Research Article| Volume 18, ISSUE 6, PS46-S52, July 2003

Wrist kinematic characterization of wheelchair propulsion in various seating positions: implication to wrist pain


      Objective. To investigate wrist kinematic characterization at various wheelchair seat positions.
      Design. A comparative study using a repetitive measures design.
      Background. People who use wheelchairs often sit on pressure-relief cushions, increasing the seat height. Wrist kinematic properties during manual propulsion could be altered. Wrist kinematics from a clinical perspective has not been previously investigated. This study characterizes wrist kinematic performance of subjects during manual wheelchair propulsion at various seat positions.
      Methods. Subjects for this investigation were 11 people with disabilities who use wheelchairs. Combinations of horizontal positions of the rear wheel and vertical seat height were evaluated. Consecutive EMG, wrist joint angle, and trigger signals were collected.
      Results. Altered seat height resulted in significant changes to temporal phases and wrist kinematic parameters; however, altered horizontal seat position did not cause significant variations. For all seat positions investigated, wrist extensor and flexor EMG signals maintained a similar level of contraction.
      Conclusion. During wheelchair propulsion, seat height was found to be a critical factor affecting the temporal parameters of movement and wrist kinematic properties of the subjects. Wrist joint angles and wrist flexion–extension range of motion all varied according to seat height. Observations and statistical analysis of the results provided useful information; however, an ideal seat position was not indicated.Relevance
      Study results have enhanced our understanding of wheelchair design, and should aid in development of future designs. In addition, the results may provide a strategy for dealing with the onset of arm/wrist pain and the prevention of carpal tunnel syndrome and other soft tissue injuries in people who use wheelchairs.


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        • Aljure J.
        • Eltorai I.
        • Bradley W.E.
        • Johnson B.
        Carpal tunnel syndrome in paraplegics.
        Paraplegia. 1985; 23: 182
        • Armstrong T.J.
        • Foulke J.A.
        • Joseph B.S.
        • Goldstein S.A.
        Investigation of cumulative trauma disorders in a poultry processing plant.
        AIHAJ. 1982; 43: 103-116
        • Burnham R.
        • Chan M.
        • Hazlett C.
        • Laskin J.
        • Steadward R.
        Acute median nerve dysfunction from wheelchair propulsion: the development of a model and study of the effect of hand protection.
        Arch. Phys. Med. Rehabil. 1994; 75: 513-518
        • Burnham R.S.
        • Higgins J.
        • Steadward R.D.
        Wheelchair basketball injuries.
        Palaestra. 1994; 10: 43-49
        • Burnham R.S.
        • Steadward R.D.
        Upper extremity peripheral nerve entrapments among wheelchair athletes: prevalence, location, and risk factors.
        Arch. Phys. Med. Rehabil. 1994; 75: 519-524
        • Clifford J.C.
        • Israels H.
        Provocative exercise maneuver: its effect on nerve conduction studies in patients with carpal tunnel syndrome.
        Arch. Phys. Med. Rehabil. 1994; 75: 8-11
        • Cooper R.A.
        Wheelchair Selection and Configuration.
        Demos Medical Publishing, 1998 (pp. 271–280 and pp. 297–321)
        • Curtis K.A.
        • Dillon D.A.
        Survey of wheelchair athletic injuries common patterns and prevention.
        Paraplegia. 1985; 23: 170-175
        • Dozono K.
        • Hachisuka K.
        • Hatada
        • Ogata H.
        Peripheral neuropathies in the upper extremities of paraplegic wheelchair marathon racers.
        Paraplegia. 1995; 33: 208-211
        • Gellman H.
        • Chandler D.
        • Sie I.
        • Petraset J.P.
        • Adkins R.
        • Waters R.L.
        Carpal tunnel syndrome in paraplegics: a study of carpal tunnel pressures.
        J. Bone Jnt. Surg. 1988; 70: 517-519
        • Hughes C.J.
        • Weimar W.H.
        • Sheth P.N.
        • Brubaker C.E.
        Biomechanics of wheelchair propulsion as a function of seat position and user-to-chair interface.
        Arch. Phys. Med. Rehabil. 1992; 73: 263-269
        • Loslever P.
        • Ranaivosoa A.
        Biomechanical and epidemiological investigation of carpal tunnel syndrome at workplaces with high risk factors.
        Ergonomics. 1993; 36: 537-555
        • Masse L.C.
        • Lamontagne M.
        • O’Riain M.D.
        Biomechanical analysis of wheelchair propulsion for various seating positions.
        J. Rehabil. Res. Dev. 1992; 29: 12-28
        • Peizer E.
        • Wright D.
        • Freiberg H.
        Bioengineering methods of wheelchair evaluation.
        Bull. Prosthet. Res. 1964; 10: 77-100
        • Phalen G.
        The carpal tunnel syndrome-clinical evaluation of 598 hands.
        Clin. Orthop. 1972; 83: 29-40
        • Shimada S.D.
        • Robertson R.N.
        • Bonninger M.L.
        • Cooper R.A.
        Kinematic characterization of wheelchair propulsion.
        J. Rehabil. Res. Dev. 1998; 35: 210-218
        • Veeger H.E.
        • Meershoek L.S.
        • van der Woude L.H.
        • Langenhoff J.M.
        Wrist motion in handrim wheelchair propulsion.
        J. Rehabil. Res. Dev. 1998; 35: 305-313
        • Woude L.H.V.
        • Veeger H.E.J.
        • Rozendal R.H.
        • Schenau G.J.
        • Rooth F.
        • Nierop P.
        Wheelchair racing: effects of rim diameter and speed on physiology and technique.
        Med. Sci. Sports Exerc. 1988; 20: 492-500
        • Woude L.H.
        • Veeger D.
        • Rozendal R.H.
        • Sargeant T.J.
        Seat height in handrim wheelchair propulsion.
        J. Rehabil. Res. Dev. 1989; 26: 37-46
        • Zipp S.
        Recommendations for the standardization of lead position in surface electromyography.
        Eur. J. Appl. Physiol. 1982; : 5041-5054