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.     

The relationship between consistency of propulsive cycles and maximum angular velocity during wheelchair racing

The purposes of this study were to examine the consistency of wheelchair athletes' upper-limb kinematics in consecutive propulsive cycles and to investigate the relationship between the maximum angular velocities of the upper arm and forearm and the consistency of the upper-limb kinematical pattern. Eleven elite international wheelchair racers propelled their own chairs on a roller while performing maximum speeds during wheelchair propulsion. A Qualisys motion analysis system was used to film the wheelchair propulsive cycles. Six reflective markers placed on the right shoulder, elbow, wrist joints, metacarpal, wheel axis, and wheel were automatically digitized. The deviations in cycle time, upper-arm and forearm angles, and angular velocities among these propulsive cycles were analyzed. The results demonstrated that in the consecutive cycles of wheelchair propulsion the increased maximum angular velocity may lead to increased variability in the upper-limb angular kinematics. It is speculated that this increased variability may be important for the distribution of load on different upper-extremity muscles to avoid the fatigue during wheelchair racing.     

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.     

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.     

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.     

Wheelchair propulsion demands during outdoor community ambulation

ObjectiveQuantify manual wheelchair propulsion effort during outdoor community ambulation.DesignCase series.SubjectsThirteen individuals (12 with SCI, 1 with spina bifida) who were experienced manual wheelchair users and had no current upper extremity injury or pain complaints.MethodsMeasurements were obtained from instrumented wheelchair rims during steady-state propulsion as subjects traversed outdoor concrete sidewalk terrain that included smooth level, aggregate level, and a ramp with a smooth surface. Propulsion effort was assessed using the average propulsion moment, average instantaneous power, and work for both upper extremities.ResultsPropulsion effort, captured by the propulsion moment, work and power, varied across ground conditions (p < 0.001). Propulsion effort was greater as the rolling resistance increased (i.e., smooth versus aggregate surfaces) and as the inclination angle progressed from level to inclined surfaces. There were no side-to-side differences across ground conditions for the propulsion moment or work. Power generation was significantly greater on the dominant compared to the non-dominant extremity during the more challenging aggregate surface and ramp conditions.ConclusionsPropulsion effort varies with demands imposed by different ground conditions. Quantification of wheelchair propulsion demands provides rehabilitations specialists with objective information to guide treatment of patients adapting to manual wheelchair use.     

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 new dynamic model of the wheelchair propulsion on straight and curvilinear level-ground paths

Independent-roller ergometers (IREs) are commonly used to simulate the behaviour of a wheelchair propelled in a straight line. They cannot, however, simulate curvilinear propulsion. To this effect, a motorised wheelchair ergometer could be used, provided that a dynamic model of the wheelchair–user system propelled on straight and curvilinear paths (WSC) is available. In this article, we present such a WSC model, its parameter identification procedure and its prediction error. Ten healthy subjects propelled an instrumented wheelchair through a controlled path. Both IRE and WSC models estimated the rear wheels' velocities based on the users' propulsive moments. On curvilinear paths, the outward wheel shows root mean square (RMS) errors of 13% in an IRE vs 8% in a WSC. The inward wheel shows RMS errors of 21% in an IRE vs 11% in a WSC. Differences between both models are highly significant (p < 0.001). A wheelchair ergometer based on this new WSC model will be more accurate than a roller ergometer when simulating wheelchair propulsion in tight environments, where many turns are necessary.     

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.     

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.     

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.     

Optimum cycle frequencies in hand-rim wheelchair propulsion. Wheelchair propulsion technique

To study the effect of different cycle frequencies on cardio-respiratory responses and propulsion technique in hand-rim wheelchair propulsion, experienced wheelchair sportsmen (WS group; n = 6) and non-wheelchair users (NW group; n = 6) performed wheelchair exercise tests on a motor-driven treadmill. The WS group wheeled at velocities of 0.55, 0.83, 1.11 and 1.39 m.s-1 and a slope of 2 degrees. The NW group wheeled at 0.83, 1.11 and 1.39 m.s-1 and a 1 degree slope. In each test, a 3-min period at a freely chosen cycle frequency (FCF: 100%) was followed by four 3-min blocks of paced cycle frequencies at 60%, 80%, 120% and 140% FCF. Effects of both cycle frequency and velocity on physiological and propulsion technique parameters were studied. Analysis of variance showed a significant effect (p less than 0.05) of cycle frequency on oxygen cost and gross mechanical efficiency in both the WS and NW group. This indicated the existence of an optimum cycle frequency which is close to the FCF at any given velocity. The optimum cycle frequency increased with velocity from 0.67 to 1.03 cps over the range studied (p less than 0.05). Oxygen cost was approximately 10% less at 100% FCF than at 60% or 140% FCF. Gross mechanical efficiency for the WS group at 100% FCF was 8.5%, 9.7%, 10.4% and 10.1%, respectively, at the four velocities.(ABSTRACT TRUNCATED AT 250 WORDS)     

An instrumented wheel for kinetic analysis of wheelchair propulsion.

An instrumented wheel system for three-dimensional kinetic analysis of upper extremity during wheelchair propulsion has been designed and validated. This system allows the direct measurements of three-dimensional dynamic forces and moments on the handrim during wheelchair propulsion in a laboratory setting as well as in the field. Static loading tests showed a high linearity and little drift (coefficient of determination, r2 > 0.999). Under dynamic loading, the instrumented wheel provided the well-matched measurement forces and moments with the predicted values from the inverse dynamic method using video-based kinematic data (correlation coefficient, p > 0.97). The three-dimensional handrim forces and moments during wheelchair propulsion by a non-disabled subject were demonstrated.     

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.     

A preliminary muscle activity analysis: Handle based and push-rim wheelchair propulsion

Approximately ninety percent of the wheelchair users worldwide prefer the conventional push rim mode of propulsion for daily mobility and rehabilitation. Even though push-rim wheelchairs help to promote a healthy life style, the high muscular demand and the non-continuous push motions can lead to serious upper extremity injuries. In this study, muscle EMG data of ten healthy subjects were recorded for a newly introduced handle based propulsion mechanism (HBP) and compared to conventional push-rim propulsion at two workloads, 25 W and 35 W respectively. The results for the mean peak muscle activations at both workloads demonstrate that push-rim propulsion leads to higher peak muscle activity compared to HBP at a similar wheelchair forward velocity of 1.11 m/s. The generation of these high peak muscle 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 prolonged propulsion.     

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.     

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.     

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.     

Effectiveness of Social Behaviors for Autonomous Wheelchair Robot to Support Elderly People in Japan

We developed a wheelchair robot to support the movement of elderly people and specifically implemented two functions to enhance their intention to use it: speaking behavior to convey place/location related information and speed adjustment based on individual preferences. Our study examines how the evaluations of our wheelchair robot differ when compared with human caregivers and a conventional autonomous wheelchair without the two proposed functions in a moving support context. 28 senior citizens participated in the experiment to evaluate three different conditions. Our measurements consisted of questionnaire items and the coding of free-style interview results. Our experimental results revealed that elderly people evaluated our wheelchair robot higher than the wheelchair without the two functions and the human caregivers for some items.