Pushrim forces and joint kinetics during wheelchair propulsion.

OBJECTIVE To investigate pushrim forces and joint kinetics during wheelchair propulsion and to discuss the differences between inexperienced and experienced wheelchair users. DESIGN Cohort study. SETTING Human engineering laboratory at a state university. SUBJECTS Four men who use manual wheelchairs for mobility and four nondisabled men who did not have extensive experience pushing a wheelchair; all subjects were asymptomatic for upper extremity pain or injury. METHODS Subjects pushed a commonly used wheelchair fitted with a force-sensing pushrim on a stationary wheelchair dynamometer. Video and force data were collected for 5 strokes at one speed of propulsion. Pushrim forces and net joint forces and moments were analyzed. MAIN OUTCOME MEASURES Pushrim forces, radial (Fr) and tangential (Ft), were analyzed and compared for both groups in relation to peak values and time to peak values and as ratios of overall forces generated. Net joint forces and moments were analyzed in a similar fashion. RESULTS Pushrim forces and joint moments were similar to those previously reported, with radial forces averaging between 34 and 39N and tangential forces ranging on average between 66 and 95N. Tangential forces were higher than radial forces, and mean ratios of tangential forces to the resultant force were approximately 75%, whereas mean radial force ratios were approximately 22%. All subjects showed higher joint moments at the shoulder than at the elbow or wrist. A large component of vertical reaction force was seen at the shoulder. Significant differences (p < .05) were found between groups for peak tangential force and time to peak tangential and peak vertical forces, with wheelchair users having lower values and longer times to reach the peak values. CONCLUSIONS Discrete variables from the force-time curves can be used to distinguish between wheelchair users and nonusers. The experienced users tended to push longer, used forces with lower peaks, and took longer time to reach peak values. This propulsive pattern may have been developed to reduce the chance of injury by minimizing the forces at the joints, as a means of maximizing efficiency or as a combination of these factors. More work investigating 3-dimensional forces and the influence of seating position and various conditions of propulsion such as speed changes, ramps, and directional changes on injury mechanisms needs to be completed.