Influence of training on biomechanics of wheelchair propulsion. Handrim wheelchair propulsion training effect on overground propulsion using biomechanical real-time visual feedback. Effect of an abdominal binder during wheelchair exercise. Power-assisted wheels ease energy costs and perceptual responses to wheelchair propulsion in persons with shoulder pain and spinal cord injury. Effects of inspiratory muscle training on respiratory function and repetitive sprint performance in wheelchair basketball players The COSTAR wheelchair study: a two-centre pilot study of self-propulsion in a wheelchair in early stroke rehabilitation EMG Biofeedback and Exercise for Treatment of Cervical and Shoulder Pain in Individuals with a Spinal Cord Injury: A Pilot Study. Strengthening and Optimal Movements for Painful Shoulders (STOMPS) in Chronic Spinal Cord Injury: A Randomized Controlled Trial Exercise with physically restrained nursing home residents: maximizing benefits of restraint reduction. The longitudinal relation between physical capacity and wheelchair skill performance during inpatient rehabilitation of people with spinal cord injury. Physical work capacity after 7 wk of wheelchair training: effect of intensity in able-bodied subjects. Physical capacity after 7 weeks of low-intensity wheelchair training
A quasi-experimental longitudinal design was used to compare pre- and posttraining biomechanical and physiological characteristics of wheelchair propulsion in manual wheelchair users ( MWCU ) across fresh and fatigue states . An instrumented wheelchair ergometer , 3D motion analysis , and computerized open-circuit spirometry were used to collect joint kinetics and kinematics , h and rim kinetics , propulsion temporal characteristics , and oxygen uptake pre- and posttraining during a submaximal exercise test to exhaustion . Each subject ( n = 19 ) participated in a specific intervention program of supervised therapeutic exercise ( strengthening , stretching , and aerobic exercise ) for 6 weeks . Pre- and posttraining measurements were compared with the use of ANOVA with repeated measures . Significant training effects included increased exercise loads for all strengthening activities , decreased stroke frequency , increased maximum elbow extension angle , increased trunk and shoulder flexion/extension range of motion ( ROM ) , increased h and rim propulsive moment , increased wrist extension moment , and increased power output . Results suggest that this training program increased biomechanical economy ( as defined by propulsive moment ) without increasing shoulder or elbow joint stresses OBJECTIVE To compare the effects of 2 manual wheelchair propulsion training programs on h and rim kinetics , contact angle , and stroke frequency collected during overground propulsion . DESIGN R and omized controlled trial comparing h and rim kinetics between 3 groups : a control group that received no training , an instruction-only group that review ed a multimedia presentation , and a feedback group that review ed the multimedia presentation and real-time visual feedback . SETTING Research laboratory . PARTICIPANTS Full-time manual wheelchair users ( N=27 ) with spinal cord injury living in the Pittsburgh area . INTERVENTIONS Propulsion training was given 3 times over 3 weeks , and data were collected at baseline , immediately after training , and at 3 months . MAIN OUTCOME MEASURES Contact angle , stroke frequency , peak result ant force , and peak rate of rise of result ant force . RESULTS Both feedback and instruction-only groups improved their propulsion biomechanics across all surfaces ( carpet , tile , and ramp ) at both target and self-selected speeds compared with the control group . While controlling for velocity , both intervention groups showed long-term reductions in the peak rate or rise of result ant force , stroke frequency , and increased contact angle . CONCLUSIONS Long-term wheelchair users in both intervention groups significantly improved many aspects of their propulsion technique immediately after training and 3 months from baseline . Furthermore , training with a low-cost instructional video and slide presentation was an effective training tool alone The purpose of this study was to determine whether use of an abdominal binder would affect oxygen uptake , trunk range of motion , and duration of the stroke phase during wheelchair propulsion . The subjects were six paraplegic wheelchair athletes with T1-T6 injuries and no abdominal muscle function . Each subject performed two trials , one while wearing the binder and one without the binder . Each trial consisted of submaximal and maximal exercise tests conducted on wheelchair rollers . Oxygen uptake was determined by open circuit spirometry while heart rate was determined by telemetry . Max VO2 values averaged 2.51 l.min-1 while average maximum heart rate values were 190 b.min-1 . A 3-D video-based motion analysis system was used to obtain kinematic parameters of wheelchair propulsion . In general , 30 % of the cycle time was comprised of the stroke phase , while 70 % was comprised of the recovery phase across speeds . There were no statistically significant effects of the abdominal binder on any of the cardiovascular or kinematic variables at submaximal or maximal levels of exercise . Under the conditions of this laboratory investigation , it appears that an abdominal binder does not alter physiological or selected biomechanical measures in highly trained athletes OBJECTIVE Test effects of pushrim-activated power-assisted wheelchairs ( PAPAWs ) on the energetics and perceptual responses to steady-state and intensity- grade d wheelchair propulsion in persons with paraplegia and tetraplegia having chronic shoulder pain . DESIGN Test , retest with a control condition . SETTING Academic medical center . PARTICIPANTS Subjects ( N=18 ) aged 19 to 70 years with chronic , motor-complete paraplegia and tetraplegia having confirmed shoulder pain . INTERVENTIONS Study participants underwent testing on 4 r and omized nonconsecutive days during either 6 minutes of steady-state or 12 minutes of intensity- grade d wheelchair propulsion on stationary rollers . Participants used their own manual wheelchair and either their customary wheels or power-assist wheels attached with an axle bracket . MAIN OUTCOME MEASURES Oxygen consumption ( V(.)O2 , L/min ) , distance ( m ) , energy cost ( L/m ) , and ratings of perceived exertion ( RPE ; Borg Categorical 6 - 20 Scale ) were measured during propulsion . RESULTS Significant main effects of testing were observed for V(.)O2 , heart rate , and RPE in both subject groups . Distances propelled were significantly increased in both groups across both tests and in each of their 2-minute exercise stages . CONCLUSIONS Use of PAPAWs by persons with paraplegia and tetraplegia having shoulder pain significantly lowers energy cost responses and perceived exertion compared with manual wheelchair propulsion while significantly increasing the distanced propelled Background There is considerable evidence that respiratory muscle training improves pulmonary function , quality of life and exercise performance in healthy athletic population s. The benefits for wheelchair athletes are less well understood . Therefore , in the present study , influence of inspiratory muscle training ( IMT ) on respiratory function and repetitive propulsive sprint performance in wheelchair basketball players was examined . Methods Using a placebo-controlled design , 16 wheelchair athletes were divided to an experimental ( IMT ; n=8 ) or placebo ( sham-IMT ; n=8 ) group based on selective grouping criteria . 30 dynamic breaths were performed by the IMT group twice daily at a resistance equivalent to 50 % maximum inspiratory pressure ( MIP ) , and 60 slow breaths were performed by the sham-IMT group once a day at 15 % MIP for a period of 6 weeks . Results In the IMT group , both MIP and maximum expiratory pressure ( 17 % and 23 % , respectively ; p≤0.03 ) were improved . Similar improvements were noted for the sham-IMT group with 23 % and 33 % from baseline for MIP and maximum expiratory pressure , respectively ( p≤0.03 ) . There were no significant changes in pulmonary function at rest and any of the performance parameters associated with the repetitive sprint test ( sprint and recovery times , peak heart rate and peak blood lactate concentration ) . Reported experiences of using the IMT training device suggested “ less breathlessness ” and “ less tightness in the chest during the training ” . Conclusions Although there was no improvement in sprint performance , an improved respiratory muscle function and quality of life were reported by participants in both the IMT and sham-IMT groups Objective : It is uncertain whether self-propulsion in a wheelchair should be encouraged or discouraged in the early stages of stroke rehabilitation . Design : A two-centre pilot study to assess the feasibility of performing a multicentre r and omized controlled trial on this subject . Setting : Clatterbridge and Aintree Stroke Rehabilitation Units , Merseyside , UK . Subjects : Forty early stroke patients ( mean age 67 years ) in whom it was uncertain whether self-propulsion in a wheelchair should be encouraged were studied . Intervention : A central r and omization service at Newcastle University was used to determine the policy about wheelchair provision and use for each patient . They were allocated to either an ‘ encouraged to self-propel ’ or a ‘ discouraged from self-propulsion group ’ . Outcome measures used : Independent outcome assessment was performed by postal question naire and telephone interview using the Barthel ADL Scale , Nottingham Extended ADL Scales and the shortened General Health Question naire ( GHQ-12 ) at 3 and 12 months . Patient 's length of stay and their Ashworth tone score were also measured either at three months or when they were discharged from hospital . Results : After considerable preparation time it was possible to conduct a trial on self-propulsion in early stroke rehabilitation in the two-pilot centres . No major differences were found between the pilot groups for any of the outcome measures . Conclusions : A multicentre r and omized controlled trial to assess this question is feasible but further work is being conducted before proceeding , to satisfy the concerns expressed to our group regarding the appropriateness of the intervention and the outcome measures . Address for correspondence : JA Barrett , Clatterbridge Hospital , Wirral , Merseyside CH69 4JY , UK . e-mail : BACKGROUND Chronic or recurrent musculoskeletal pain in the cervical and shoulder region is a common secondary problem after spinal cord injury ( SCI ) , reported by 30 % to 70 % of individuals . OBJECTIVE The purpose of this study was to investigate the effect of electromyographic ( EMG ) biofeedback training , in addition to a st and ard exercise program , on reducing shoulder pain in manual wheelchair users with SCI . METHODS Fifteen individuals with SCI , C6 or lower , who were manual wheelchair users with shoulder pain were r and omly assigned to 1 of 2 interventions . The Exercise group ( n = 7 ) received instruction on a st and ard home-based exercise program . The EMG Biofeedback plus Exercise group ( n = 8) received identical exercise instruction plus EMG biofeedback training to improve muscle balance and muscle relaxation during wheelchair propulsion . Shoulder pain was assessed by the Wheelchair Users Shoulder Pain Index ( WUSPI ) at baseline , at posttest 10 weeks after the start of intervention , and at follow-up 16 weeks after posttest . RESULTS The number of participants per group allowed only within-group comparisons ; however , the findings indicated a beneficial effect from EMG biofeedback training .  Shoulder pain , as measured by WUSPI , decreased 64 % from baseline to posttest for the EMG Biofeedback plus Exercise group ( P = .02 ) . Shoulder pain for the Exercise group decreased a nonsignificant 27 % . At follow-up , both groups showed continued improvement , yet the benefit of EMG biofeedback training was still discernible . The EMG Biofeedback plus Exercise group had an 82 % reduction in shoulder pain from baseline to follow-up ( P = .004 ) , while the Exercise group showed a 63 % reduction ( P = .03 ) over the same time period . CONCLUSIONS This study provides preliminary evidence that EMG biofeedback has value when added to an exercise intervention to reduce shoulder pain in manual wheelchair users with SCI . These findings indicate that EMG biofeedback may be valuable in remediating musculoskeletal pain as a secondary condition in SCI . This preliminary conclusion will need to be studied and verified through future work Background Shoulder pain is a common problem after spinal cord injury ( SCI ) , with negative effects on daily activities and quality of life ( QOL ) . Objective The purpose of this study was to determine the effect of an exercise program and instruction to optimize performance of upper-extremity tasks on shoulder pain in people with paraplegia from SCI . Methods / Design Eighty individuals with paraplegia from SCI and shoulder pain were r and omly assigned to receive either an exercise/movement optimization intervention or an attention control intervention . The exercise/movement optimization intervention consisted of a 12-week home-based program of shoulder strengthening and stretching exercises , along with recommendations on how to optimize the movement technique of transfers , raises , and wheelchair propulsion . The attention control group viewed a 1-hour educational video . Outcome measures of shoulder pain , muscle strength ( force-generating capacity ) , activity , and QOL were assessed at baseline , immediately after intervention , and 4 weeks later . Results Shoulder pain , as measured with the Wheelchair User 's Shoulder Pain Index , decreased to one third of baseline levels after the intervention in the exercise/movement optimization group , but remained unchanged in the attention control group . Shoulder torques , most 36-Item Short-Form Health Survey question naire ( SF-36 ) subscale scores , and QOL scores also were improved in the exercise/movement optimization group , but not in the attention control group . Improvements were maintained at the 4-week follow-up assessment . Limitations Many of the outcome measures were self-reported , and the participant dropout rate was high in both groups . Additional studies are needed to determine whether the results of this study can be generalized to individuals with tetraplegia . Conclusions This home-based intervention was effective in reducing long-st and ing shoulder pain in people with SCI . The reduction in pain was associated with improvements in muscle strength and health-related and overall QOL OBJECTIVE To evaluate an exercise protocol design ed to improve strength and mobility , and to decrease injury risk factors in physically restrained nursing home residents . DESIGN A r and omized controlled trial . PARTICIPANTS Ninety-seven residents were r and omized into either exercise or control groups . Thirty-five exercise and 37 control group residents completed all post- assessment s after a 9-week trial . INTERVENTION Walking or wheelchair movement training was supplemented by rowing exercise three times per week . Practice in behaviors related to safe movement was provided incidental to the exercise . MEASUREMENT Endurance , speed , and injury risk measures relevant to walking , wheelchair propulsion , and st and ing were assessed by st and ardized protocol s. Rowing endurance , rowing range of motion , and h and grip strength measures were collected to assess the effect of the rowing component of the exercise protocol . RESULTS Fifty-four percent of the subjects who provided consent did not complete the protocol because of health status changes , lack of cooperation , or physical limitations that precluded exercise . The subjects who completed the exercise program showed significant improvement on injury risk and measures related to upper body strength ( h and grip strength , rowing endurance , wheelchair endurance , and speed ) . Measures related to lower body strength did not significantly improve . CONCLUSION Physically restrained residents are very frail , and it is difficult to implement a long-term exercise program with many residents because of the frailty . However , a substantial proportion of residents did cooperate well with the exercise program and showed improvement on measures correlated with decreased injury risk . The exercise program could be easily modified to include more lower body exercise , and the result ant protocol would be an important adjunct to restraint reduction programs OBJECTIVE To study the longitudinal relation between physical capacity and wheelchair skill performance in subjects with spinal cord injury ( SCI ) during rehabilitation . DESIGN Observational prospect i ve cohort study . Measurements were taken 3 times during subjects ' rehabilitation . SETTING Eight rehabilitation centers in the Netherl and s. PARTICIPANTS Ninety-seven subjects with SCI . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Parameters of physical capacity were upper-extremity muscle strength ( manual muscle test [ MMT ] sum score ) , peak oxygen uptake , and peak power output ( POpeak ) . The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores : ability , performance time , and physical strain . RESULTS POpeak was related to all 3 scores of the Wheelchair Circuit , and the MMT sum score was related to the ability score and the performance time score . The results indicate that ( 1 ) subjects with higher values of POpeak and /or the MMT sum score had better scores on the Wheelchair Circuit than subjects with lower values and ( 2 ) when a subject increased his/her POpeak and /or MMT sum score , this was associated with better wheelchair skill scores . CONCLUSIONS There is a significant longitudinal relation between wheelchair skill performance and POpeak and MMT sum score during the rehabilitation of people with SCI . To optimize wheelchair skill performance , attention should be directed toward manual wheelchair exercise training and strength training of the upper body PURPOSE The purpose of this study was to study the effects of a 7-wk wheelchair training program on physical work capacity in able-bodied subjects . Effects of training intensities of 50 and 70 % heart rate ( HR ) reserve ( HRR ) were studied for different subject groups . METHODS Twenty-seven able-bodied male subjects participated in this study . They were r and omly divided into a control group ( N = 8) , a 50%-intensity group ( N = 9 ) , and a 70%-intensity group ( N = 10 ) . The 50%- and the 70%-intensity groups received a 7-wk wheelchair training program : three times a week , one-half hour wheelchair exercise on a motor driven treadmill at an average intensity of 50 and 70 % of the HRR , respectively . Before and after the training period , parameters for physical work capacity ( maximal isometric strength ( Fiso ) , sprint power ( P30 ) , maximal power output ( POmax ) and peak oxygen uptake ( VO2peak ) ) , and submaximal performance ( mechanical efficiency , HR ) at 20 and 40 % of the estimated POmax ( ME20 , ME40 ; HR20 , HR40 ) were obtained during tests on a stationary wheelchair ergometer . RESULTS A two-factor ANOVA for repeated measures on the within-subjects factor " pre-post tests , " the between-subject factor training ( 50 % and 70 % training vs control ) and the interaction term showed that the 50%-intensity group significantly increased on P30 and POmax compared with the control group . The 70 % intensity group significantly increased on P30 , POmax and VO2peak compared with the control group ( P < 0.05 ) . The 70 % group did not show significantly higher increases in P30 and POmax over training than the 50 % intensity . No significant effects were found for the Fiso and the parameters at submaximal PO . CONCLUSIONS The wheelchair training at both intensities can have favorable effects on maximal physical work capacity in able-bodied subjects , and possibly also on mechanical efficiency at submaximal power output . Effects are seen in parameters for both aerobic and anaerobic work capacities . Although training at 70 % intensity was more effective than the 50 % intensity , training at 50 % HRR may initially be more appropriate in untrained individuals , such as novice wheelchair users at the start of their rehabilitation , to prevent fatigue and enhance motivation Purpose . To simulate the effect of low-intensity exercise in early rehabilitation , we investigated the effect of a 7-week low-intensity norm duration h and rim wheelchair training on the physical capacity in untrained able-bodied individuals . Method . Twenty-five able-bodied participants were r and omly assigned to an experimental and control group : 10 participants exercised 7 weeks , three times a week at 30 % heart rate reserve ( HRR ) for 30 min ( experimental group ) . The control group consisted of  15 participants who did not receive training .  Physical capacity ( maximal isometric strength , sprint power , peak power output and peak oxygen uptake ) and submaximal performance [ heart rate ( HR ) , oxygen uptake ( VO2 ) , mechanical efficiency ( ME ) ] were assessed pre- and post-training . The levels of upper-body discomfort were determined with the use of a Local Perceived Discomfort scale . Results . Compared to the control group the experimental group significantly improved on sprint power ( + 31.2 % ) , peak aerobic power output ( + 34 % ) , submaximal HR , VO2 and ME ( + 16.9 % ) . The participants did not experience high levels of local discomfort in the upper body during the training . Conclusions . Low-intensity norm duration h and rim wheelchair training which significantly improved peak aerobic and sprint power output , efficiency and physical strain in able-bodied untrained individuals . Training at 30 % HRR ( 3 × /week , 30 min/session ) may be appropriate in untrained individuals , such as novice wheelchair users at the start of their rehabilitation , to prevent early fatigue and overuse and enhance motivation . Please note that this article was published in error in a previous issue of the Journal . This paper was su bmi tted and accepted as part of the Special Issue entitled 4th International State-of-the-art-Congress ‘ Rehabilitation : Mobility , Exercise & Sports ’ and has therefore been republished in this issue . The publisher apologises for this error
Conclusion : Exercise training programs seem to be effective in improving wheelchair propulsion capacity .
However , there is remarkably little research , particularly for individuals who do not have spinal-cord injury
Objective : An adequate wheelchair propulsion capacity is required to perform daily life activities .
Exercise training may be effective to gain or improve wheelchair propulsion capacity .
This review investigates whether different types of exercise training programs are effective in improving wheelchair propulsion capacity .