Forward dynamic optimization of handle path and muscle activity for handle based isokinetic wheelchair propulsion: A simulation study

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.     

The intra-push velocity profile of the over-ground racing wheelchair sprint start

The aim of this study was to analyse the first six pushes of a sprint start in over-ground racing wheelchair propulsion. One international male wheelchair athlete (age=28 years; body mass=60.6 kg; racing classification=T4) performed maximal over-ground sprint trials, over approximately 10 m, in his own racing wheelchair fitted with a velocometer. Each trial was filmed at 200 Hz using a "Pan and Tilt" system. Eight trials were manually digitised at 100 Hz. Raw co-ordinate data were smoothed and differentiated using a quintic spline routine. Across the period from pushes one to six the duration of each push cycle decreased (0.82+/-0.02-0.45+/-0.01 s) with the mean duration of the propulsive phase decreasing from 0.62+/-0.02 to 0.21+/-0.01 s and the recovery phase increasing from 0.20+/-0.01 to 0.24+/-0.02 s. The push-rim was contacted progressively closer to top dead centre and released progressively closer to bottom dead centre with each push. The data indicate that peak velocity occurred after release. The main findings of this study support the observation that racing wheelchair sprint propulsion is a complex form of locomotion and cannot be described accurately by using just the established definitions of a propulsive and a recovery phase.     

Prediction of applied forces in handrim wheelchair propulsion

Researchers of wheelchair propulsion have usually suggested that a wheelchair can be properly designed using anthropometrics to reduce high mechanical load and thus reduce pain and damage to joints. A model based on physiological features and biomechanical principles can be used to determine anthropometric relationships for wheelchair fitting. To improve the understanding of man-machine interaction and the mechanism through which propulsion performance been enhanced, this study develops and validates an energy model for wheelchair propulsion. Kinematic data obtained from ten able-bodied and ten wheelchair-dependent users during level propulsion at an average velocity of 1m/s were used as the input of a planar model with the criteria of increasing efficiency and reducing joint load. Results demonstrate that for both experienced and inexperienced users, predicted handrim contact forces agree with experimental data through an extensive range of the push. Significant deviations that were mostly observed in the early stage of the push phase might result from the lack of consideration of muscle dynamics and wrist joint biomechanics. The proposed model effectively verified the handrim contact force patterns during dynamic propulsion. Users do not aim to generate mechanically most effective forces to avoid high loadings on the joints.     

Individual muscle contributions to push and recovery subtasks during wheelchair propulsion

Manual wheelchair propulsion places considerable physical demand on the upper extremity and is one of the primary activities associated with the high prevalence of upper extremity overuse injuries and pain among wheelchair users. As a result, recent effort has focused on determining how various propulsion techniques influence upper extremity demand during wheelchair propulsion. However, an important prerequisite for identifying the relationships between propulsion techniques and upper extremity demand is to understand how individual muscles contribute to the mechanical energetics of wheelchair propulsion. The purpose of this study was to use a forward dynamics simulation of wheelchair propulsion to quantify how individual muscles deliver, absorb and/or transfer mechanical power during propulsion. The analysis showed that muscles contribute to either push (i.e., deliver mechanical power to the handrim) or recovery (i.e., reposition the arm) subtasks, with the shoulder flexors being the primary contributors to the push and the shoulder extensors being the primary contributors to the recovery. In addition, significant activity from the shoulder muscles was required during the transition between push and recovery, which resulted in increased co-contraction and upper extremity demand. Thus, strengthening the shoulder flexors and promoting propulsion techniques that improve transition mechanics have much potential to reduce upper extremity demand and improve rehabilitation outcomes.     

Differences in performance between trained and untrained subjects during a 30-s sprint test in a wheelchair ergometer

To compare physiological responses and propulsion technique of able bodied subjects with no prior experience of wheelchairs (AB) and wheelchair dependent subjects (WD), ten AB and nine WD performed a 30-s sprint test in a wheelchair ergometer. The WD had spinal cord injuries with a lesion at T8 or lower. The WD and AB did not show significantly different physiological responses. The power values averaged for the right wheel over the 30 s of the test were 50.2 (SD 14.7) W and 48.0 (SD 4.4) W for WD and AB, respectively. No significant differences in torque application could be discerned, although WD subjects seemed to have a more flattened torque curve with a smaller negative deflection at the beginning of the push. The WD applied a significantly higher horizontal propulsive force to the handrims but did not apply force more effectively. The percentages of effective force to total propulsive force were 61 (SD 16)% for WD and 57 (SD 4)% for AB. With regard to the kinematic parameters, AB followed the handrims significantly longer than WD (end angle AB 65°, WD 44°), started the push phase with their arms more in retroflexion and flexed their trunks further forward. The AB did however show a movement pattern comparable to that of wheelchair athletes measured in a comparable experiment. It could not be decided conclusively that inexperience in wheelchair propulsion led to a less effective propulsion technique. Despite the selection of WD with respect to lesion level, interindividual differences in terms of level of training may have been responsible for the absence of significant results.     

The push force pattern in manual wheelchair propulsion as a balance between cost and effect

We investigate the hypothesis that the direction of the propulsion force in manual wheelchair propulsion can be interpreted as a result of the balance between the mechanical task requirements and the driver's biomechanical possibilities. We quantify the balance at the joint level in the form of an effect-cost criterion, from which we predict the force direction that results in an optimal compromise. Kinematic and dynamic data were collected from nine habitual wheelchair users driving at four velocities (0.83, 1.11, 1.39, 1.67 m/s) and three external power levels (10, 20, 30 W). Experimental data and predictions are in good agreement in the middle and final part of the push; the effect-cost value in this region approximates the achievable maximum. Early in the push the effect-cost criterion predicts an upwards propulsion force whereas the experimental force is downwards, the difference probably being mainly attributable to the force generation dynamics of the muscles. As a result of the geometric features of large-rim manual wheelchairs, the mechanically required and biomechanically preferred force directions are not in accordance during a substantial part of the push, making even the best compromise a poor one. This may contribute to the low mechanical efficiency of manual wheelchair propulsion and the high incidence of shoulder complaints.     

Comparison between overground and dynamometer manual wheelchair propulsion

Laboratory-based simulators afford many advantages for studying physiology and biomechanics; however, they may not perfectly mimic wheelchair propulsion over natural surfaces. The goal of this study was to compare kinetic and temporal parameters between propulsion overground on a tile surface and on a dynamometer. Twenty-four experienced manual wheelchair users propelled at a self-selected speed on smooth, level tile and a dynamometer while kinetic data were collected using an instrumented wheel. A Pearson correlation test was used to examine the relationship between propulsion variables obtained on the dynamometer and the overground condition. Ensemble resultant force and moment curves were compared using cross-correlation and qualitative analysis of curve shape. User biomechanics were correlated (R ranging from 0.41 to 0.83) between surfaces. Overall, findings suggest that although the dynamometer does not perfectly emulate overground propulsion, wheelchair users were consistent with the direction and amount of force applied, the time peak force was reached, push angle, and their stroke frequency between conditions.     

Mechanical energy and power flow analysis of wheelchair use with different camber settings

It has been suggested that minimisation of energy cost is one of the primary determinants of wheelchair designs. Wheel camber is one important parameter related to wheelchair design and its angle may affect usability during manual propulsion. However, there is little available literature addressing the effect of wheel camber on the mechanical energy or power flow involved in manual wheelchair propulsion. Twelve normal subjects (mean age, 22.3 years; SD, 1.6 years) participated in this study. A video-tracking system and an instrumented wheel were used to collect 3D kinematic and kinetic data. Wheel camber of 0° and 15° was chosen to examine the difference between mechanical power and power flow of the upper extremity during manual wheelchair propulsion. The work calculated from power flow and the discrepancy between the mechanical work and power flow work of upper extremity had significantly greater values with increased camber. The upper arm had a larger active muscle power compared with that in the forearm and hand segments. While propelling the increased camber, the magnitude of both the proximal and distal joint power and proximal muscle power was increased in all three segments. While the propelling wheel with camber not only needs a greater energy cost but also there is greater energy loss.     

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

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.     

Load on the upper extremity in manual wheelchair propulsion

To study joint contributions in manual wheelchair propulsion, we developed a three-dimensional model of the upper extremity. The model was applied to data collected in an experiment on a wheelchair ergometer in which mechanical advantage (MA) was manipulated. Five male able-bodied subjects performed two wheelchair exercise tests (external power output P_ext = 0.25–0.50 W · kg⁻¹) against increasing speeds (1.11–1.39–1.67 m.s⁻¹), which simulated MA of 0.58–0.87. Results indicated a decrease in mechanical efficiency (ME) with increasing MA that could not be related to applied forces or joint torques. Increase in P_ext was related to increases in joint torques. On the average, the highest torques were noted in shoulder flexion and adduction (35.6 and 24.6 N · m at MA = 0.58 and P_ext= 0.50 W · kg⁻¹). Peak elbow extension and flexion torques were −10.6 and 8.5 N · m. Based on the combination of torques and electromyographic (EMG) records of upper extremity muscles, anterior deltoid and pectoralis muscles are considered the prime movers in manual wheelchair propulsion. Coordinative aspects of manual wheelchair propulsion concerning the function of (biarticular) muscles in directing the propulsive forces and the redistribution of joint torques in a closed chain are discussed. We found no conclusive evidence for the role of elbow extensors in direction of propulsive forces.     

A comparison of static and dynamic optimization muscle force predictions during wheelchair propulsion

The primary purpose of this study was to compare static and dynamic optimization muscle force and work predictions during the push phase of wheelchair propulsion. A secondary purpose was to compare the differences in predicted shoulder and elbow kinetics and kinematics and handrim forces. The forward dynamics simulation minimized differences between simulated and experimental data (obtained from 10 manual wheelchair users) and muscle co-contraction. For direct comparison between models, the shoulder and elbow muscle moment arms and net joint moments from the dynamic optimization were used as inputs into the static optimization routine. RMS errors between model predictions were calculated to quantify model agreement. There was a wide range of individual muscle force agreement that spanned from poor (26.4% F_max error in the middle deltoid) to good (6.4% F_max error in the anterior deltoid) in the prime movers of the shoulder. The predicted muscle forces from the static optimization were sufficient to create the appropriate motion and joint moments at the shoulder for the push phase of wheelchair propulsion, but showed deviations in the elbow moment, pronation–supination motion and hand rim forces. These results suggest the static approach does not produce results similar enough to be a replacement for forward dynamics simulations, and care should be taken in choosing the appropriate method for a specific task and set of constraints. Dynamic optimization modeling approaches may be required for motions that are greatly influenced by muscle activation dynamics or that require significant co-contraction.     

Effect of work rate increment on peak oxygen uptake during wheelchair ergometry in men with quadriplegia

The purpose of this study was to determine the effect of work rate increment on peak oxygen uptake (VO2 peak) during wheelchair ergometry (WCE) in men with quadriplegia due to cervical spinal cord injuries (CSCI). Twenty-two non-ambulatory subjects (aged 20-38 years) with CSCI were divided into two groups based on wheelchair sports classification (n = 12 for IA group and n = 10 for IB/IC group). Subjects underwent three different, continuous graded exercise tests (spaced at least 1 week apart) on an electronically braked wheelchair ergometer. Following a 3-min warmup, the work rate was increased 2, 4, or 6 W.min-1 for the IA group and 4, 6, or 8 W.min-1 for the IB/IC group. Ventilation and gas exchange were measured breath-by-breath with a computerized system. Repeated-measures ANOVA showed no significant difference among the three protocols for VO2 peak in the IA group (P greater than 0.05). The mean (SD) VO2 peak values (ml.kg-1.min-1) were 9.3 (2.4), 9.4 (3.2), and 8.4 (2.6) for the 2, 4, and 6 W.min-1 protocols, respectively. In contrast, the IB/IC group showed a significant difference among the protocols for VO2 peak (P less than 0.05). The mean (SD) VO2 peak values (ml.kg-1,min-1) were 15.1 (4.0), 14.1 (4.4), and 12.7 (4.0) for the 4, 6, and 8 W.min-1 protocols, respectively. Post hoc analysis revealed a difference between the 4 and 8 W.min-1 protocols. Our results suggest that graded exercise testing of men with quadriplegia due to CSCI, using WCE, should employ work rate increments between 2 and 6 W.min-1 and that work rate increments of 8 W.min-1 or greater will result in an underestimate of VO2 peak.     

Shoulder model validation and joint contact forces during wheelchair activities

Chronic shoulder impingement is a common problem for manual wheelchair users. The loading associated with performing manual wheelchair activities of daily living is substantial and often at a high frequency. Musculoskeletal modeling and optimization techniques can be used to estimate the joint contact forces occurring at the shoulder to assess the soft tissue loading during an activity and to possibly identify activities and strategies that place manual wheelchair users at risk for shoulder injuries. The purpose of this study was to validate an upper extremity musculoskeletal model and apply the model to wheelchair activities for analysis of the estimated joint contact forces. Upper extremity kinematics and handrim wheelchair kinetics were measured over three conditions: level propulsion, ramp propulsion, and a weight relief lift. The experimental data were used as input to a subject-specific musculoskeletal model utilizing optimization to predict joint contact forces of the shoulder during all conditions. The model was validated using a mean absolute error calculation. Model results confirmed that ramp propulsion and weight relief lifts place the shoulder under significantly higher joint contact loading than level propulsion. In addition, they exhibit large superior contact forces that could contribute to impingement. This study highlights the potential impingement risk associated with both the ramp and weight relief lift activities. Level propulsion was shown to have a low relative risk of causing injury, but with consideration of the frequency with which propulsion is performed, this observation is not conclusive.     

Glenohumeral joint dynamics and shoulder muscle activity during geared manual wheelchair propulsion on carpeted floor in individuals with spinal cord injury

This study investigated the effects of using geared wheels on glenohumeral joint dynamics and shoulder muscle activity during manual wheelchair propulsion. Seven veterans with spinal cord injury propelled their wheelchairs equipped with geared wheels over a carpeted floor in low gear (1.5:1) and standard gear (1:1) conditions. Hand-rim kinetics, glenohumeral joint dynamics, and muscle activity were measured using a custom instrumented geared wheel, motion analysis, and surface electromyography. Findings indicated that the propulsion speed and stroke distance decreased significantly during the low gear condition. The peak hand-rim resultant force and propulsive moment, as well as the peak glenohumeral inferior force and flexion moment, were significantly less during the low gear condition. The peak and integrated muscle activity of the anterior deltoid and pectoralis major decreased significantly, while the normalized integrated muscle activity (muscle activity per stroke distance) was not significantly different between the two conditions. Propulsion on carpeted floor in the low gear condition was accompanied by a reduced perception of effort. The notable decrease in the peak shoulder loading and muscle activity suggests that usage of geared wheels may be beneficial for wheelchair users to enhance independent mobility in their homes and communities while decreasing their shoulder demands.     

Characterization of the shoulder net joint moment during manual wheelchair propulsion using four functional axes

Understanding how individuals distribute mechanical demand imposed on their upper extremity during physically demanding activities provides meaningful insights to preserve function and mitigate detrimental mechanical loading of the shoulder. In this study, we hypothesized that parameterization of the shoulder net joint moment using four functional axes could characterize distribution tendencies about the shoulder during manual wheelchair propulsion and that regardless of demographics, a shoulder flexor dominant NJM distribution would be predominantly used by individuals with paraplegia (n = 130). Forces and kinematics of the upper extremity and trunk were quantified using motion capture and an instrumented wheel during steady state manual wheelchair propulsion at self-selected fast speeds on a stationary ergometer. The results indicate that parsing out the internal/external rotation component of the shoulder net joint moment about the upper arm and distributing the remainder across the three orthogonal axes of the torso was successful in identifying common shoulder net joint moment distribution techniques used across individuals with paraplegia during manual wheelchair propulsion. Distribution tendencies were predominantly flexor dominant across injury level, gender, time since injury, body mass index, and height demographics. The 4-axis parameterization of the shoulder NJM effectively differentiated moment distribution tendencies used by individuals during manual wheelchair propulsion using a functionally relevant representation of shoulder kinetics. Use of the four-axis parameterization of joint kinetics in future studies is expected to provide important insights that can advance knowledge, preserve function, and inform clinical decisions.     

Short-term adaptations in co-ordination during the initial phase of learning manual wheelchair propulsion.

The purpose of this study was to analyse adaptations in kinematics and muscle activity/co-contraction in novice able-bodied subjects during the initial phase of learning hand rim wheelchair propulsion. Nine able-bodied subjects performed three 4-min practice blocks on a wheelchair ergometer. The external power output and velocity were constant for all blocks, respectively 0.25 W x kg(-1) and 1.11 m x s(-1). Electromyography of 16 arm, shoulder, back and chest muscles and kinematics were measured. Some small changes in the segmental movement pattern were seen during the practice period. Moreover, an increase in muscle activity and co-contraction of several muscles was found over time. The hypothesis that subjects instinctively search for an optimum frequency, in which the recovery phase is related to the eigenfrequency of the arms and, therefore, the least muscle activity, could not be supported. Since co-contraction of antagonist pairs remained the same or even increased, the hypothesis that there would be a decrease in muscle co-contraction as a result of practice, was not confirmed. This study was probably too short for the novice subjects to explore this new task of wheelchair propulsion completely and reach an optimum in terms of cycle frequency and muscle activity/co-contraction.     

Preferred elbow position in confined wheelchair configuration

High mechanical load leads to pain and damage in the upper extremities of wheelchair users. Wheelchair users suffer a limited range of motion of the upper extremities due to the confining wheelchair configuration. This is a key factor affecting the efficiency of wheelchair propulsion and upper extremity loading. With a view toward further understanding the interaction between the user and wheelchair, this study identifies the accessible workspace of the elbow under conventional wheelchair design and identifies the actual location and range of motion of the elbow during wheelchair propulsion. An eight-camera motion analysis system recorded the kinematics of 14 non-experienced wheelchair users. Users under standardized conservative wheelchair-sitting position moved their right elbow as widely as possible at five different wheel angles while elbow positions were recorded, thereby establishing the maximum possible elbow workspace. Actual positions of the right elbow were recorded during wheelchair propulsion. The arc angles of the elbow workspace range from 68.8° to 83.4° and are located at the lateral and posterior quadrant of the circle on which the elbow trajectories located. Reachable workspace is smaller when the hand holds the hand rim at a larger wheel angle. The preferred positions for propulsion are located approximately 2/3's of the way through the total workspace. The obtained data will be useful for improved wheelchair design and biomechanical modeling of the wheelchair/user system.     

Drag force mechanical power during an actual propulsion cycle on a manual wheelchair

The object of this study was to compute the mechanical power of the resultant braking force during an actual propulsion cycle with a manual wheelchair on the field. The resultant braking force was calculated from a mechanical model taking into account the rolling resistances of the front and rear wheels. Both the resultant braking force and the wheelchair velocity were not constant during the propulsion cycle and varied according to the subject's fore-and-aft and vertical movements in the wheelchair. These variations had logical repercussions on the braking force mechanical power, which ranged from 20.6 to 34.5 W (mean = 29.6 W) during the propulsion cycle. The mechanical power was also calculated from the conditions of a classical drag test, by the product of the cycle mean velocity and a constant braking force corresponding to a 60% rear wheels distribution of the subject-and-wheelchair's weight. This second mechanical power (32.4 W) was 10% higher than the average of the instantaneous power. Beyond the need of a clear definition of the two phases of the propulsion cycle, this study showed that the assumption on wheelchair locomotion usually admitted on laboratory ergometers cannot be applied in field studies, and that the kinetic energy variations during the cycle propulsive phase should be considered for evaluating the subject's mechanical work and power.     

Shoulder demands in manual wheelchair users across a spectrum of activities

ObjectiveInvestigate shoulder joint kinetics over a range of daily activity and mobility tasks associated with manual wheelchair propulsion to characterize demands placed on the shoulder during the daily activity of manual wheelchair users.DesignCase series.SubjectsTwelve individuals who were experienced manual wheelchair users.MethodsUpper extremity kinematics and handrim wheelchair kinetics were measured over level propulsion, ramp propulsion, start and stop over level terrain, and a weight relief maneuver. Shoulder intersegmental forces and moments were calculated from inverse dynamics for all conditions.ResultsWeight relief resulted in significantly higher forces and ramp propulsion resulted in significantly higher moments than the other conditions. Surprisingly, the start condition resulted in large intersegmental moments about the shoulder equivalent with that of the ramp propulsion, while the demand imparted by the stop condition was shown to be equivalent to level propulsion across all forces and moments.ConclusionsThis study provides characterization of daily living and mobility activities associated with manual wheelchair propulsion not previously reported and identifies activities that result in higher shoulder kinetics when compared to standard level propulsion.