Effects of variable practice on the motor learning outcomes in manual wheelchair propulsion

Abstract

BackgroundHandrim wheelchair propulsion is a cyclic skill that needs to be learned during rehabilitation. It has been suggested that more variability in propulsion technique benefits the motor learning process of wheelchair propulsion.The purpose of this study was to determine the influence of variable practice on the motor learning outcomes of wheelchair propulsion in able-bodied participants. Variable practice was introduced in the form of wheelchair basketball practice and wheelchair-skill practice. Motor learning was operationalized as improvements in mechanical efficiency and propulsion technique.MethodsEleven Participants in the variable practice group and 12 participants in the control group performed an identical pre-test and a post-test. Pre- and post-test were performed in a wheelchair on a motor-driven treadmill (1.11 m/s) at a relative power output of 0.23 W/kg. Energy consumption and the propulsion technique variables with their respective coefficient of variation were calculated. Between the pre- and the post-test the variable practice group received 7 practice sessions. During the practice sessions participants performed one-hour of variable practice, consisting of five wheelchair-skill tasks and a 30 min wheelchair basketball game. The control group did not receive any practice between the pre- and the post-test.ResultsComparison of the pre- and the post-test showed that the variable practice group significantly improved the mechanical efficiency (4.5 ± 0.6% → 5.7 ± 0.7%) in contrast to the control group (4.5 ± 0.6% → 4.4 ± 0.5%) (group x time interaction effect p < 0.001).With regard to propulsion technique, both groups significantly reduced the push frequency and increased the contact angle of the hand with the handrim (within group, time effect). No significant group × time interaction effects were found for propulsion technique. With regard to propulsion variability, the variable practice group increased variability when compared to the control group (interaction effect p < 0.001).ConclusionsCompared to a control, variable practice, resulted in an increase in mechanical efficiency and increased variability. Interestingly, the large relative improvement in mechanical efficiency was concomitant with only moderate improvements in the propulsion technique, which were similar in the control group, suggesting that other factors besides propulsion technique contributed to the lower energy expenditure.Electronic supplementary materialThe online version of this article (doi:10.1186/s12984-016-0209-7) contains supplementary material, which is available to authorized users.

Motor learning outcomes of handrim wheelchair propulsion during active spinal cord injury rehabilitation in comparison with experienced wheelchair users

“…Both with and without the inclusion of the covariate, there were no significant differences in propulsion technique between the recent SCI and the experienced group. In contrast, the difference in mechanical efficiency approached significance without correction and was higher in the group with a recent SCI (6.1%±0.7% vs 5.1 ± 1.3%, 1.865 (20), p ¼ 0.077, 95% CI [À0.1, 2.1]). After correcting for the difference in relative power output, the corrected mean mechanical efficiency was significantly higher in the experienced group (5.2%±0.2% vs 5.5%±0.2%, 36.028(2), p < 0.001, 95% CI [À1.0, 0.4]).…”

“…Chi-square was used to check for initial differences in categorical data (gender, lesion completeness, lesion level). Since relative power output during the submaximal test differed significantly between the groups, it was used as a correction factor as it influences both the propulsion technique and the mechanical efficiency [19,20]. Other outcomes i.e., work capacity and wheelchair skills were not corrected for differences in power output because it is not defined whether and how the power output influences all those outcome measures.…”

“…In previous literature, propulsion technique and mechanical efficiency showed to be sensitive to change in the early stages (12 min to 7 weeks) of learning in able-bodied participants [5,6,19,20]. This motivated our choice to initiate the measurements at the start of active rehabilitation.…”

Evidenced Based Education Interventions to Preserve Upper Limb Function Among Full Time Manual Wheelchair Users

“…Both groups demonstrated improved technique (reduced SF with in increased CA) suggesting the CG derived technique benefits from repeat testing without practice. Because the magnitude of change in technique variables were similar between groups with improved ME in the IG, the authors suggest other factors besides technique may have contributed to the lower levels of energy expenditure observed (Leving, Vegter et al 2016). van der Scheeret al(van der Scheer, de Groot et al 2015)conducted anonblinded RCT on long term inactive MWUs with SCI(N=29) to investigate the effects of low intensity wheelchair training on propulsion technique during treadmill propulsion with an instrumented force and moment sensing wheel attached.…”

“…For example,Levinget al (Leving, Vegter et al 2016) examine the influence of uninstructed variable practice on both technique and motor learning outcomes in 23 able bodied participants. Importantly, this study implemented a training approach without providing feedback or instruction favoring motor exploration as a means to promote learning.…”