured persons, and the push-rim is the preferred mode of propulsion for a large percentage of wheelchair users even though it is associated with the least efficient pattern of propulsion [1]. Extensive research has been performed to understand the biomechanical and physiological factors of wheelchair propulsion [2]. ...
... Upper-extremity pain and injury represent a major problem for wheelchair dependent persons as use of the arms is essential for independent mobility and participation in the community. Alternative modes for wheelchair propulsion, such as lever-propelled, hub-crank and arm-crank devices, use a continuous cyclic movement for propulsion, which offers higher efficiency compared to conventional PRP [1,4]. ...
... The hub-crank mechanism uses cranks that are directly mounted on the hubs of the rear wheels and so allow a continuous motion of the hands. Gross mechanical efficiency (GME) is higher than in PRP, but the position of the hands combined with difficulties in steering and braking make this device impractical [1]. Arm-cranking devices use a continuous cyclic motion for propulsion [1,4]. ...
Article
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Push-rim wheelchair propulsion frequently causes severe upper limb injuries in people relying on the wheelchair for ambulation. To address this problem, we developed a novel handle-based wheelchair propulsion method that follows a cyclic motion within ergonomic joint ranges of motion. The aim of this study was to measure hand propulsion forces, joint excursions and net joint torques for this novel propulsion device and to compare its performance against traditional push-rim wheelchair propulsion. We hypothesized that under similar conditions, joint excursions of this novel handle-based device will remain within their ergonomic range and that the effectiveness of the propulsion forces will be higher, leading to lower average propulsion forces compared to push-rim propulsion and reducing the risk of injury. Eight paraplegic subjects propelled the new device at two different loads on a custom-made wheelchair-based test rig. Video motion capture and force sensors were used to monitor shoulder and wrist joint kinematics and kinetics. Shoulder and wrist loads were calculated using a modified upper-extremity Wheelchair Propulsion Model available in OpenSim. The results show that with this novel propulsion device joint excursions are within their recommended ergonomic ranges, resulting in a reduced range of motion of up to 30% at the shoulder and up to 80% at the wrist, while average resultant peak forces were reduced by up to 20% compared to push-rim propulsion. Furthermore, the lower net torques at both the shoulder and wrist demonstrate the potential of this novel propulsion system to reduce the risk of upper-extremity injuries.
... Hand rim wheelchair propulsion is a necessity in daily activities of many individuals with spinal cord injury or other lower limb impairments [22]. Mobility restoration, activities of daily living and sports require several different propulsion speeds. ...
... It is safer due to the fact that hands are in constant contact with levers, far from turning wheels. It was proved that lever propulsion mechanism provides a more effective transfer of power by increasing mechanical advantage and placing the arms in a more natural segmental position and orientation [8], [21], [22]. Moreover, leveractivated wheelchair propulsion has been described as more efficient and less physically straining than hand rim wheelchair propulsion. ...
... Moreover, leveractivated wheelchair propulsion has been described as more efficient and less physically straining than hand rim wheelchair propulsion. Energy expenditure studies [5], [12], [22] have shown that it is physiologically efficient and reduces energy consumption, compared to hand rim wheelchair propulsion. Apart from evaluating kinematic and kinetic parameters of upper limbs, muscle activity assessment is one of the most precise methods used when comparing the ergonomics of wheelchair propulsion. ...
Article
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Purpose: The aim of this study was to compare the activity of upper limb muscles during hand rim wheelchair propulsion and lever wheelchair propulsion at two different velocity levels. Methods: Twenty male volunteers with physical impairments participated in this study. Their task was to push a lever wheelchair and a hand rim wheelchair on a mechanical wheelchair treadmill for 4 minutes at a speed of 3.5 km/h and 4.5 km/h in a flat race setting (conditions of moving over flat terrain). During these trials, activity of eight muscles of upper limbs were examined using surface electromyography. Results: The range of motion in the elbow joint was significantly higher in lever wheelchair propulsion (59.8 ± 2.43°) than in hand rim wheelchair propulsion (43.9 ± 0.26°). Such values of kinematics resulted in a different activity of muscles. All the muscles were more active during lever wheelchair propulsion at both velocity levels. The only exceptions were extensor and flexor carpi muscles which were more active during hand rim wheelchair propulsion due to the specificity of a grip. In turn, the examined change in the velocity (by 1 km/h) while moving over flat terrain also caused a different EMG timing of muscle activation depending on the type of propulsion. Conclusions: Lever wheelchair propulsion seems to be a good alternative to hand rim wheelchair propulsion owing to a different movement technique and a different EMG timing of muscle activity. Therefore, we believe that lever wheelchair propulsion should serve as supplement to traditional propulsion.
... Indoors, this wheelchair type is very useful, due to its maneuverability. However, hand-rim propulsion has a low mechanical efficiency and can often contribute to overuse injuries around the shoulder joint [1,2]. To increase the mobility in this group, alternative modes of wheelchair propulsion have been investigated and the handcycle has become an important assistive device [2,3]. ...
... However, hand-rim propulsion has a low mechanical efficiency and can often contribute to overuse injuries around the shoulder joint [1,2]. To increase the mobility in this group, alternative modes of wheelchair propulsion have been investigated and the handcycle has become an important assistive device [2,3]. ...
... Although the differences between cadence settings are not significant in the post-hoc tests, our results are in agreement with the literature [2,8,27,28], in that a cadence higher than 50±60 rpm is less mechanically efficient. It takes less energy to propel the handcycle with a lower hand's velocity, as indicated by a lower HR and VO 2 at 52 rpm (G3). ...
... Approximately 5.5 million (2.3 %) of adults in the united states used a wheelchair for their daily mobility in 2014 (Taylor, 2018). It is estimated that over 90 % of wheelchair users use hand-rim propelled manual wheelchairs (Kaye et al., 2000). ...
... Lever and crank propelled wheelchairs allow a much more natural position of the hands and shoulders than a hand-rim propulsion mechanism during wheelchair mobility. Therefore, they may be less straining and have higher mechanical efficiency compared with hand-rim propulsion, particularly for outdoor use (Lui et al., 2013;van der Woude et al., 2001b;Van der Woude et al., 2006). However, the use of these alternative manual wheelchairs is limited in comparison with standard manual wheelchairs due to disadvantages such as weight, size, and limited maneuverability, as well as being less friendly for transferring (Kloosterman et al., 2013;Van der Woude et al., 2006). ...
Article
Geared manual wheelchair wheels, a recently developed alternative propulsion mechanism, have the potential to alleviate the high upper extremity demands required for wheelchair propulsion and help decrease the risk of secondary injuries in manual wheelchair users. The objective of this study was to investigate the effects of using geared manual wheelchairs on hand-rim biomechanics of wheelchair propulsion in individuals with spinal cord injury (SCI). Seven manual wheelchair users with SCI propelled their wheelchairs equipped with geared wheels over tile, carpet, and up a ramp in low gear (gear ratio 1.5:1) and standard gear (gear ratio 1:1) conditions. Hand-rim kinetics and stroke cycle characteristics were measured using a custom instrumented geared wheel. Using the geared wheels in the low gear condition, propulsion speed (P=0.013), peak resultant force (P=0.005), peak propulsive moment (P<0.006), and peak rate of rise of the resultant force (P=0.035) decreased significantly in comparison with the standard gear condition. The significant increase in the number of stroke cycles when normalized to distance (P=0.004) and decrease in the normalized integrated moment (P=0.030) indicated that although a higher number of stroke cycles are required for travelling a given distance in the low gear than the standard gear condition, the low gear condition might be less demanding for the upper extremity. These results suggest that geared wheels could be a useful technology for manual wheelchair users to independently accomplish strenuous propulsion tasks including mobility on carpeted floors and ramp ascension, while reducing the risk factors contributing to the incidence of secondary upper extremity injuries.
... The use of AB participants may be acceptable as a starting point, but testing under the most ecologically valid conditions, that is, using participants with a disability, is recommended. 77,78 Handcycling experience or skill level, regularly denoted as the number of years of participation, has been associated with higher aerobic capacity and ME. 21,28 During submaximal, steady-state handcycling, ME is defined as the ratio between external PO and the total energy cost, which is calculated from the VO 2 , RER, and a standard conversion table. ...
... Participants classified in the H1 and H2 classes have lower VO 2peak , PO peak , and HR peak, than H3-5 handcyclists, due to impaired cardiovascular, respiratory, and neuromuscular function. 29,77 For example, impaired triceps and grip function affects cycle kinetics and potentially affects upper limb kinematics and muscle activity. 91 As such, even within a handcycling cohort, athletes with full arm function (H3-5) are likely to respond more homogenously, demonstrated by their similar cycle force profiles, 91 than a group also including H1-2 athletes. ...
Article
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Handcycling is a mode of mobility, and sport format within Para-cycling, for those with a lower limb impairment. The exercise modality has been researched extensively in the rehabilitation setting. However, there is an emerging body of evidence detailing the physiological responses to handcycling in the competitive sport domain. Competitive handcyclists utilise equipment that is vastly disparate to that used for rehabilitation or recreation. Furthermore, the transferability of findings from early handcycling research to current international athletes regarding physiological profiles is severely limited. This narrative review aims to map the landscape within handcycling research and document the growing interest at the elite end of the exercise spectrum. From 58 experimental/case studies and four doctoral theses we: provide accounts of the aerobic capacity of handcyclists and the influence training status plays; present research regarding the physiological responses to handcycling performance, including tests of sprint performance; discuss the finite information on handcyclists’ training habits and efficacy of bespoke interventions. Furthermore, given the wide variety of protocols employed and participants recruited previously, we present considerations for the interpretation of existing research and recommendations for future work, all with a focus on competitive sport. The majority of studies (n=21) reported aerobic capacity, detailing peak rates of oxygen uptake and power output, with values >3.0 L∙min-1 and 240 W shown in trained, male H3-H4 classification athletes. Knowledge, though, is lacking for other classifications and female athletes. Similarly, little research is available concerning sprint performance with only one from eight studies recruiting athletes with an impairment.
... If the upper body can still be physically active, the manual handrim wheelchair is the most common form of wheeled mobility [1][2][3]. An alternative way of outdoor wheeled mobility to cover longer distances is the handcycle [4][5][6]. Handcycles exist in a number of different forms, for example as an attachable unit to a wheelchair (with/without power assist) or as a fixed-frame tricycle with a number of different body positions and often with a range of gear settings (Figure 1). The size of the tricycle or any other handcycle makes functional handcycling most suitable as an outdoor activity, obviously including indoor race tracks and/ or gymnasia. ...
... Consequently, the risk of overuse injuries associated with the repetitive nature of propulsion is lower in daily outdoor handcycle use compared to outdoor wheelchair use. In addition, handcycling has a mechanical efficiency of 10-17% at submaximal level, while this is only 5-10% during handrim wheelchair propulsion [4,55,60,61]. Therefore, a switch to outdoor handcycling could be beneficial to reduce physiological and biomechanical strain of ambulation. ...
Article
Full-text available
Aim: In this narrative review the potential and importance of handcycling are evaluated. Four conceptual models form the framework for this review; (1) the International Classification of Functioning, Disability and Health; (2) the Stress-Strain-Capacity model; (3) the Human-Activity-Assistive Technology model; and (4) the power balance model for cyclic exercise. Methods: Based on international handcycle experience in (scientific) research and practice, evidencebased benefits of handcycling and optimization of handcycle settings are presented and discussed for rehabilitation, daily life and recreational sports. Results: As the load can be distributed over the full 360 degrees cycle in handcycling, peak stresses in the shoulder joint and upper body muscles reduce. Moreover, by handcycling regularly, the physical capacity can be improved. The potential of handcycling as an exercise mode for a healthy lifestyle should be recognized and advocated much more widely in rehabilitation and adapted sports practice. The interface between handcycle and its user should be optimized by choosing a suitable person-specific handcycle, but mainly by optimizing the handcycle dimensions to one’s needs and desires. These dimensions can influence efficient handcycle use and potentially improve both endurance and speed of handcycling. Conclusion: To optimize performance in rehabilitation, daily life and recreational sports, continued and more systematic research is required. Full article available at: https://www.tandfonline.com/doi/full/10.1080/09638288.2020.1815872
... An active lifestyle in users of handrim-wheelchairs would always be in a fragile balance to upper extremity loading. Here the handcycle is the preferred alternative mode of locomotion [100][101][102], being more energy-efficient and less mechanically loading for the shoulders due to the 360 fully active cycle with both flexors and extensors being involved. As a consequence higher speeds and/or distances can be travelled [103,104]. ...
... The measurements are focused on physical and mental capacity, and wellbeing outcomes [110][111][112][113]. Handcycling is assumed to benefit both the shoulder health and the cardio-metabolic condition and beyond that is fun as a sport or recreation outdoor. Attach-unit bikes provide an alternative model for commuting, but neither of them could enter shops, housing, or other public buildings [100]. The HandbikeBattle may be seen as a first stepping stone towards a model for life-long rehabilitation care for persons with a spinal cord injury, as suggested by Stuart et al. for stroke patients [114]. ...
Article
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Background Human movement, rehabilitation, and allied sciences have embraced their ambitions within the cycle of “RehabMove” congresses over the past 30 years. This combination of disciplines and collaborations in the Netherlands has tried to provide answers to questions in the fields of rehabilitation and adapted sports, while simultaneously generating new questions and challenges. These research questions help us to further deepen our understanding of (impaired) human movement and functioning, with and without supportive technologies, and stress the importance of continued multidisciplinary (inter)national collaboration. Methods This position stand provides answers that were conceived by the authors in a creative process underlining the preparation of the 6th RehabMove Congress. Results The take-home message of the RehabMove2018 Congress is a plea for continued multidisciplinary research in the fields of rehabilitation and adapted sports. This should be aimed at more individualized notions of human functioning, practice, and training, but also of performance, improved supportive technology, and appropriate “human and technology asset management” at both individual and organization levels and over the lifespan. Conclusions With this, we anticipate to support the development of rehabilitation sciences and technology and to stimulate the use of rehabilitation notions in general health care. We also hope to help ensure a stronger embodiment of preventive and lifestyle medicine in rehabilitation practice. Indeed, general health care and rehabilitation practice require a healthy and active lifestyle management and research agenda in the context of primary, secondary, and tertiary prevention. • IMPLICATIONS FOR REHABILITATION • Continued multidisciplinary (international) collaboration will stimulate the development of rehabilitation and human movement sciences. • Notions from “human and technology asset management and ergonomics” are fundamental to rehabilitation practice and research. • The rehabilitation concept will further merge into general health care and the quality there-off.
... The gear ratio of the HBP mechanism to the wheel is set as 2:1. The lower gear ratio was set for the HBP mechanism because the gear ratio of 1:1 will need greater exertion of force to the handle while the hand velocity and the muscle contraction drop and this may lead to fatigue (Van Der Woude et al., 2001). Also increasing the gear ratio may decrease the mechanical efficiency of the propulsion (Faupin, 2008). ...
... Hence the muscle activities observed in this study will be higher compared to values collected from bilateral propulsion. As the subjects in this study had very good trunk control and stability we assume that muscle activity of the shoulder muscles is not significantly influenced by the unilateral propulsion (Van Der Woude et al., 2001). ...
Article
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Approximately ninety percent of the wheelchair users worldwide prefer the conventional push rim modeof propulsion for daily mobility and rehabilitation. Even though push-rim wheelchairs help to promote ahealthy life style, the high muscular demand and the non-continuous push motions can lead to seriousupper extremity injuries. In this study, muscle EMG data of ten healthy subjects were recorded for anewly introduced handle based propulsion mechanism (HBP) and compared to conventional push-rimpropulsion at two workloads, 25 W and 35 W respectively. The results for the mean peak muscle activa-tions at both workloads demonstrate that push-rim propulsion leads to higher peak muscle activity com-pared to HBP at a similar wheelchair forward velocity of 1.11 m/s. The generation of these high peakmuscle activations with increasing loads in push-rim propulsion over time can lead to overuse injuries.Overall, the use of the HBP mechanism is less straining to the muscles and may reduce fatigue during pro-longed propulsion
... Maksymalne położenie dłoni w pozycji początkowej i końcowej oznaczane są jako początkowe i końcowe punkty aplikacji siły PFAS i PFAE [5]. Całkowity kąt obrotu ciągu ϕc zapisać można jako sumę kąta początkowego i końcowego (13). (13) Rys. 5. Schemat obrazujący kąty -φp, φk , oraz punkty początkowe PFAS i końcowe PFAE położenia dłoni Przyjmując że wartości kątów dla napędu dźwigniowego oznaczane będą za pomocą przypisu górnego -ϕp * , ϕk * i ϕc * zapisać można nierówności, które porównują napęd dźwigniowy z ciągowy pod względem kąta obrotu ciągów. ...
... Całkowity kąt obrotu ciągu ϕc zapisać można jako sumę kąta początkowego i końcowego (13). (13) Rys. 5. Schemat obrazujący kąty -φp, φk , oraz punkty początkowe PFAS i końcowe PFAE położenia dłoni Przyjmując że wartości kątów dla napędu dźwigniowego oznaczane będą za pomocą przypisu górnego -ϕp * , ϕk * i ϕc * zapisać można nierówności, które porównują napęd dźwigniowy z ciągowy pod względem kąta obrotu ciągów. Ze względu na krótsze ramie obrotu ciągów względem dźwigni całkowity kąt obrotu przyjmuje największe wartości dla napędu ciągowego ϕc> ϕc * . ...
Article
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W artykule przeanalizowano dynamiczne aspekty napędzania wózka inwalidzkiego wyposażonego w ręczny napęd. Skupiono się zarówno na dynamice całego układu antropotechnicznego jak i na dynamice ciała człowieka. Ponad to na podstawie uzyskanych konkluzji zaproponowano dwa alternatywne rozwiązania techniczne ręcznych napędów wózków inwalidzkich. [PL] The article analyzes the dynamic aspects of driving a wheelchair equipped with a manual drive. The focus was both on the dynamics of the entire anthropotechnical system as well as on the dynamics of the human body. Moreover, based on the obtained conclusions, two alternative technical solutions for manual wheelchair drives have been proposed. [EN]
... This is not surprising since handcycling is a relatively easy mode to cover large distances at a high speed compared to handrim wheelchair propulsion [1]. Benefits of handcycling include its higher efficiency and lower strain compared to wheelchair propulsion, possibly reducing the risk of upper body overuse injuries [2][3][4]. Moreover, it has been shown that handcycling can be a good way to improve physical capacity in, for example, individuals with a spinal cord injury (SCI) already early in rehabilitation [5]. ...
... Above mentioned results are predominantly based on studies that focused on wheelchair capacity, which is different from handcycling, as demonstrated by the lower submaximal strain and higher peak power output (POpeak) during handcycling [3,4]. Next to wheelchair ergometry, asynchronous arm ergometry is studied in individuals with SCI [15][16][17][18]. ...
Article
Purpose: To develop and validate predictive models for peak power output to provide guidelines for individualized handcycling graded exercise test protocols for people with spinal cord injury (SCI); and to define reference values. Materials and methods: Power output was measured in 128 handcyclists with SCI during a synchronous handcycling exercise test. Eighty percent of the data was used to develop four linear regression models: two theoretical and two statistical models with peak power output (in W and W/kg) as dependent variable. The other 20% of the data was used to determine agreement between predicted versus measured power output. Reference values were based on percentiles for the whole group. Results: Lesion level, handcycling training hours and sex or body mass index were significant determinants of peak power output. Theoretical models (R² = 42%) were superior to statistical models (R²=39% for power output in W, R² = 30% for power output in W/kg). The intraclass correlation coefficients varied between 0.35 and 0.60, depending on the model. Absolute agreement was low. Conclusions: Both models and reference values provide insight in physical capacity of people with SCI in handcycling. However, due to the large part of unexplained variance and low absolute agreement, they should be used with caution. • Implications for rehabilitation • Individualization of the graded exercise test protocol is very important to attain the true peak physical capacity in individuals with spinal cord injury. • The main determinants to predict peak power output during a handcycling graded exercise test for individuals with a spinal cord injury are lesion level, handcycling training hours and sex or body mass index. • The predictive models for peak power output should be used with caution and should not replace a graded exercise test.
... Manual wheelchairs are widely used in daily life by young, elderly and physically challenged persons, possibly due to spinal cord injury (SCI) or other accidental injuries [1]. Although wheelchairs help in the ambulation and physical rehabilitation of the persons, prolonged use of the manually driven wheelchair frequently leads to injuries especially in the regions of shoulder and wrist [2]. ...
... The joint torques were determined in an inverse dynamic calculation using the Newton-Euler equation (1). The vector represents the unknown values of joint torques, M (q) is the mass matrix, is the vector of Coriolis and centrifugal forces, G (q) represents the gravity. ...
Conference Paper
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Wheelchairs are important for daily mobility and recreation of the elderly and physically challenged individuals. The non-ergonomical propulsion design of wheelchairs frequently causes injuries to the upper extremities, especially in the wrist region. In this study, the joint kinematics and kinetics of the wrist joint was analyzed on subjects propelling a novel handle based wheelchair propulsion unit at 1.2m/s speed (20W and 40W respectively). The joint kinematics and the joint moments of the wrist were determined using a 3D musculoskeletal model. The mean values of joint ranges and torques during propulsion at the mentioned speeds were lower when compared to standard wheelchair propulsion with the push-rim, making the novel propulsion mechanism with its compact design an interesting alternative for wheelchair users that might help to avoid or reduce joint injuries
... Another study regarding a lever wheelchair was carried out by van der Woude, Dallmeijer, Janssen, and Veeger (2001). They determined differences between hand rim wheelchair propulsion and lever wheelchair propulsion and described several advantages of using a lever wheelchair, e.g., a possibility of synchronous and asynchronous propulsion (including one-handed propulsion), and of more efficient and less energy-consuming movement. ...
... They determined differences between hand rim wheelchair propulsion and lever wheelchair propulsion and described several advantages of using a lever wheelchair, e.g., a possibility of synchronous and asynchronous propulsion (including one-handed propulsion), and of more efficient and less energy-consuming movement. However, they noticed that maneuverability and steering in small spaces could be more problematic for lever wheelchair users (van der Woude et al., 2001). Sarraj et al. (2010) surveyed individuals who had used the lever drive prototype wheelchair for two days. ...
Article
Objective. The purpose of this study was to compare aerobic parameters in the multistage field test (MFT) in hand rim wheelchair propulsion and lever wheelchair propulsion. Methods. Twenty-one men performed MFT using two different types of propulsion, i.e., lever and hand rim wheelchair propulsion. The covered distance and physiological variables (oxygen uptake (VO2), minute ventilation (VE), carbon dioxide output (VCO2), respiratory coefficient (RQ), and heart rate (HR)) were observed. Physiological variables were measured with Cosmed K5 system. Kolmogorov–Smirnov test, t-test, Wilcoxon test and effect sizes (ESs) were used to assess differences. Statistical significance was set at p < .05. Results. A significantly longer distance was observed in lever wheelchair propulsion than in hand rim wheelchair propulsion (1,194 and 649 m, respectively). VO2max and RQ were higher in hand rim wheelchair propulsion. All physiological variables for the last (fifth) level of the test in hand rim propulsion were significantly higher than in lever wheelchair propulsion. ES was large for each observed difference. Conclusion. The lever wheelchair propulsion movement is less demanding than hand rim wheelchair propulsion and longer distances can be achieved by the user. There is a need to check lever wheelchair propulsion in different types of field tests.
... Fabrication of a working prototype has crucial with local market OEM (original equipment manufacturer) parts available in low cost in order to demonstrate the unique features and suitable for smooth and rough terrains. Fabrication of prototype has done using AISI 1018 which has an optimized solution between cost and features [5]. The brake has installed on the end of the lever to facilitate ease of working. ...
... This results in locking of sprocket during forward stroke of levers and free during backward stroke. Where C D =1, ƍ air =0.94kg/m 3 , a= 0.6 m 2 , rider + chair mass = 75 kg and g= 9.81 m/s 2 Road surfaces in developing countries vary from tarmac to gravel to mud to sand, corresponding to rolling friction coefficients, μ roll, ranging from 0.005-0.5 [4,5]. ...
Article
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This paper aims at introducing an innovative "Disabled Utility Chair" (DUC). Traditional wheelchair/tricycle for disabled prove not to be that much comfortable and efficient or dynamically efficient, which must be of prime concern in this regard. Team surveyed various rehabilitation center and asked basic problem by the user basic features such as turning radius, space for goods, comfort conditions for long sitting remain absent. In India, varying torque, speed and gradiability is also required for both easy accessibility and safety of driving person on road. Also for the domestic purposes, small turning radius, enough space for holdings and carrying goods and essentially ergonomically stable and standardized design is required for continuous and long sitting. In this innovative design of leveraged propelled disabled utility chair, steering is controlled by its brakes installed on the levers itself. These levers offer dual advantage of propelling the DUC at different torque at different speeds and improved gradiability. The sophisticated dimensions of disabled utility chair (DUC) and absence of any eccentricity and unrequired space or gap results in great reduction in turning radius. Innovative steering mechanism reduces the turning radius up to 0.94 m which is far less than other wheelchairs. DUC serves both medical as well as regular purposes. The topple angle for the chair is 12 which makes it suitable to drive on high slope as well. The shoe brakes independently on each wheel are provided so that on applying brake any one of the wheel DUC will start turning in the direction of the wheel which has been braked by the user. Although, the general purpose of brakes will accomplished by applying brakes simultaneously. Some experiments are also performed on frames and combined results of them providing an unique solution which has less complicacy to facilitate fabrication at lower price range; for this OEM parts are considered in fabrication. The newly developed frame has virtuous ergonomics which enables user for long sitting hours. It also consists of portable platform on which user can work in desired conditions. Further, the modification will enable DUC for night use by providing a light source, lighter materials for reduction of weight and improvement of frame to make it more compact.
... This type of propulsion may be associated with different arm movement strategies; eventually leading to complex hand trajectories for an efficient work on the handrail [14], [15]. Applying a torque on the wheel actually requires gripping a narrow rotating surface outside the vision field and applying an important force over a very short time (around 0.6 s [16]). Numerous works conclude that such propulsion often leads to microtraumas at the hand, wrists and shoulders level [17]- [19]. ...
... Numerous studies on MWCs with lever propulsion have shown that this system is more efficient and less traumatic [20]- [22]. For instance, the studies carried out in [16] outline that for an estimated equivalent power of 30 W, the raw mechanical yield of a lever propulsion is about 12%, significantly higher than that of a classic hand-rim propulsion which lies around 9%. Lever propulsion involves a cyclic movement of the hands in the sagittal plane at the ventral level of the user, hands remaining in the visual field for increased motor control. ...
Article
This paper introduces a new concept of manual wheelchair (MWC), consisting in different modules enabling customizations based on specific pathologies as well as patients’ environment. This wheelchair is as maneuverable as an electric wheelchair while remaining lighter, more convenient and less costly. The module concept allows adaptability aimed at specific uses making it particularly suitable for the elderly. The first modules proposed in our study concern the standing and folding systems. A new unpublished propulsion system, was also designed to facilitate movement by reducing the physical effort required. These functional aspects are supported by numerical simulations of the structure on the one hand and of the patient’s muscular activity required for wheelchair motion on the other hand. In relation with industry the next step of our study is to propose a rapid prototyping for a better optimization.
... Handbike design evolved considerably during the 19th and 20th centuries, with disabled individuals employing asynchronous handcycling for the purpose of transportation. 2 In the early 1980s, a group of enthusiasts in the United States developed the first fixed-frame handbike. The advent of solid frame designs permitted a recumbent, long seat position, with legs outstretched in front of individuals who adopted a synchronous crank configuration. ...
Article
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The aim of this narrative review is to provide insight as to the history, biomechanics, and physiological characteristics of competitive handcycling. Furthermore, based upon the limited evidence available, this paper aims to provide practical training suggestions by which to develop competitive handcycling performance. Handbike configuration, individual physiological characteristics, and training history all play a significant role in determining competitive handcycling performance. Optimal handcycling technique is highly dependent upon handbike configuration. As such, seat positioning, crank height, crank fore-aft position, crank length, and handgrip position must all be individually configured. In regard to physiological determinants, power output at a fixed blood lactate concentration of 4 mmol·L −1 , relative oxygen consumption, peak aerobic power output, relative upper body strength, and maximal anaerobic power output have all been demonstrated to impact upon handcycling performance capabilities. Therefore, it is suggested that that an emphasis be placed upon the development and frequent monitoring of these parameters. Finally, linked to handcycling training, it is suggested that handcyclists should consider adopting a concurrent strength and endurance training approach, based upon a block periodization model that employs a mixture of endurance, threshold, interval, and strength training sessions. Despite our findings, it is clear that several gaps in our scientific knowledge of handcycling remain and that further research is necessary in order to improve our understanding of factors that determine optimal performance of competitive handcyclists. Finally, further longitudinal research is required across all classifications to study the effects of different training programs upon handcycling performance.
... In 2012, it was estimated that about 68% of WMADs users in Canada relied on MWCs for mobility [2]. MWCs can promote a physically active lifestyle [3] and they are known to be more affordable, manoeuvrable and transportable alternatives to power wheelchairs (PWCs) [1]. Despite these positive aspects, long-term use of MWCs can increase the risk of repetitive strain injuries at the wrist and shoulder [4]. ...
Article
Purpose: The study had three main objectives. (1) To investigate the perceived impact of power-assist devices (PADs) on manual wheelchair (MWC) user mobility. (2) To compare perceptions about different types of PADs. (3) To identify preferred features and design characteristics of PADs. Methods: Semi-structured interviews were conducted with community-dwelling MWC users aged 31 years and older, with at least 2.5 years of experience using an MWC independently (n = 16). Data were thematically analysed using an inductive approach. Results: Two main themes related to participants' perceptions about the effects of PAD use were identified: (1) "Expanding my world", which illustrated the perceived benefits of using PADs (e.g., gaining a sense of autonomy and access to new environments, maintaining physical health) and (2) "Falling short", which described challenges with PADs (e.g., safety, reliability and portability issues). Participants also identified strengths and limitations of different types of PADs that were mainly related to specific user-device and device-environment interactions as well as various functional characteristics. Moreover, participants outlined their priorities for future PAD design, including improving controllability, customizability and affordability of these devices. Conclusions: Participants' perceptions about PADs varied across different types of devices and in different contexts. However, PADs were generally perceived as enhancing the capabilities of MWCs. Our findings provide insight into the factors that can be considered when selecting a PAD and can inform the development of future PADs that are better equipped to overcome challenges that MWC users frequently encounter.Implications for RehabilitationPower-assist devices (PADs) for manual wheelchairs (MWCs) have the potential to improve the mobility, community participation and well-being of users.Some of the existing PADs have safety and reliability issues that affect their performance and limit their use by MWC users.The three types of PADs (front-mounted attachments, rear-mounted attachments, powered wheels) offer different types of assistance that can benefit users with various capabilities.
... Note that, about 90% of all these WCs are basic manual push-rim propelled WCs [5,6]. However, most of these WC models lack transferability as well as toilet accessibility, though both being an integral and important part of an individual's life. ...
Article
Purpose Existing wheelchair (WC) designs lack independent toilet accessibility, transferability and indoor manoeuvrability combined in a WC. In this regard, a new WC model is proposed to simultaneously accommodate these distinct and essential features. In this open-source hardware project, the design, analysis and fabrication of a new active commode WC for indoor applications are performed. Materials and method A field survey is conducted to identify the requirements of users so as to choose specific features and design constraints for the WC. In this multipurpose self-propelled model, a temporarily detachable circular section is fitted in the seat position to access the water closet bowl. This hinged portion can be released by gravity before reaching above the closet basin. After the toilet usage, the circular lid can be brought back to the initial seating using a lever mechanism and a spring-loaded lock restrains its downward movement. Thereafter, it can be used as an ordinary WC for indoor applications. Moreover, a small wheel with 22 in diameter and removable hand-rests ensured the transferability between utilities. A CAD model is prepared and numerical simulation is performed to verify the structural stability of the design. Results The optimized model is fabricated using standard manufacturing practices and is delivered to different persons with disabilities to collect user feedback. A systematic skill test is conducted to validate the compliance of the prototype with the user requirements including transferability and independent restroom access. Conclusion The opinions from most of the users are positive which categorically indicated that the proposed design addresses the multipurpose mobility requirements at indoors. • Implications for rehabilitation • The expected outcomes and implications of the current commode WC project with regard to rehabilitation purpose are enlisted below: • In the present scenario, a WC user is heavily dependent on external assistance to access private spaces in general and toilets in particular. The introduced model is capable to address this shortcoming by enabling the user to access the toilet utility directly by self propelling. • Indeed, for a person with locomotor disability, a WC is the natural extension of his physical body. Thereby, this multipurpose commode WC design offers much Independence and greater flexibility to the indoor movements. • The proposed design instils confidence to a WC user to access and transfer between facilities by means of self effort. Consequently it is expected to improve the quality of one’s personal life significantly. • Importantly, this is an open-source project, those who are interested in rehabilitation motives can modify the present design to suit their local requirements especially in resource-limited settings.
... As the right shock compresses and the left relaxes, consequently enabling the seat to level itself, offering greater stability to the wheelchair structure seat. The determination of shocks ought to take into consideration autonomous control of spring rate and damping ratio, consequently enabling the system work even in a stationary situation as well [17]. ...
... A motorized wheelchair will reduce exercise to a level of close to 0%, and thus stimulate the process of de-conditioning even more. 3 ...
Article
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Community participation is a complicated and complex issue with a pparent impediments which effect the person’s ability to involve ingathering in community. Slopes or slants are not only environmental or architectural barriers but they also reveal a biodiversity of public and private spaces or buildings hindering their social integration and participation. A manual wheelchair is the accelerator to increase independence in social and cultural integration by minimizing the barriers. Manual wheelchair not only provides mobility to physical disabled but also improves the general health and quality of life. Many disabled persons live in poor accessible situations or surroundings due to geographical conditions in hilly areas. These hilly terrains are often occupied by snow and curvy roads, posing a great difficulty to persons having limited mobility. Such environmental impediments place additional requirements on the strength and durability of wheelchairs. Keeping in mind all difficulties to these mobility chair, generally will be the provision of an motorized wheelchair. This case study basically emphasized on manual wheelchairs as barrier on hilly sloppy roads rather than on plain levelled wheeled mobility.
... Three main categories of manual propulsion systems can be distinguished from the literature: the classical hand-rim propulsion (Woude et al. 2001), the handcycling (Matthew 2011) and the lever propulsion (Sarraj and Massarelli 2011). Each manual propulsion displays both benefits and limitations. ...
... As the vehicle mechanics of the handcycle originally stem from bicycle technology, the handcycling crank mode was initially asynchronous, i.e. the cranks were mounted with a phase shift of 180 degrees. Over the years, handcycling became more popular and the crank mode switched from asynchronous (Asyn) to synchronous (Syn), in other words to the parallel crank setting seen today [12]. The differences between both crank modes have been subject to research over the years, but to date a proper one-to-one biophysical comparison, combining a biomechanical with a physiological analysis, is lacking. ...
Article
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Background: Originally, the cranks of a handcycle were mounted with a 180° phase shift (asynchronous). However, as handcycling became more popular, the crank mode switched to a parallel mounting (synchronous) over the years. Differences between both modes have been investigated, however, not into great detail for propulsion technique or practice effects. Our aim is to compare both crank modes from a biomechanical and physiological perspective, hence considering force and power production as a cause of physiological outcome measures. This is done within a practice protocol, as it is expected that motor learning takes place in the early stages of handcycling in novices. Methods: Twelve able-bodied male novices volunteered to take part. The experiment consisted of a pre-test, three practice sessions and a post-test, which was subsequently repeated for both crank modes in a counterbalanced manner. In each session the participants handcycled for 3 × 4 minutes on a leveled motorized treadmill at 1.94 m/s. Inbetween sessions were 2 days of rest. 3D forces, handlebar and crank angle were measured on the left hand side. Kinematic markers were placed on the handcycle to monitor the movement on the treadmill. Lastly, breath-by-breath spirometry combined with heart-rate were continuously measured. The effects of crank mode and practice-based learning were analyzed using a two way repeated measures ANOVA, with synchronous vs asynchronous and pre-test vs post-test as within-subject factors. Results: In the pre-test, asynchronous handcycling was less efficient than synchronous handcycling in terms of physiological strain, force production and timing. At the post-test, the metabolic costs were comparable for both modes. The force production was, also after practice, more efficient in the synchronous mode. External power production, crank rotation velocity and the distance travelled back and forwards on the treadmill suggest that asynchronous handcycling is more constant throughout the cycle. Conclusions: As the metabolic costs were reduced in the asynchronous mode, we would advise to include a practice period, when comparing both modes in scientific experiments. For handcycle users, we would currently advise a synchronous set-up for daily use, as the force production is more effective in the synchronous mode, even after practice.
... The current study will primarily address handrim wheelchair propulsion and the measurement thereof because it is the most prominent form of manually wheeled mobility in scientific literature. However, notions discussed below are equally valid for other wheelchair propulsion mechanisms (e.g., levers, cranks 41 ). ...
... Increasing popularity as Paralympic discipline inspired lighter and more aerodynamic handbikes [9]. Despite its increasing recognition, knowledge about the bioenergetics and biomechanics of athletes riding race handbikes in ecological conditions is scarce. ...
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Background: A study aimed at comparing bioenergetics and biomechanical parameters between athletes with tetraplegia and paraplegia riding race handbikes at submaximal speeds in ecological conditions. Methods: Five athletes with tetraplegia (C6-T1, 43 ± 6 yrs, 63 ± 14 kg) and 12 athletes with paraplegia (T4-S5, 44 ± 7 yrs, 72 ± 12 kg) rode their handbikes at submaximal speeds under metabolic measurements. A deceleration method (coasting down) was applied to calculate the rolling resistance and frontal picture of each participant was taken to calculate air resistance. The net overall Mechanical Efficiency (Eff) was calculated by dividing external mechanical work to the corresponding Metabolic Power. Results: Athletes with tetraplegia reached a lower aerobic speed (4.7 ± 0.6 m s-1 vs. 7.1 ± 0.9 m s-1, P = 0.001) and Mechanical Power (54 ± 15 W vs. 111 ± 25 W, P = 0.001) compared with athletes with paraplegia. The metabolic cost was around 1 J kg-1 m-1 for both groups. The Eff values (17 ± 2% vs. 19 ± 3%, P = 0.262) suggested that the handbike is an efficient assisted locomotion device. Conclusion: Handbikers with tetraplegia showed lower aerobic performances but a similar metabolic cost compared with handbikers with paraplegia at submaximal speeds in ecological conditions.
... The hand rim system is the world's most used propulsive method in everyday lives thanks to its extreme firmness and maneuverability [1] to provide people with disabilities independent locomotion [2]. Nevertheless, this system shows various issues [3]. ...
Article
Aim: This paper presents the study, design and prototyping of a manual wheelchair, named handwheelchair.q, with an innovative propulsion's system. The research is based on a novel system of propulsion that is more efficient and ergonomic than the hand rim one. The main goal of the designed prototype is to facilitate the mobility and to extend the reachable areas while reducing the required time. Methods: The propulsion is realised through a rowing-inspired gesture. Results: This gesture avoids the damages caused on shoulders by the compressive force of the hand rim and lever systems. Conclusion: The prototyping allowed the analysis of the project parameters and their influence on the kinematic characteristics of the prototype and the biomechanical characteristics of the gesture. The same propulsion's system can be adopted on wheelchairs devoted to sport activities, representing the starting point for a future prototype of racing wheelchairs. In this regard, the wheelchair's braking system has been redesigned in order to improve efficiency and safety. • Implication for rehabilitation • The use of the Handwheelchair.q may have positive impacts in terms of the quality of life, in order to reduce the shoulder pain caused by the handrim and lever system. • In addition, it can be a good tool for rehabilitation because the activity can be performed outdoor.
... Many studies [1][2][3] assert that wheelchair users suffer from upper limb injuries more frequently than the rest of the population. Since the handrim is the world's most used manual propulsion system [4], the main causes of upper limb pain depend on the motion of the handrim system that is a pushing movement. Outdoor and indoor motor activities are extremely important for the well-being of everyone. ...
Article
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In this paper, an innovative system of propulsion inspired by a rowing gesture for manual wheelchairs is shown. The innovative system of propulsion, named Handwheelchair.q, can be applied to wheelchairs employed in everyday life and to sports wheelchairs for speed races, such as Handbike and Wheelchair racing. The general features of the innovative system of propulsion and the functional designs of the different solutions are described in detail. In addition, the design of the mechanism for the transmission of motion, employed in a second prototype, Handwheelchair.q02, is presented and analysed. Finally, the dynamic model of the Handwheelchair.q has been developed in order to obtain important results for the executive design of Handwheelchair.q.
... Paciorek e Jones (2001), ao avaliarem atletas do atletismo paralímpico, notaram que em provas em que era utilizada cadeira de rodas, os atletas que usavam equipamentos mais sofisticados obtiveram melhores resultados, demonstrando que o resultado pode ter sido em função do avanço da tecnologia nas cadeiras de rodas. Van der Woude et al. (2001), ao avaliarem o deslocamento na cadeira de rodas esportiva, concluem em seus estudos que: a velocidade da cadeira de rodas é alterada em decorrência do tamanho do aro da cadeira, reduzindo significativamente o tempo de impulso, proporcionando melhor eficiência na propulsão dos atletas. ...
Article
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O esporte paralímpico brasileiro vive um momento de destaque esportivo em virtude de suas recentes conquistas: oitavo lugar nos Jogos Paralímpicos do Rio de Janeiro em 2016 e líder por três edições consecutivas dos Jogos Para-Panamericanos (2007, 2011, 2015). A tecnologia esta cada vez mais presente no esporte paralímpico e busca o aprimoramento da performance de atletas de alto rendimento. Neste ensaio com abordagem qualitativa, procuramos através da análise bibliográfica e reflexão teórica, trazer ao leitor um breve conhecimento sobre a tecnologia que vem sendo aplicada no cotidiano de atletas paralímpicos. Consideramos que o conhecimento e o investimento em inovações tecnológicas no esporte paralímpico são consideradas fundamentais para um país que busca se manter entre as principais potências paralímpicas mundiais.
... Initially, the handcycle was based on bicycle technology and had an asynchronous crank mode (asyn). Nowadays, they are all equipped with a synchronous crank mode (syn)( Hettinga et al., 2010;van der Woude, Dallmeijer, Janssen, & Veeger, 2001). The aim of this study was to investigate the effects of gear, imposed resistance and crank mode on the mechanical efficiency and physiological parameters. ...
... Manual wheelchair propulsion has a high prevalence of upper-limb musculoskeletal disorders (MSDs) (Boninger et al., 2005;van der Woude et al., 2001) due to induced joint loads, postures close to the joint limits and task repetitiveness (Apple Jr et al., 1996). One way to prevent MSDs during wheelchair propulsion, transfer movements and daily-life or working activities (Jacquier-Bret et al., 2012;Tanaka et al., 2005) is to improve the wheelchair design according to the morphology and physical capabilities of the user (Munaretto et al., 2012(Munaretto et al., , 2013. ...
Article
The aim of this work was to assess handrim wheelchair propulsion effectiveness, related to the applied forces on the handrim, through the force feasible set. For a given posture of the upper-limb, it represents the set of isometric forces that can be applied on the handrim in any direction. The force feasible set was predicted from a musculoskeletal model of the upper-limb and trunk (10 degrees of freedom and 56 muscles). The aim of the first part of the study was to compare the force feasible set prediction and the force currently applied on the handrim. The second part proposes the creation of a new index called "Musculoskeletal Postural Performance Index" (MPPI) derived from the force feasible set and its comparison with the Mechanical Efficiency Force (MEF). These comparisons were conducted at 60, 80, 100, 120 and 140% of the Freely Chosen Frequency at submaximal and maximal conditions on 5 different phases of the push phase. The values of the MPPI were significantly correlated with those of the MEF. During the course of the push phase, the orientation of the force feasible set main axis approached that of the measured force and the force effectiveness evaluated through the MPPI increased.
Article
Different mechanisms of force transmission have been developed for the movement of wheelchairs, from the standard pushrim propulsion to the handbike. Contributing to this repertoire, we recently developed a system of propulsion based on a pulley-cable mechanism, the Handwheelchair.Q. In contrast to other propulsion systems, the Handwheelchair.Q requires users to extend the shoulders and flex the elbows to move the wheelchair forward, mimicking the rowing gesture. Whether however our proposed, propulsion system imposes a similar degree of shoulder muscles excitation with respect to the conventional, pushrim system is yet to be addressed. In this study we therefore assess whether the Handwheelchair.Q demands a similar degree and timing of muscle excitation with respect to the pushrim wheelchair, for a given travelled distance. We address this issue by sampling the angular speed of the two wheels and the surface EMGs from ten, shoulder muscles, while seven subjects use the two propulsion systems at constantly low and high speeds, one at a time. As expected, results revealed opposite muscle groups were excited when comparing the two mechanisms for wheelchair propulsion. ANOVA statistics indicated the amplitude of EMGs was greater for shoulder flexors and elbow extensors during the drive phase of pushrim propulsion, with the opposite being observed for the Handwheelchair.Q. Interestingly, from the angular speed we observed a significantly greater average displacement was achieved with the Handwheelchair.Q. Our results support therefore the notion that, with respect to pushrim propulsion, subjects were able to move faster without overloading the shoulder muscle with the Handwheelchair.Q.
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Introduction In wheelchair rugby, players use either an offensive or defensive wheelchair depending on their field position and level of impairment. Performance of wheelchair rugby players is related to several parameters, however it is currently unclear if differences in performance are related to wheelchair type or no: the effect of wheelchair type on performance variables has not been evaluated. The aim of this study was to compare offensive and defensive wheelchairs on performance variables during a straight-line sprint. Methods Thirteen able-bodied people performed two 20 m sprint trials: one with an offensive and one with a defensive wheelchair. Data were collected using inertial measurement units fixed on the wheelchair. Peak wheelchair velocities and left-right asymmetries in peak wheel velocities were measured during the acceleration and constant peak velocity phases. Sprint time, cycle frequency, and mean and maximum velocity were calculated over the entire sprint. Results The peak velocities of the first 2 pushes (acceleration phase) were significantly higher with the defensive than the offensive wheelchair ( p < 0.04 and p < 0.02). Mean and maximum sprint velocity were significantly higher ( p < 0.03 and p < 0.04, respectively) with the defensive wheelchair. Cycle frequency and asymmetry did not differ between wheelchairs. Conclusion Performance was higher with the defensive than the offensive wheelchair, suggesting that the frequent finding that the higher performance of offensive as compared to defensive players is not related to the use of an offensive wheelchair.
Article
The aim of this review is to investigate existing and developing technologies assessing metrics of manual wheelchair propulsion. A scoping review of scientific and grey literature was performed. Five databases were searched - Medline, Scopus, Cinahl, Institute of Electrical and Electronics Engineers (IEEE), and Embase. The 38 retained articles identified 27 devices categorized into accelerometers, wheelchair-mounted devices, instrumented wheels, and wearables. The devices included in this review can be used by manual wheelchair users to monitor propulsion effort and activity goals, by clinicians to assess rehabilitation programs, and to inform and guide future research. The findings support a need for further research into the development of custom algorithms for manual wheelchair user populations as well as further validation in broader free-living environments with equitable participant populations.
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For people with physical disabilities, manual wheelchairs are essential enablers of mobility, participation in society, and a healthy lifestyle. Their most general design offers great flexibility and direct feedback, but has been described to be inefficient and demands good coordination of the upper extremities while critically influencing users’ actions. Multiple research groups have used Inertial Measurement Units (IMUs) to quantify physical activities in wheelchairs arguing that knowledge over behavioural patterns in manual wheelchair usage can guide technological development and improved designs. The present study investigates turning behaviour among fulltime wheelchair users, laying the foundation of the development of novel steering systems that allow directing kinetic energy by means other than braking. Three wearable sensors were installed on the wheelchairs of 14 individuals for tracking movement over an entire week. During detected “moving windows”, phases where the velocities of the two rear wheels differed by more than 0.05 m/s were considered as turns. Kinematic characteristics for both turns-on-the-spot as well as for moving turns were then derived from the previously reconstructed wheeled path. For the grand total of 334 km of recorded wheelchair movement, a turn was detected every 3.6 m, which equates to about 900 turns per day on average and shows that changing and adjusting direction is fundamental in wheelchair practice. For moving turns, a median turning radius of 1.09 m and a median turning angle of 39° were found. With a median of 89°, typical turning angles were considerably larger for turns-on-the-spot, which accounted for roughly a quarter of the recognised turns and often started from a standstill. These results suggest that a frequent pattern in daily wheelchair usage is to initiate movement with an orienting turn-on-the-spot, and cover distances with short, straightforward sections while adjusting direction in small and tight moving turns. As large bends often require simultaneous pushing and breaking, this is, perhaps, the result of users intuitively optimising energy efficiency, but more research is needed to understand how the design of the assistive devices implicitly directs users’ movement.
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A number of people on the globe have been encountering difficulties in functioning and have almost no suppleness, have been using the wheelchair and other assistive equipment for their assistance for a very long time. It has assisted them in traveling faster and independently at all places possible. With the advent of electrically assisted systems, there are several other functions that the wheelchair can provide to the user namely, climbing the stairs with the help of a stair-climbing wheelchair or standing upright with the help of the motorized wheelchair. However, wheelchairs for a specific group of people viz. sportsmen, require a thoroughly different kind of design to cater to their needs. It is essential to effectuate a study, which is a cause-and-effect analysis and has an ideation process followed by the feasibility analysis that can help us design parts that can be incorporated in the wheelchair. This paper discusses the feasibility of the wheelchair concerning the components already present in a wheelchair. Thus, these components can be appended or modified based on various factors namely inefficient product design or the environmental facts and the parameters which insinuate us about the extent of modifications are repetition, force, duration, and body posture. These components have been designed and Topologically Optimized to reduce the weight and material requirements in the product and to allow users to reach a particular point swiftly and comfortably. This study can help in designing products considering the human factors and also considering the optimization of the products. Thus, this study is an endeavor to consider all the design and engineering factors that can be used to design an efficient and safe product for the people in the scope of the study.
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Background: Hand-rim wheelchair propulsion is straining and mechanically inefficient, often leading to upper limb complaints. Previous push-pull lever propulsion mechanisms have shown to perform better or equal in efficiency and physiological strain. Propulsion biomechanics have not been evaluated thus far. A novel push-pull central-lever propulsion mechanism is compared to conventional hand-rim wheelchair propulsion, using both physiological and biomechanical outcomes under low-intensity steady-state conditions on a motor driven treadmill. Methods: In this 5-day (distributed over a maximum of 21 days) between-group experiment, 30 able-bodied novices performed 60 minutes (5x3x4 min) of practice in either the push-pull central lever wheelchair (n=15) or the hand-rim wheelchair (n=15). At the first and final sessions cardiopulmonary strain, propulsion kinematics and force production were determined in both instrumented propulsion mechanisms. Repeated measures ANOVA evaluated between (propulsion mechanism type), within (over practice) and interaction effects. Results: Over practice, both groups significantly improved on all outcome measures. After practice the peak forces during the push and pull phase of lever propulsion were considerably lower compared to those in the handrim push phase (42±10 & 46±10 vs 63±21 N). Concomitantly, energy expenditure was found to be lower as well (263±45 vs 298±59 W), on the other hand gross mechanical efficiency (6.4±1.5 vs 5.9±1.3 %), heart-rate (97±10 vs 98±10 bpm) and perceived exertion (9±2 vs 10±1) were not significantly different between modes. Conclusion: The current study shows the potential benefits of the newly designed push-pull central-lever propulsion mechanism over regular hand rim wheelchair propulsion. The much lower forces and energy expenditure might help to reduce the strain on the upper extremities and thus prevent the development of overuse injury. This proof of concept in a controlled laboratory experiment warrants continued experimental research in wheelchair-users during daily life.
Article
Le but de cette revue de littérature narrative est d’identifier à travers les logiques internes de deux disciplines collectives paralympiques en fauteuil roulant manuel (FRM), l’apport et les limites des principaux dispositifs accessibles aux parasportifs en FRM. Dans le cadre de l’optimisation des performances, les parasportifs sont habituellement testés au laboratoire et/ou sur le terrain. Au laboratoire, les ergomètres à manivelles (EM), les ergomètres à rouleaux pour fauteuil (ERF) et le tapis roulant (TR) sont les plus utilisés. Les EMs ne permettent pas de simuler la gestuelle mécanique de la propulsion du FRM. Les ERFs permettent l’utilisation du FRM personnel mais, neutralisent les forces de résistance des roulettes du FRM. Le TR est plus réaliste mais neutralise les mouvements latéraux du FRM. La technologie embarquée est une évolution des outils de laboratoire. Ainsi, les roues instrumentées (RI) et des centrales inertielles (CI) sont adaptées pour les mesures en situations de terrain. Cependant, la masse des RI limite le comportement du FRM et les CI ne quantifient pas les forces développées sur les mains courantes. La simulation des forces exercées sur les mains courantes à partir des données des CI permettra en perspective le développement de capteurs de force miniaturisés.
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This study evaluated the effect of a low-intensity norm duration synchronous handcycle wheelchair training in untrained able-bodied women. The training group (n = 9) received 7-weeks of low-intensity upper body training in an instrumented handcycle on a motor-driven treadmill (MDT), 3 × 30 min/week at 30% heart rate reserve. The control group (n = 10) received no training. Incremental handcycle tests on the MDT were used to determine peak values for oxygen uptake (VO2peak), power output (POpeak), heart rate (HRpeak), minute ventilation (VEpeak), and respiratory exchange ratio (RERpeak), submaximal values for heart rate (HR), oxygen uptake (VO2) and gross efficiency (GE) before and after training. Local perceived discomfort and rate of perceived exertion (RPE) were also assessed. Training significantly improved POpeak (+20%), HRpeak (+3%), RERpeak (+5%), submaximal GE (+21%), VO2 (−20%), VE (−33%), HR (−12%) and RPE was low (7.1 ± 0.5) (p < 0.05). No effects were found in VO2peak and VEpeak (p > 0.05). Though VO2peak did not improve, low-intensity norm duration handcycling training improved handcycling POpeak, while RPE was low. Also, GE increased, suggesting a motor control improvement. Handcycle training seems to be an appropriate exercise mode to improve physical capacity, and prevent early fatigue and overuse in untrained individuals.
Article
The classification system for handcycling groups athletes into five hierarchical classes, based on how much their impairment affects performance. Athletes in class H5, with the least impairments, compete in a kneeling position, while athletes in classes H1 to H4 compete in a recumbent position. This study investigated the average time-trial velocity of athletes in different classes. A total of 1,807 results from 353 athletes who competed at 20 international competitions (2014-2018) were analyzed. Multilevel regression was performed to analyze differences in average velocities between adjacent pairs of classes, while correcting for gender, age, and event distance. The average velocity of adjacent classes was significantly different (p < .01), with higher classes being faster, except for H4 and H5. However, the effect size of the differences between H3 and H4 was smaller (d = 0.12). Hence, results indicated a need for research in evaluating and developing evidence-based classification in handcycling, yielding a class structure with meaningful performance differences between adjacent classes.
Chapter
In this paper the second prototype of a manual wheelchair, named Handwheelchair.q, is presented. Handwheelchair.q is a manual wheelchair with an innovative system of propulsion inspired by a rowing gesture which has been made possible employing a cable for the motion transmission to a special freewheel connected to the wheel. As a result this gesture generates a traction force on the shoulder instead of the compression force generated by the gesture with the hand-rim system. The main goal of the innovative prototype is to increase the mobility of the disabled people reducing the stress on shoulder employing a conventional manual wheelchair. The functional design and the prototype are presented. Moreover, the methods and the results of preliminary tests are described and discussed. The tests aim to evaluate the traction force and the efficiency of the prototype.
Article
Purpose: The aim of this study was to test the hypotheses that, during manual-wheelchair foot propulsion backward on a soft surface, lowering the seat height increases speed, push frequency and push effectiveness, and decreases perceived difficulty. Materials and methods: In a repeated-measures crossover study, 50 able-bodied participants used one foot to propel a manual wheelchair 5 m backward on a soft surface at 5 seat heights, ranging from 5.08 cm below to about 5.08 cm above lower-leg length, in random order. We recorded Wheelchair Skills Test (WST) capacity scores and used the Wheelchair Propulsion Test (WPT) to calculate speed (m/s), push frequency (cycles/s) and push effectiveness (m/cycle). We also recorded the participants’ perceived difficulty (0–4) and video-recorded each trial. Results: WST capacity scores were reduced at the higher seat heights. Using repeated-measures models (adjusted for age, sex and order), there were negative relationships between seat height and speed (p < 0.0001) and push effectiveness (p < 0.0001). Lowering the seat height by 5.08 cm below lower-leg length corresponded to improvements in speed of 0.097 m/s and in push effectiveness of 0.101 m/cycle. The trend for push frequency was also significant (p = 0.035) but the effect size was smaller. Perceived difficulty increased with seat height (p < 0.0001). The video-recordings provided qualitative kinematic data regarding the seated “gait cycles”. Conclusions: During manual-wheelchair foot propulsion backward on a soft surface, lowering the seat height increases speed and push effectiveness, and decreases perceived difficulty. • IMPLICATIONS FOR REHABILITATION • Backward wheelchair foot propulsion on soft surfaces is affected by seat height. • Speed (m/s) is improved if the seat height is lowered. • Push effectiveness (m/gait cycle) is improved if the seat height is lowered. • Perceived difficulty of propulsion is lower if the seat height is lowered.
Article
Purpose: To test the hypotheses that, during manual wheelchair foot propulsion forward on smooth level surfaces, lowering the seat height increases speed, push frequency and push effectiveness, and decreases perceived difficulty. Materials and methods: In a repeated-measures crossover study, 50 able-bodied participants used one foot to propel a manual wheelchair 10 m on a smooth level surface at 5 seat heights in random order, ranging from 5.08 cm below to about 5.08 cm above lower-leg length. We recorded Wheelchair Skills Test (WST) capacity scores and used the Wheelchair Propulsion Test (WPT) to calculate speed (m/s), push frequency (cycles/s) and push effectiveness (m/cycle). We also recorded the participants’ perceived difficulty (0–4) and video-recorded each trial. Results: WST capacity scores were reduced at the higher seat heights. Using repeated-measures models (adjusted for age, sex and order), there were negative relationships between seat height and speed (p < 0.0001) and push effectiveness (p < 0.0001). Lowering the seat height by 5.08 cm below lower-leg length corresponded to improvements in speed of 0.20 m/s and in push effectiveness of 0.20 m/cycle. The trend for push frequency was also significant (p = 0.003) but the effect size was smaller. Perceived difficulty increased with seat height (p < 0.001). The video-recordings provided qualitative kinematic data regarding the seated “gait cycles”. Conclusions: During manual wheelchair foot propulsion forward on smooth level surfaces, lowering the seat height increases speed and push effectiveness, and decreases perceived difficulty. Clinical Trial Registration Number: NCT03330912. • Implications for Rehabilitation • Generally, wheelchairs used for forward foot propulsion should have a seat height that is 2.54-5.08 cm less than the sitting lower-leg length. • Clinicians should, however, take into consideration other functions that may be adversely affected by lowering the seat height.
Thesis
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Wheelchair propulsion has been reported to be responsible for musculoskeletal pain in the upper extremities. Epidemiological studies have shown a high prevalence of shoulder complaints in paraplegic and quadriplegic spinal cord injured (SCI) people. It has been argued that the high incidence of shoulder complaints in SCI was the result of the weight bearing or propulsion function of the upper extremity in those subjects.This work aimed at proposing an alternative wheelchair propulsion technique based on the levers’ system. The interface prototype-users, the wheelchair skills evaluation, the oxygen uptake and the cardiac frequency are investigated by an objective and subjectivestudies.Our prototype is designed to be an attempt in the field of disabled athletes having some advantages of a non-conventional manual wheelchair propulsion technique, avoiding complications induced by the conventional one.
Article
Objective: To examine the circumstances surrounding the worst fall experienced by full time manual wheelchair users in the past 12 months, the recovery process, and influence on community participation. Design: Mixed-methods. Semi-structured interviews were conducted to understand the circumstances of the worst fall experienced and the recovery process. A quantitative fear of falling assessment and the Community Participation Indicators (CPI) were used to further evaluate the influence of the fall. Results: 20 manual wheelchair users, 47 ± 13 years old (mean ± SD), 55% male. Falls most commonly occurred outside during wheelchair propulsion. Falls were attributed to both intrinsic and extrinsic factors. 70% of participants reported a fear of falling and 80% required assistance to recovery. No significant correlations were found between fall frequency and CPI scores. Participants who needed assistance to recover (56.70 ± 17.66) had lower CPI importance scores compared to participants able to recover independently (88.93 ± 22.13), P= 0.05. Conclusion: Falls are complex and the majority of manual wheelchair users need assistance to recover. Comprehensive programs including education on prevention and post fall management are needed. Results may increase understanding of the circumstances associated with falls and inform the development of evidenced-based clinical practice guidelines.
Article
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A wheelchair user faces many difficulties in their everyday attempts to use ramps, especially those of some length. The present work describes the design and build of a propulsion system for manual wheelchairs for use in ascending or descending long ramps. The design is characterized by a self-locking mechanism that activates automatically to brake the chair when the user stops pushing. The system consists of a planetary transmission with a self-locking capacity coupled to a push rim with which the user moves the system. Different transmission ratios are proposed, adapted to the slope and to the user's physical capacity (measured as the power the user can apply over ample time periods). The design is shown to be viable in terms of resistance, and approximate dimensions are established for the height and width of the propulsion system. Also, a prototype was built in order to test the self-locking system on ramps.
Article
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Push-rim wheelchair propulsion is biomechanically inefficient and physiologically stressful to the musculoskeletal structure of human body. This study focuses to obtain a new, optimized propulsion shape for wheelchair users, which is within the ergonomic ranges of joint motion, thus reducing the probability of injuries. To identify the propulsion movement, forward dynamic optimization was performed on a 3D human musculoskeletal model linked to a handle based propulsion mechanism, having shape and muscle excitations as optimization variables. The optimization resulted in a handle path shape with a circularity ratio of 0.95, and produced a net propulsion power of 34.7 watts for an isokinetic propulsion cycle at 50 rpm. Compared to push-rim propulsion, the compact design of the new propulsion mechanism along with the ergonomically optimized propulsion shape may help to reduce the risk of injuries and thus improve the quality of life for wheelchair users.
Chapter
Although many improvements are still being investigated in the Manual Wheelchair (MWC), a number of criticisms are formulated by a vast majority of daily users. One of the most significant concerns are related to the handrim propulsion system, which is responsible for micro-traumas. The numerical study described in this paper compares two types of propulsion systems: the classical handrim and the lever propulsion. The purpose is to assess the force required for propulsion and the related consequences on involved muscles in the case of a paraplegic patient. Numerical results on lever propulsion demonstrates improved force distribution and reduced muscle activity compared to the classic handrim propulsion. In our view, these results constitute a promising initial step for demonstrating the superiority of lever propulsion from an ergonomics viewpoint.
Article
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The aim of this work is to show an innovative system of propulsion for manual wheelchair, named handwheelchair.q. The idea of the realisation of an alternative manual propulsive system comes from the analysis of the various problematic issues related to the classic ringsystem and the other mobility means. The innovative system of propulsion is inspired by a rowing gesture. This gesture avoids the damages caused on shoulders by the compressive force of the hand rim and lever systems. The main goal of this innovative system of propulsion is to facilitate and extend movement reducing time.
Conference Paper
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The purpose of this study was to determine the muscle activity patterns resulting from dynamic optimization of a novel continuous wheelchair propulsion movement having a circularity ratio of 0.89. For the study four major muscle groups were selected and a bang-bang control strategy was adopted to reduce the complexity and time for the optimization with a cost function to increase the net propulsion power. The successful completion of the optimization resulted in muscle excitation and activation curves for each actuator and a net power > 30 watts. The proposed propulsion mechanism can act as a substitute for the normal propulsion mechanisms used in daily life and sports activities.
Article
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A review of wheelchair research within the scope of the wheelchair as a means of daily ambulation is presented. The relevance of a combined biomechanical and physiological research approach is advocated for enhancing the body of knowledge of wheelchair ergonomics, that is, the wheelchair/user interaction in relation to aspects of vehicle mechanics and the user's physical condition. Results of experiments regarding variations in the wheelchair/user interface stress the possibilities of optimization in terms of wheelchair dimensions and user characteristics. Analysis of propulsion technique is aimed at the within-cycle characteristics and the time-dependent organization of technique.
Article
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The primary aim of this investigation was to compare maximum wheelchair performance with arm cranking using a multistage progressive work load protocol. In five subjects with a wide range of neurological disability and two normal males the differences observed in maximum oxygen uptake, heart rate and ventilation during two forms of upper limbs exercise, were not significant.
Article
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The purpose of this investigation was to compare peak performance capabilities of male paraplegics with arm crank and wheelchair ergometry. Eleven male paraplegics (aged 26.0 +/- 4.5 year) with spinal lesions at levels ranging from T5 to L4 were assessed during arm cranking and while propelling a wheelchair on a treadmill. Subjects completed both tests in randomised order within a 1 week period with a minimum of 48 hours between tests. Based on the data analysis, peak VO2 for the treadmill and arm crank were not significantly different while HR values for the treadmill were significantly greater (P less than 0.05) when compared to arm crank. A regression analysis indicated that wheelchair treadmill peak VO2 values can be accurately predicted from arm crank peak VO2 (r = 0.74).
Article
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Arm cycle ergometry has been shown to be an effective mode of cardiopulmonary training for individuals with spinal cord injuries. Arm cycle ergometry training results in an increased maximal oxygen uptake, exercise-induced bradycardia, and increased physical work capacity. Whether improvements in cardiopulmonary function parallel improvements in functional endurance, however, is unknown. In addition, no readily available tool to evaluate improvements in functional endurance has been identified. The purpose of this investigation was to determine the effects of arm cycle ergometry training on the wheelchair propulsion endurance of individuals with spinal cord injuries. Eight adult men with quadriplegia were evaluated before and after eight weeks of arm cycle ergometry training. A modified Cooper's 12-minute run-walk test, a sustained wheelchair propulsion task, was used to document improvements in functional endurance. Submaximal exercise heart rate, physical work capacity, and maximal oxygen uptake were used to document improvements in cardiopulmonary function. The results demonstrate that improvements in cardiopulmonary function parallel increases in wheelchair propulsion endurance. A sustained 12-minute wheelchair propulsion task is shown to be a readily available tool in the evaluation of functional endurance of individuals with spinal cord injuries. The improvements in wheelchair propulsion endurance should assist the individual in completing activities of school, work, recreation, and daily living.
Article
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Previous studies have shown that arm cranks and arm levers, working as propulsion mechanisms for nonambulatory individuals, may have mechanical and physiologic advantages over standard handrim wheelchairs. This study evaluated physiologic responses to arm lever and arm crank ergometry using identical workloads. An arm lever ergometer (ALE) was constructed and adapted to an arm crank ergometer (ACE) so that equal workloads could be applied with both ergometers. Fifteen able-bodied men and 15 able-bodied women exercised at a low (15 watts) and a high (45 watts) workload, with a three-minute rest interval. While exercising at each level, oxygen consumption (VO2), minute ventilation (VE), and heart rate (HR) were monitored. When low workloads with ALE and ACE were compared, no significant differences (p greater than 0.05) were demonstrated in any of the variables for men or women. For the men, at the high workload, the ALE elicited significantly lower (p less than 0.05) VO2 (by 9.8%), HR (by 6.3%), and VE (by 7.5%), than did the ACE. For the women, at the high workload, VO2 was significantly lower (p less than 0.05) (by 7.6%) with the ALE, as was VE (by 7.5%), but HR, although 3.3% lower with the ALE, was not significantly different (p greater than 0.05) from the ACE. These data suggest that the ALE is physiologically less stressful than the ACE at high workloads. Arm levers may, therefore, provide an advantage for handicapped persons when they propel themselves in wheelchairs.
Article
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The various stages of development of a lever drive system are described. The use of both roller and friction clutches are discussed and the means for controlling forward, reverse, and braking are included. The current system allows good maneuverability without requiring hand skills and may be effective for quadriplegics.
Article
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To compare metabolic and circulatory responses for wheelchair ergometer (WERG) and arm crank ergometer (ACE) exercise at equal power-output (PO) levels, wheelchair-dependent (n = 7) and able-bodied (n = 10) subjects exercised at PO levels at 30, 90, 150, and 210 kpm times min-1 for each mode of ergometry. Steady-state values of oxygen uptake (VO2), pulmonary ventilation (VE), ventilatory equivalent of oxygen (VE times VO2-1), cardiac output (Q), stroke volume (SV), arteriovenous oxygen difference (a-VO2), heart rate (HR), systolic blood pressure (SBP), and rate pressure product (RPP) were determined at each PO. With the exception of VE times VO2-1 and a-VO2, each variable tended to increase with PO. Generally, VO2, VE, Q, SV, HR, SBP, and RPP responses were higher for WERG than ACE exercise at each PO level. When Q and RPP were expressed in relation to VO2, both variables were higher for WERG exercise. These data suggest that the wheelchair hand-rim system is inherently more strenuous than arm cranking, and that the latter should be studied further as an alternative method for wheelchair propulsion.
Article
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The purpose of this investigation was to compare physical work capacity (PWC), peak oxygen uptake (peak VO2), maximal pulmonary ventilation (VEmax), maximal heart rate (HRmax), and maximal blood lactate concentration (LAmax) for wheelchair ergometer (WERG) and arm crank ergometer (ACE) exercise. For this, wheelchair-dependent (n = 6) and able-bodied (n = 10) subjects completed a progressive intensity, discontinuous test for each mode of exercise. Each test was terminated by physical exhaustion and/or an inability to maintain a flywheel velocity of 180 m.min-1. Relatively high correlation coefficients were found between values obtained during the two modes of ergometry for PWC, peak VO2, VEmax, and HRmax. WERG exercise was found to elicit a significantly (P less than 0.05) lower PWC (by 36%), HRmax (by 7%), and LAmax (by 26%) than ACE exercise. Peak VO2 and VEmax, however, were similar for both exercise modes. These data suggest that either exercise mode may be used for fitness testing and training of people who cannot use their legs and that arm cranking may be a superior method to propel wheelchairs.
Article
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Seven subjects with chronic paralysis due to spinal cord injury completed a series of experiments to 1) determine and compare the metabolic cost of propelling the Handbike and Rowcycle, and 2) evaluate the potential of these upper body-powered devices for improving the cardiorespiratory fitness of persons with lower limb disabilities. Mean intrasubject differences between the Handbike and Rowcycle rides for heart rate, minute ventilation, oxygen uptake, and net locomotive energy cost were small and did not reach statistical significance for any of the ride conditions. Lower net locomotive energy cost (greater economy) during a 5.5 mi.hr-1 ride condition predicted vehicle preference in all cases (P = 0.008). The range of values for percent peak oxygen uptake suggests that all but one of the subjects were able to utilize either vehicle at an intensity sufficient for improving and maintaining cardiorespiratory fitness without undue fatigue.
Article
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To describe physical strain during activities of daily living (ADL), 44 men with spinal cord injuries (C4-L5) performed a set of standardised tasks. The physical strain was defined as the highest heart rate response expressed as a percentage of the individual heart rate reserve (%HRR). The physical strain averaged over the subjects who performed all tasks (n = 24) was (mean +/- SD): 20.2 +/- 7.2 %HRR (washing hands), 20.4 +/- 7.3 %HRR (passing a side-hung door), 28.8 +/- 10.8 %HRR (transfer to a toilet), 31.2 +/- 13.1 %HRR (ascending an 8 cm curb). 33.9 +/- 12.0 %HRR (transfer to a shower seat), 35.1 +/- 10.5 %HRR (transfer to bed), 36.4 +/- 13.3 %HRR (preparing lunch), 37.1 +/- 12.0 %HRR (washing up), 38.7 +/- 14.9 %HRR (ascending a ramp), 39.8 +/- 15.6 %HRR (transfer to a shower wheelchair), 41.4 +/- 12.1 %HRR (changing sheets), and 45.9 +/- 10.4 %HRR (entering a car). Physical strain could be notably high, but large variations among subjects were present. During all tasks, subjects with tetraplegia had significantly higher levels of strain than subjects with low (T6-L5) lesions. Physical strain was inversely related to parameters of physical capacity: isometric strength (r: -0.34 to -0.72), sprint power (r: -0.34 to -0.69), peak oxygen uptake (r: -0.41 to -0.81) and maximal power output (r: -0.52 to -0.82). Parameters of physical capacity were better predictors of physical strain than was the lesion level, and explained 37-71% of the variance in strain during ADL. It was also concluded that the method used in this study provides a quantitative and objective estimation of physical strain and may therefore be a useful tool to identify task difficulty during rehabilitation and to evaluate the results of task and physical training on the physical strain during ADL.
Article
The purpose of this study was to identify the most desirable cranking rate to be used by paraplegic individuals during submaximal arm training programs. Eleven healthy paraplegic males ( M age = 28.8 years) with lesion levels ranging from T4 to T12 served as subjects. Arm exercise loads for the four submaximal cranking rates studied (50, 60, 70, and 80 rpm) were set to elicit 60% of peak V̇O 2 . Duration of the submaximal tests was 15 min. V̇E, V̇O 2 , RER, HR, and differentiated RPE were recorded each minute throughout the 15-min test. A randomized block ANOVA and Duncan’s post hoc analysis indicated that 80 rpm produced significantly higher ( p <.05) values for HR, absolute V̇O 2 , V̇E, V̇CO 2 , and V̇E/V̇O 2 than any other rates. Cranking at 70 rpm resulted in significantly higher ( p <.05) values for O 2 pulse, while relative V̇O 2 was significantly higher ( p <05) at 70 rpm than at all other rates except 80 rpm. RPE was significantly higher ( p <.05) at 50 rpm than at 60 or 70 rpm, with no difference between 50 and 80 or 60, 70, and 80. The authors concluded that 70 rpm was the most appropriate cranking rate for paraplegic males to use during arm training programs.
Article
Objective: Contribution to the optimization of the driving technique in hand-lever wheelchairs. Subjects: Eight paraplegic subjects and eight subjects without physical handicaps participated in the study. Design: Peak forces were measured on the hand levers of the wheelchairs (1) during synchronous (parallel; 0 degree phase-shift) and asynchronous (180 degree phase-shift) propulsion at a stationary ergometer from 15 to 75 Joule/s (Watts) as a maximum, and (2) during wheelchair propulsion on a treadmill also at 25, 40 and 55 Joule/s. In addition the development of peak force with and without a wheelchair back-rest was examined under both conditions (synchronous, asynchronous). Results: On the ergometer both paraplegic subjects and those without physical handicaps had significantly higher peak push than peak pull forces with synchronous as well as asynchronous lever propulsion. The peak forces developed during synchronous lever propulsion without a back-rest were higher for both groups during the pull than during the push cycle. For asynchronous propulsion, the peak lever force was similiar for the push and pull cycles. During asynchronous propulsion, on the treadmill, the paraplegic subjects had a significantly higher peak push than peak pull force with a back-rest. The subjects without physical handicaps had similiar peak push and pull forces during wheelchair propulsion on the treadmill. Conclusions: The ergonomical optimization of modern hand-lever drive systems and of the driving techniques will improve the mobility of wheelchair users remarkably.
Article
Handrim wheelchair propulsion is a straining form of ambulation. In contrast, arm crank exercise in laboratory settings has shown a higher degree of gross mechanical efficiency and increased levels of peak power output. Moreover, arm crank exercise can be conducted at different gear ratios and in asynchronic or synchronic mode. Although tricycle crank exercise or handcycling has become increasingly popular for recreational use, sports and outdoor wheeling over the last decade, today little is known about the cardiopulmonary strain in handcycling. The physiological and subjective responses during handcycling were evaluated in a group of 12 male non-wheelchair users (age 24.6 +/- 2.7 yr; body weight 73.7 +/- 9.7 kg). During an incremental submaximal exercise test on a motor driven treadmill (velocity: 1.8 ms-1; an incremental slope of 1% per 3 min; 0-3%; mean power output of the subject group varied between 7.6 +/- 1.6 W and 47.5 +/- 6.2 W), effects of asynchronic and synchronic crank settings and three different gear ratios (1:0.42, 1:0.59, 1:0.74 (or 24, 36 and 44 rpm)) were evaluated in a random testing sequence. Significantly lower levels of mean oxygen uptake, ventilation, relative heart rate and oxygen uptake were seen during synchronic arm use and for the lighter gear ratios (i.e. higher movement frequency; 44 rpm). Subjective local perceived discomfort showed similar trends. Conversely, gross mechanical efficiency appeared higher for these conditions. The need for strong medio-lateral stabilizing muscle effort during asynchronic arm use (to ensure a proper wheeling direction as well as simultaneous power transfer to the cranks) and the effective use of the trunk in this subject group may explain the advantage of synchronic arm use. Whether this advantage is consolidated among wheelchair confined individuals needs further study. Apart from the important effects of a shift in force--velocity characteristics of the contracting muscles with varying gear ratios, increased static finger flexor and arm muscle activity may explain the increased strain in the somewhat unnatural heavy gear condition (24 rpm) at the studied velocity. Results need to be re-evaluated for wheelchair user populations and different higher velocities and power conditions. Moreover, other aspects of the wheelchair--user interface must be studied in order to generate optimum fitting and design guidelines for different user groups and conditions of use.
Article
Running is one of the most popular leisure sports activities. Next to its beneficial health effects, negative side effects in terms of sports injuries should also be recognised. Given the limitations of the studies it appears that for the average recreational runner, who is steadily training and who participates in a long distance run every now and then, the overall yearly incidence rate for running injuries varies between 37 and 56%. Depending on the specificity of the group of runners concerned (competitive athletes; average recreational joggers; boys and girls) and on different circumstances these rates vary. If incidence is calculated according to exposure of running time the incidence reported in the literature varies from 2.5 to 12.1 injuries per 1000 hours of running. Most running injuries are lower extremity injuries, with a predominance for the knee. About 50 to 75% of all running injuries appear to be overuse injuries due to the constant repetition of the same movement. Recurrence of running injuries is reported in 20 to 70% of the cases. From the epidemiological studies it can be concluded that running injuries lead to a reduction of training or training cessation in about 30 to 90% of all injuries, about 20 to 70% of all injuries lead to medical consultation or medical treatment and 0 to 5% result in absence from work. Aetiological factors associated with running injuries include previous injury, lack of running experience, running to compete and excessive weekly running distance. The association between running injuries and factors such as warm-up and stretching exercises, body height, malalignment, muscular imbalance, restricted range of motion, running frequency, level of performance, stability of running pattern, shoes and inshoe orthoses and running on 1 side of the road remains unclear or is backed by contradicting or scarce research findings. Significantly not associated with running injuries seem age, gender, body mass index, running hills, running on hard surfaces, participation in other sports, time of the year and time of the day. The prevention of sports injuries should focus on changes of behaviour by health education. Health education on running injuries should primarily focus on the importance of complete rehabilitation and the early recognition of symptoms of overuse, and on the provision of training guidelines.
Article
Purpose : The Arm propelled three wheeled chair (APTWC) is in common use in the economically poor countries for outdoor ambulation, the propulsion force of which is exerted by arm cranking in asynchronous fashion. The purpose of the study was to assess the ambulatory performance of the users of the device using heart rate as a control index, at graded speeds. Method : Fifteen regular users of APTWC male with paraplegia and poliomyelitis were ambulated at seven different graded speeds in outdoor settings and the resting and ambulatory heart rate was measured during steady state and then physiological cost index and comfortable speed of propulsion was computed. Results : The physiological strain, linear regression of the relationship between heart rate and speed with correlation coefficient of r = 0.86 (p < 0.001), polynomial regression of the relationship between physiological cost index (PCI) and speed with correlation coefficient of r = 0.83 (p < 0.001) and comfortable speed of propulsion (120 m/min) was reported. Conclusions : Heart rate can be used to evaluate the ambulatory performance of the device, quantifying energy economy for outcome evaluation and decision making for clinical recommendation.
Article
Preface. Introduction: Rehabilitation engineering US legislation influencing rehabilitation engineering International policy influencing rehabilitation engineering Assistive technology Rehabilitation technology suppliers Engineering acceptable performance Rehabilitation engineering design Assistive technology design criteria Product testing Summary Further reading and references. Fundamentals of rehabilitation engineering design: Design considerations Total quality management in rehabilitation engineering Steel as a structural material Aluminum for assistive technology design Use of composites for assistive technology design Design with engineering materials Fabrication Basic electric circuits Further reading and references. Biomechanics of mobility and manipulation: Human motion analysis Gait analysis Functional neuromuscular stimulation for movement restoration Biomechanics of wheelchair propulsion Biomechanics of seating Biomechanics of manipulation Further reading and references. Universal design and accessibility: Barrier-free design Elemental resource model Factors affecting barrier-free design Interior space design Design for people with disabilities Accessible transportation Access legislation Further reading and references. Personal transportation: Introduction Selecting a vehicle Lift mechanisms Wheelchair securement systems Passenger restraint systems Automobile hand-controls Control of secondary functions Further reading and references. Wheelchair safety, standards and testing: Introduction Standard tests Normative values Static stability A geometric approach to static stability Stability with road crown and inclination Impact strength tests Fatigue strength tests Finite-element modeling applied to wheelchair design/testing Test dummies Power wheelchair range testing Power wheelchair controller performance Designing for safe operation Further reading and references. Manual wheelchair design: Introduction Classes of manual wheelchairs Frame design Materials The wheelchair and rider Wheels and casters Components Human factors design considerations Future directions Further reading and references. Power wheelchair design: Introduction Classes of power wheelchairs Motor selection Servoamplifiers Microprocessor control Shared control Fault-tolerant control Integrated controllers Electromagnetic compatibility Batteries Gear boxes User interfaces Further reading and references. Postural support and seating: Seating and postural support systems Distribution of stresses in soft tissues Seating pressure measurement Control interface integration Multi-configuration seating and postural support systems Further reading and references. Prosthetics and orthotics: Introduction Upper-extremity prostheses Upper-extremity orthoses Lower-extremity prostheses Lower-extremity orthoses Functional neuromuscular stimulation Ambulations aids Aids to daily living Further reading and references. Recreational devices and vehicles: Introduction Racing wheelchairs Arm-powered bicycles and tricycles Off-road vehicles Water sports Adaptive ski equipment Recreational vehicles Further reading and references. Rehabilitation robotics: Introduction Components and configurations of robots Robot kinematics Robot motion Robot control Robot sensors Human interfaces to robotic systems Further reading and references. Index.
Article
A preliminary series of tests has been conducted to study the influence of shoulder-to-crank-center distance and crank length on maximum power output of healthy adults. It was clear from the trials that the arm trajectories of the subjects changed substantially for different ergometer configurations, although detailed position and orientation information was not gathered. Biomechanically, the shoulder/arm/crank system is underconstrained, i.e. the elbow is free to take on a wide range of positions relative to the shoulder and wrist and still complete the cranking task. Three-dimensional plots of maximum power vs. crank length and horizontal position for each subject showed a bimodal peak, which was still pronounced when all trials for all subjects were combined and averaged.
Article
A new arm-powered racing bicycle is described. The features and performance of this bicycle are delineated, and the relative advantages over tricycles are outlined.
Article
This study investigated in rather specific wheelchair tests the relationships among estimates of isometric upper-body strength (Fiso), sprint power (P30), aerobic power (VO2peak), and maximal power output (POaer) in a group of 44 men (age 34 +/- 12 yr) with longstanding spinal cord injuries ranging from C4/C5 to L5. Fiso was defined as the maximum force that could be exerted on the blocked rims of a stationary wheelchair ergometer. The estimation of P30 involved the measurement of the mean power during a 30-s all-out sprint test on the same wheelchair ergometer. VO2peak and POaer were determined as the peak oxygen uptake and highest sustained power output during a discontinuous progressive maximal exercise test on a motorized treadmill, while subjects used their own daily use wheelchair. Fiso ranged from 1.5 N.kg-1 (mean of both arms) in the group with quadriplegia to 3.4 N.kg-1 in the group with lowest-lesions, and P30 ranged from 0.5 to 1.5 W.kg-1 among the subjects. VO2peak ranged from 13.6 ml.kg-1.min-1 in the group with quadriplegia to 31.3 ml.kg-1.min-1 in the group with lowest-lesions, and POaer ranged from 0.4 to 1.1 W.kg-1. Strong positive relationships (r = 0.81-0.92) were demonstrated among all variables. Regression equations among variables were calculated: P30 = 0.51 Fiso - 0.18 (R2 = 0.75); POaer = 0.34 Fiso - 0.02 (R2 = 0.66); POaer = 0.67 P30 + 0.11 (R2 = 0.81); VO2peak = 6.52 Fiso + 4.15 (R2 = 0.76); VO2peak = 12.03 P30 + 7.43 (R2 = 0.77); VO2peak = 16.81 POaer + 6.44 (R2 = 0.84).(ABSTRACT TRUNCATED AT 250 WORDS)
Article
Handrim wheelchair propulsion is a straining form of ambulation. In contrast, arm crank exercise in laboratory settings has shown a higher degree of gross mechanical efficiency and increased levels of peak power output. Moreover, arm crank exercise can be conducted at different gear ratios and in asynchronic or synchronic mode. Although tricycle crank exercise or handcycling has become increasingly popular for recreational use, sports and outdoor wheeling over the last decade, today little is known about the cardiopulmonary strain in handcycling. The physiological and subjective responses during handcycling were evaluated in a group of 12 male non-wheelchair users (age 24.6 +/- 2.7 yr; body weight 73.7 +/- 9.7 kg). During an incremental submaximal exercise test on a motor driven treadmill (velocity: 1.8 ms-1; an incremental slope of 1% per 3 min; 0-3%; mean power output of the subject group varied between 7.6 +/- 1.6 W and 47.5 +/- 6.2 W), effects of asynchronic and synchronic crank settings and three different gear ratios (1:0.42, 1:0.59, 1:0.74 (or 24, 36 and 44 rpm)) were evaluated in a random testing sequence. Significantly lower levels of mean oxygen uptake, ventilation, relative heart rate and oxygen uptake were seen during synchronic arm use and for the lighter gear ratios (i.e. higher movement frequency; 44 rpm). Subjective local perceived discomfort showed similar trends. Conversely, gross mechanical efficiency appeared higher for these conditions. The need for strong medio-lateral stabilizing muscle effort during asynchronic arm use (to ensure a proper wheeling direction as well as simultaneous power transfer to the cranks) and the effective use of the trunk in this subject group may explain the advantage of synchronic arm use. Whether this advantage is consolidated among wheelchair confined individuals needs further study. Apart from the important effects of a shift in force--velocity characteristics of the contracting muscles with varying gear ratios, increased static finger flexor and arm muscle activity may explain the increased strain in the somewhat unnatural heavy gear condition (24 rpm) at the studied velocity. Results need to be re-evaluated for wheelchair user populations and different higher velocities and power conditions. Moreover, other aspects of the wheelchair--user interface must be studied in order to generate optimum fitting and design guidelines for different user groups and conditions of use.
Article
Spiroergometric examination with defined work loads and permanent records of the common circulatory and metabolic values were carried out on a group of healthy adults and one wheelchair occupant, using a fixed wheelchair simulator with lever propulsion, which was connected to an ergometer. Comparative studies were performed in three different seat positions in relation to the lever, as well as six different lengths of the connecting rod. The best values were measured, under steadystate conditions, with increasing lengths of the connecting rod and posterior placement of the seat unit. The results are in agreement with the experience gained by other authors with respect to arm work, and show that the optimal efficiency of hand lever work is obtained in the anterior position. In this context it proved to be particularly advantageious from the ergonomic viewpoint, if, when bending forward, as necessitated by a long connecting rod, both the upper part of the body and the trunk musculature are employed. The practical consequences of the simulator tests on an adequate wheelchair design and wheelchair prescription are discussed.
Article
Circulatory strain encountered in everyday life was low, taxing 15-24% of HRR. Similar results (Th8-Th12) was estimated from their heart rates (fH) recorded continuously by portable tape recorders for up to 48 h. The degree of strain was expressed in per cent of the individual's heart rate reserve (HRR), i.e. of the span between resting and maximal fH. The average strain of everyday life was low, taxing 15-24% of HRR. Similar results were obtained in a rehabilitated patient (subj. 5, Th12) at the hospital. fH higher than 50% of HRR which could be expected to have a training effect on the circulatory system was recoreded only when ambulating with crutches, driving wheelchair uphill, playing basketball, or during specific training (arm cranking in subj. 6 (Th2) who attended a post-rehabilitation course). The results confirm that daily life activities with no additional training are not intense enough to maintain the circulatory and physical fitness of rehabilitated paraplegics.
Article
Running is one of the most popular leisure sports activities. Next to its beneficial health effects, negative side effects in terms of sports injuries should also be recognised. Given the limitations of the studies it appears that for the average recreational runner, who is steadily training and who participates in a long distance run every now and then, the overall yearly incidence rate for running injuries varies between 37 and 56%. Depending on the specificity of the group of runners concerned (competitive athletes; average recreational joggers; boys and girls) and on different circumstances these rates vary. If incidence is calculated according to exposure of running time the incidence reported in the literature varies from 2.5 to 12.1 injuries per 1000 hours of running. Most running injuries are lower extremity injuries, with a predominance for the knee. About 50 to 75% of all running injuries appear to be overuse injuries due to the constant repetition of the same movement. Recurrence of running injuries is reported in 20 to 70% of the cases. From the epidemiological studies it can be concluded that running injuries lead to a reduction of training or training cessation in about 30 to 90% of all injuries, about 20 to 70% of all injuries lead to medical consultation or medical treatment and 0 to 5% result in absence from work. Aetiological factors associated with running injuries include previous injury, lack of running experience, running to compete and excessive weekly running distance. The association between running injuries and factors such as warm-up and stretching exercises, body height, malalignment, muscular imbalance, restricted range of motion, running frequency, level of performance, stability of running pattern, shoes and inshoe orthoses and running on 1 side of the road remains unclear or is backed by contradicting or scarce research findings. Significantly not associated with running injuries seem age, gender, body mass index, running hills, running on hard surfaces, participation in other sports, time of the year and time of the day. The prevention of sports injuries should focus on changes of behaviour by health education. Health education on running injuries should primarily focus on the importance of complete rehabilitation and the early recognition of symptoms of overuse, and on the provision of training guidelines.
Article
To study the effect of tangential speed of the handrims independent of external power output on gross mechanical efficiency (ME), nine able-bodied subjects performed wheelchair exercise tests on a stationary ergometer. The ergometer allowed for measurement of torque and three-dimensional forces on the rims and tangential velocity of the rear wheels. The experiment comprised two series of submaximal tests against constant external power outputs (0.25 and 0.50 W.kg-1) and four wheelchair speeds (0.83, 1.11, 1.39, and 1.67 m.s-1), which simulated a wheelchair speed of 1.67 m.s-1 and mechanical advantages of 0.43-0.87. ME stayed below 10.5% and changed inversely with speed of movement of the handrims. Peak torques on the right handrim stayed even with speed, leading to a significant increase in peak power output. Energy losses owing to braking torques at the beginning and end of the push phase increased with handrim speed but hardly exceeded 5 W. The effective force component applied to the handrims was below 71% of the magnitude of the total force vector and dropped up to 13% with increasing handrim speed. It is suggested that an ineffective direction of forces on the rims might (partly) be responsible for the low ME and for a decrease in ME in relation to tangential handrim velocity. This suggestion is discussed from a number of theoretical perspectives. It is concluded that the use of handrims with a lower mechanical advantage will increase wheelchair propulsion efficiency.
Article
This study describes the responses of 20 paraplegic athletes (mean age: 26.8 +/- 1.6 years) to a continuous incremental workload test until exhaustion on an arm cranking ergometer (ACE) and on a wheelchair ergometer (WCE). Both ergometers used the same electromagnetic braking device allowing a fair comparison between results. Tests were conducted at a 24 hour interval at the same time of the day. Oxygen uptake (VO2), heart rate (HR), workload (W), blood pressure (BP), Borg index, and mechanical efficiency (ME) were measured at every minute during the effort and the cool down periods of both tests. The purpose of this study was to analyse the different responses obtained on ACE and on WCE during maximal effort by paraplegics, and also to determine which ergometer permits the higher ME. Results indicate that paraplegics reached the same max HR on ACE and on WCE (97% of the predicted max HR). The lack of significant difference (p less than 0.05) between ACE and WCE in terms of maximal values of VO2, VE and HR suggests that the subjects reached their maximal capacity on each test regardless of the type of ergometer. Nevertheless, W max (in Watts) was 26% higher on ACE than on WCE. Maximal ME values were respectively 16% and 11.6% on ACE and WCE. Results suggest that ergometers and protocol used in this study are appropriate to measure physiological responses of paraplegic athletes during arm cranking and wheelchair exercise without excessive or early arm fatigue.