• Physical Therapy Korea
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• v.9 no.2
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• pp.19-32
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• 2002

The purpose of this paper is to provide the reader with a pertinent information and research trends of biomechanics in wheelchair propulsion. Biomechanical studies for wheelchair propulsion mainly focus on the most suitable propulsion performance and methods for preventing upper extremity injuries. Recent issues have concentrated on wheelchair propulsion style and cycle mainly because of the high prevalence of repetitive strain injuries in the upper extremely such as shoulder impingement and carpel tunnel syndrome. Optimizing wheelchair propulsion performances as well as medical reflections are presented throughout the review. Information on the underlying musculoskeletal mechanisms of wheelchair propulsion has been introduced through a combination of data collection under experimental conditions and a more fundamental mathematical modelling approach. Through a synchronized analysis of the movement pattern and muscular activity pattern, insight has been gained in the wheelchair propulsion dynamics of people with a different level of disability (various level of physical activity and functional potential). Through mathematical modelling simulation, and optimization (minimizing injury and maximizing performance), underlying musculoskeletal mechanisms during Wheelchair propulsion is investigated.

• Physical Therapy Korea
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• v.11 no.4
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• pp.7-17
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• 2004

Individuals who propel wheelchairs have a high prevalence of upper extremity injuries (i.e., carpal tunnel syndrome, elbow/shoulder tendonitis, impingement syndrome). Musculoskeletal injuries can result from overuse or incorrect use of manual wheelchairs, and can hinder rehabilitation efforts. To better understand the mechanisms of upper extremity injuries, this study investigates the motion of the wrist during wheelchair propulsion. This study also examines changes in the variables that occur with fatiguing wheelchair propulsion to determine how the time parameters of wheelchair propulsion and the state of fatigue influence the risk of injury. A two dimensional (2-D) analysis of wrist movement during the wheelchair stroke was performed. Twenty subjects propelled a wheelchair handrim on a motor-driven treadmill at two different velocities (50, 70 m/min). The results of this study were as follows; The difference in time parameters of wheelchair propulsion (cadence, cycle time, push time, recovery time, and PSP ratio) at two different velocities was statistically significant. The wrist kinematic characteristics had statistically significant differences at two different velocities, but wrist radial deviation and elbow flexion/extension had no statistically significant differences. There were statistically significant differences in relation to fatigue in the time parameter of wheelchair propulsion (70 m/min) between initial 1 minute and final 1 minute. The wrist kinematic characteristics between the initial 1 minute and final 1 minute in relation to fatigue had statistically significant differences but the wrist flexion-extension (50 m/min) had no statistically significant differences. According to the results, the risk of musculoskeletal injuries is increased by fatigue from wheelchair propulsion. To prevent musculoskeletal injuries, wheelchair users should train in a muscle endurance program and consider wearing a splinting/grove. Moreover, wheelchair users need education on propulsion posture, suitable joint position, and proper recovery patterns of propulsion.

• Physical Therapy Korea
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• v.10 no.2
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• pp.1-10
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• 2003

This study was carried out to help the comprehensive rehabilitation of spinal cord injuries by measuring propulsion force and endurance exerted on wheelchair handrims, and predicting the differences among three different rear axle positions. The BTE (Baltimore Therapeutic Exerciser) work simulator was used on 9 paraplegia to test the force and endurance during wheelchair propulsion. The 141 large wheel of the BTE work simulator and a standard wheelchair with removed handrims were used for simulating wheelchair propulsion. The neurological and demographical characteristics of the patients were collected by personal interviews and direct examinations. The Kruskal-Wallis test was used to compare force and endurance among the groups. The strongest maximum isometric strength was produced when the rear axle of the wheelchair and the acromion process were on the same coronal plane. Although there were no significant differences statistically, moving the rear axle forward did result in greater isotonic strength. The research suggests that better functional activity of persons with paraplegia is possible when the rear axle of the wheelchair is appropriately adjusted.

• Journal of Biomedical Engineering Research
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• v.43 no.4
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• pp.241-250
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• 2022

It is known that chronic pain and injury of upper limb joint tissue in manual wheelchair users is usually caused by muscle imbalance, and the propulsion speed is reported to increase this muscle imbalance. In this study, kinematic variables, electromyography, and ultrasonographic images of the upper limb were measured and analyzed at two different propulsion speeds to provide a quantitative basis for the risk of upper extremity joint injury. Eleven patients with spinal cord injury for the experimental group (G_E) and 27 healthy adults for the control group (G_C) participated in this study. Joint angles and electromyography were measured while subjects performed self-selected comfortable and fast-speed wheelchair propulsion. Ultrasound images were recorded before and after each propulsion task to measure the acromiohumeral distance (AHD). The range of motion of the shoulder (14.35 deg in G_E; 20.24 deg in G_C) and elbow (5.25 deg in G_E; 2.57 deg in G_C) joints were significantly decreased (p<0.001). Muscle activation levels of the anterior deltoid, posterior deltoid, biceps brachii, and triceps brachii increased at fast propulsion. Specifically, triceps brachii showed a significant increase in muscle activation at fast propulsion. AHD decreased at fast propulsion. Moreover, the AHD of G_E was already narrowed by about 60% compared to the G_C from the pre-tests. Increased load on wheelchair propulsion, such as fast propulsion, is considered to cause upper limb joint impingement and soft tissue injury due to overuse of the extensor muscles in a narrow joint space. It is expected that the results of this study can be a quantitative and objective basis for training and rehabilitation for manual wheelchair users to prevent joint pain and damage.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2010.05a
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• pp.1421-1422
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• 2010

• The Journal of Korean Physical Therapy
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• v.13 no.3
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• pp.777-789
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• 2001

The purpose of this study was to investigate the possibility of using surface electromyographic signals as a measure of muscle fatigue during the wheelchair propulsion. Subjects performed wheelchair exercise tests on a motor-driven treadmill with a constant-velocity of 1.25 m/sec. During each test, the raw EMC signals were acquired from the surface electrodes attached on the belly of five muscle groups: biceps brachii, pectoralis major. deltoid, triceps brachii, and trapezius. The median power frequency(MPF), and the root mean square(RMS) amplitude were calculated for each cyclic contraction in order to quantify muscle fatigue. During the wheelchair propulsion, the MPF decreased and the RMS increased in the trapezius and deltoid. However, the decreasing MPF and the increasing RMS also fluctuated severly during dynamic muscle contractions. Therefore, the MPF and RMS values should be estimated with well-designed methods and used with caution to quantify muscle fatigue during wheelchair propulsion.

• Journal of rehabilitation welfare engineering & assistive technology
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• v.7 no.1
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• pp.21-27
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• 2013

Manual wheelchair propulsion can lead to pain and injuries of users due to mechanical inefficiency of wheelchair propulsion motion. The kinetic analysis of the upper limbs during manual wheelchair propulsion needs to be studied. A two dimensional inverse dynamic model of upper limbs was developed to compute the joint torque during manual wheelchair propulsion. The model was composed of three segments corresponding to upper arm, lower arm and hand. These segments connected in series by revolute joints constitute open chain mechanism in sagittal plane. The inverse dynamic method is based on Newton-Euler formalism. The model was applied to data collected in experiments. Kinematic data of upper limbs during wheelchair propulsion were obtained from three dimensional trajectories of markers collected by a motion capture system. Kinetic data as external forces applied on the hand were obtained from a dynamometer. The joint rotation angles and joint torques were computed using the inverse dynamic model. The developed model is for upper limbs biomechanics and can easily be extended to three dimensional dynamic model.

• Proceedings of the KSME Conference
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• 2001.06c
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• pp.464-469
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• 2001

This work provides the biomechanical evaluations of a manual wheelchair with a bi-directional driving system. The new propulsion strategy can be accomplished by employing a special gear system that converts the oscillatory motion of a handrim into the unidirectional output motion of a wheel. A main feature of the forward. backward propulsion is to supply continuous driving torque without break. Motion. analysis has been performed through 2-dimensional image processing for measuring the kinematic properties of the upper arm and fore arm. Then, the inverse dynamics analysis has been done for obtaining the joint torques, the handrim forces and input/output powers. Results show that the output power by the forward. reverse propulsion is almost twice as much as that by conventional propulsion. Also, the new propulsion is expected to reduce the fatigues and injuries at arm joints by employing more muscle groups for movement. In conclusion, the forward. reverse propulsion can greatly improve the performances of manual wheelchairs by providing better mobility as well as by guaranteeing several advantages from a biomechanical viewpoint. Future development of a manual wheelchair optimized for the bi-directional propulsion will further improve the propulsion performances.

• Physical Therapy Korea
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• v.12 no.2
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• pp.1-10
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• 2005

Pressure ulcers are serious complications of tissue damage that can develop in patients with diminished pain sensation and diminished mobility. Pressure ulcers can result in irreversible tissue damage caused by ischemia resulting from external loading. There are many intrinsic and extrinsic contributors to the problem, including interface tissue pressure, shear, temperature, moisture, hygiene, nutrition, tissue tolerance, sensory and motor dysfunction, disease and infection, posture, and body support systems. The purposes of this study were to investigate the relationship between buttock interface pressure and seating position, wheelchair propulsion speed. Seated-interface pressure was measured using the Force Sensing Array pressure mapping system. Twenty subjects propelled wheelchair handrim on a motor-driven treadmill at different velocities (40, 60, 80 m/min) and seating position used recline ($100^{\circ}$, $110^{\circ}$, $120^{\circ}$) with a wheelchair simulator. Interface pressure consists of average (mean of the pressure sensor values) and maximum pressure (highest individual sensor value). The results of this study were as follows; No significant correlation in maximum/average pressure was found between a static position and a 40 m/min wheelchair propulsion (p>.05). However, a significant increase in maximum/average pressure were identified between conditions of a static position and 60 m/min, and 80 m/min wheelchair propulsion (p<.05). No significant correlation in maximum pressure were found between a $90^{\circ}$ recline (neutral position) and a $100^{\circ}$, $110^{\circ}$, or $120^{\circ}$ recline of the wheelchair back (p>.05). No significant difference in average pressure was found between conditions of a $90^{\circ}$ recline and both a $100^{\circ}$ and $110^{\circ}$ recline of wheelchair back. However, a significant reduction in average pressure was identified between conditions of a $90^{\circ}$ and $120^{\circ}$ recline of wheelchair back (p<.05). This study has shown some interesting results that reclining the seat by $120^{\circ}$ reduced average interface pressure, including the reduction or prevention in edema. And interface pressure was greater during dynamic wheelchair propulsion compared with static seating. Therefore, the optimal seating position and seating system ought to provide postural control and pressure relief. We need an education on optimal seating position and a suitable propulsion speeds for wheelchair users.

• Korean Journal of Applied Biomechanics
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• v.17 no.3
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• pp.225-232
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• 2007

This work intends to investigate the effects of shift characteristics on the propulsion performance of a manual wheelchair with an automatic transmission. A planetary gear train is employed to generate a two-stage shift automatically, based on the distance traveled from rest. Motion analysis has been performed for measuring kinematic properties of the arm and then the inverse dynamics has been applied for estimating joint forces/torques. Then, a parametric study has been performed to find a set of the shift ratios and the shift intervals for optimizing propulsion performance. Results show that the propulsion performance is closely related to the shift condition. It is found that a short shift interval is desirable for a short distance propulsion. However, an optimum shift interval for a long distance propulsion is inversely proportional to the shift ratio approximately. Consequently, the automatic transmission can greatly lower the joint loadings by the speed reduction, which eventually contribute to prevent joint injuries of wheelchair users.