The influence of altering push force effectiveness on upper extremity demand during wheelchair propulsion

• Published in: Journal of biomechanics 2010-10, Vol.43 (14), p.2771-2779
• Main Authors: Rankin, Jeffery W, Kwarciak, Andrew M, Mark Richter, W, Neptune, Richard R
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Biomechanical Phenomena; Biomechanics; Biomechanics. Biorheology; Cumulative Trauma Disorders - etiology; Cumulative Trauma Disorders - physiopathology; Diseases of the osteoarticular system. Orthopedic treatment; Efficiency; Electromyography; Equipment Design; Forward dynamics simulation; Fundamental and applied biological sciences. Psychology; Handrim force; Humans; Male; Medical sciences; Models, Anatomic; Models, Biological; Movement - physiology; Muscle, Skeletal - physiopathology; Musculoskeletal model; Paraplegia - pathology; Paraplegia - physiopathology; Physical Medicine and Rehabilitation; Push technique; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Shoulder Joint - injuries; Shoulder Joint - physiopathology; Tissues, organs and organisms biophysics; Upper Extremity - pathology; Upper Extremity - physiopathology; Wheelchairs; Wheelchairs - adverse effects
• ISSN: 0021-9290; 1873-2380
• DOI: 10.1016/j.jbiomech.2010.06.020

Abstract Manual wheelchair propulsion has been linked to a high incidence of overuse injury and pain in the upper extremity, which may be caused by the high load requirements and low mechanical efficiency of the task. Previous studies have suggested that poor mechanical efficiency may be due to a low effective handrim force (i.e. applied force that is not directed tangential to the handrim). As a result, studies attempting to reduce upper extremity demand have used various measures of force effectiveness (e.g., fraction effective force, FEF) as a guide for modifying propulsion technique, developing rehabilitation programs and configuring wheelchairs. However, the relationship between FEF and upper extremity demand is not well understood. The purpose of this study was to use forward dynamics simulations of wheelchair propulsion to determine the influence of FEF on upper extremity demand by quantifying individual muscle stress, work and handrim force contributions at different values of FEF. Simulations maximizing and minimizing FEF resulted in higher average muscle stresses (23% and 112%) and total muscle work (28% and 71%) compared to a nominal FEF simulation. The maximal FEF simulation also shifted muscle use from muscles crossing the elbow to those at the shoulder (e.g., rotator cuff muscles), placing greater demand on shoulder muscles during propulsion. The optimal FEF value appears to represent a balance between increasing push force effectiveness to increase mechanical efficiency and minimize upper extremity demand. Thus, care should be taken in using force effectiveness as a metric to reduce upper extremity demand.