Hand rim-propelled manual WC are unsuitable for outdoor ambulation due to low speed and high physiological demand; they are also of little use indoors as they are difficult to maneuver under the environmental conditions and architectural restraints. So, they should not be recommended without proper assessment of the user's activity level and requirements.
Self-ambulation at free chosen speed regularly for 10-12 weeks provides efficiency and improves fitness status required for wheelchairs driven by an asynchronous arm crank propulsion technique and no special exercise programme is required.
Heart rate can be used to evaluate the ambulatory performance of the device, quantifying energy economy for outcome evaluation and decision making for clinical recommendation.
Disabled people in India frequently use the arm-crank propelled three-wheeled chair (ACWC) for outdoor transportation. Two models of these chairs are commercially available: one is powered by cranking using one arm (ACWC-1) and the other uses both arms (ACWC-2). The purpose of the study was to compare the efficiency of the two types of propulsion with respect to the standard physiological responses and, consequent upon the findings, to recommend the use of a suitable one. The energetics of locomotion of the users at their freely chosen speed (FCS) were measured and compared with changes in the physiological parameters in the within-subject groups. The study was conducted in outdoor settings to simulate the actual locomotive conditions encountered by the users in their practical life. 14 males, who had been regular and proficient users of both propulsion systems for more than last six years and who had a history of paraplegia (below the 10th thoracic vertebra, n=11) and poliomyelitis (n=3) participated in the study. The subjects were required to propel the test chair (a combination of both the propulsion systems built in a single model) on an oval track of 358 m circumference at their FCS for 5 min; ambulatory data were collected during last 3 min of exercise and averaged. The FCS (m/min), heart rates (bpm) and oxygen uptake (l/min) were measured. Physiological cost index (b/m) oxygen consumption (ml/kg/min), oxygen cost (ml/kg/m) and net locomotor energy cost (kcal/kg/km) of the two sets of observations were derived and compared using a t-test for the paired observations. The FCS was significantly higher and the physiological parameters were lower with the ACWC-2 than with ACWC-1, except for heart rate and oxygen consumption, where the difference was not significant . It is concluded that two-arm use is more efficient and less physically demanding than one-arm use in the arm-crank propulsion system and that the former is more suitable for efficient ambulation.
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