Hand Rim Wheelchair Propulsion Training Using Biomechanical Real-Time Visual Feedback Based on Motor Learning Theory Principles

Abstract

Background/Objective: As considerable progress has been made in laboratory-based assessment of manual wheelchair propulsion biomechanics, the necessity to translate this knowledge into new clinical tools and treatment programs becomes imperative. The objective of this study was to describe the development of a manual wheelchair propulsion training program aimed to promote the development of an efficient propulsion technique among long-term manual wheelchair users. Methods: Motor learning theory principles were applied to the design of biomechanical feedback-based learning software, which allows for random discontinuous real-time visual presentation of key spatiotemporal and kinetic parameters. This software was used to train a long-term wheelchair user on a dynamometer during 3 low-intensity wheelchair propulsion training sessions over a 3-week period. Biomechanical measures were recorded with a SmartWheel during over ground propulsion on a 50-m level tile surface at baseline and 3 months after baseline. Results: Training software was refined and administered to a participant who was able to improve his propulsion technique by increasing contact angle while simultaneously reducing stroke cadence, mean resultant force, peak and mean moment out of plane, and peak rate of rise of force applied to the pushrim after training. Conclusions:The proposed propulsion training protocol may lead to favorable changes in manual wheelchair propulsion technique. These changes could limit or prevent upper limb injuries among manual wheelchair users. In addition, many of the motor learning theory-based techniques examined in this study could be applied to training individuals in various stages of rehabilitation to optimize propulsion early on.

Characterization of the Immediate Effect of a Training Session on a Manual Wheelchair Simulator With Haptic Biofeedback: Towards More Effective Propulsion

“…When activated, HB will artificially increase the apparent rolling resistance of the wheelchair as the participant's MEF pattern deviates from the target pattern. Higher rolling resistance itself was found to increase both work load and MEF [9], [10]. However, as the participants get closer to the desired target pattern, the resistance progressively decreases and cannot influence the achieved MEF anymore.…”

“…Finally, both Kotajarvi et al and de Groot et al chose to simultaneously display other propulsion variables, such as speed [10], [11] and power output [10] in addition to the FEF during their training sessions. These extra variables may have distracted participants from their main focus of attention and made learning and acquiring motor skills more complex [9].…”

“…When shoulder integrity is impaired, activities of daily living become increasingly difficult to perform and functional mobility is often compromised [6], [7]. Therefore, prevention of shoulder impairments through proper propulsion technique training is strongly advised [6]- [9].…”

A theoretical analysis of the influence of wheelchair seat position on upper extremity demand

“…contact angle, release angle) and temporal (i.e. push time, cadence) variables are influenced by propulsion technique and differences in upper extremity impairment (e.g., Newsam et al, 1996;Finley et al, 2004;Mulroy et al, 2004), training (e.g., Rodgers et al, 2001;Rice et al, 2010;Richter et al, 2011) and terrain (e.g., Newsam et al, 1996;Richter et al, 2007;Chow et al, 2009;Cowan et al, 2009). The wheelchair propulsion technique analyzed in this study was derived from representative spatiotemporal values (e.g., Richter, 2001;PVACSCM, 2005;Lin et al, 2009), but other techniques exist.…”

Real-time feedback as a method of monitoring walking velocity during gait analysis

“…Real-time feedback has been used during biomechanical analyses for purposes such as helping participants alter their mechanics to avoid injury, match a certain protocol, and give information about force production or muscle activation [7][8][9][10]. As a method of monitoring walking velocity, real-time feedback allows for consistent walking velocities, potentially reducing the need to perform trials that may ultimately be discarded from data analysis.…”