PURPOSE: Developing evidence-based approaches to teaching manual wheelchair skills and proper propulsion for persons with a spinal cord injury (SCI) is important to successful rehabilitation for everyday wheelchair use. The purpose of this project was to pilot test a manual wheelchair training program based on motor learning and repetition-based training for new manual wheelchair users with an SCI. We hypothesized that, after participants received the wheelchair training intervention, they would increase push angle, decrease push force, and improve wheelchair skills proficiency.

BACKGROUND: The most common type of wheelchair used for everyday mobility by persons with SCI is a manual wheelchair (National Spinal Cord Injury Statistical Center, 2013). Although wheelchair propulsion is an essential skill for maneuvering a manual wheelchair, research has suggested that the repetitive loading on the upper extremities may contribute to pain and chronic overuse injuries (Boninger et al., 2005; Gellman et al., 1988).

Manual wheelchair users may benefit from training in proper wheelchair propulsion to help decrease the possibility of injuries that may affect their mobility and activities of daily living. Although a relationship between wheelchair propulsion and chronic overuse injuries has been documented, clinical guidelines have been developed, and research has been conducted on different approaches, new manual wheelchair users are often given little information on or training in how to propel their wheelchairs (Boninger et al., 2002; Best, Routhier, & Miller, 2015).

DESIGN: A repeated-measures within-subject design was used with participants acting as their own controls.

PARTICIPANTS: Six persons with an SCI requiring the use of a manual wheelchair participated in a wheelchair training intervention.

METHOD: The intervention included nine 90-min training sessions. The primary focus was on wheelchair propulsion biomechanics, and the secondary focus was on wheelchair skills. At each testing session (Pretest 1, Pretest 2, and posttest), kinematics related to propulsion and wheelchair performance overground were measured. Kinetic propulsion variables and wheelchair skills were measured immediately before the intervention (Pretest 2) and immediately after (posttest).

ANALYSIS: A repeated-measures analysis of variance was used to determine whether there were significant differences in the wheelchair kinematic variables and the wheelchair performance variables across three testing times (p < .05). A paired t test was used to determine significant differences in the wheelchair push force variables and wheelchair skills variables between Pretest 2 and posttest (p < .05).

RESULTS: Significant changes in area of the push loop, hand-to-axle relationship, and slope of the push forces were found. Changes in propulsion patterns were identified pre- and posttraining. No significant differences were found in peak and average push forces and wheelchair skills pre– and post–wheelchair training.

DISCUSSION: This project identified trends in change related to a repetition-based motor learning approach for propelling a manual wheelchair. The changes found were related to the propulsion pattern of the participants. However, there are many challenges associated with implementing interventions for new manual wheelchair users.

IMPACT STATEMENT: The results of this study have clinical implications, because the motor learning principles used in the training program during this research could be applied to teaching manual wheelchair skills training during rehabilitation.

Best, K. L., Routhier, F., & Miller, W. C. (2015). A description of manual wheelchair skills training: Current practices in Canadian rehabilitation centers. Disability and Rehabilitation. Assistive Technology, 10, 393–400. http://dx.doi.org/10.3109/17483107.2014.907367

Boninger, M. L., Koontz, A., Sisto, S., Dyson-Hudson, T., Chang, M., Price, R., & Cooper, R. A. (2005). Pushrim biomechanics and injury prevention in spinal cord injury: Recommendations based on CULP-SCI investigations. Journal of Rehabilitation Research & Development, 42(3, Suppl.), 9–19.

Boninger, M. L., Souza, A., Cooper, R. A., Fitzgerald, S., Koontz, A., & Fay, B. (2002). Propulsion patterns and pushrim biomechanics in manual wheelchair propulsion. Archives of Physical Medicine and Rehabilitation, 83, 718–723. http://dx.doi.org/10.1053/apmr.2002.32455

Gellman, H., Chandler, D. R., Petrasek, J., Sie, I., Adkins, R., & Waters, R. L. (1988). Carpal tunnel syndrome in paraplegic patients. Journal of Bone and Joint Surgery, 70, 517–519.

National Spinal Cord Injury Statistical Center. (2013). Annual statistical report—Complete public version. Tuscaloosa: University of Alabama.