People with paraplegia and tetraplegia often rely upon manual wheelchair propulsion as their primary means of independent mobility. It has been reported that wheelchairs are difficult for many individuals to propel effectively. Between 25% and 80% of wheelchair users experience wrist, elbow and shoulder injuries (Cooper et al. 2001). Pushrim biomechanics has been linked to upper extremity injuries (Boninger et al. 1999). The articles in this section focus on the kinetic (forces, mechanical loads, moments (torque)) and kinematics (movement at joints or between body segments) during propulsion, the effects of propulsion on the body and the effect of the environment on propulsion thereby on the body and, potential for overuse injuries.
Most articles refer to wheelchair propulsion in two phases, push or propulsion phase and recovery phase. The push phase starts when the hand contacts the hand rim and ends when contact with hand rim ends. The recovery phase is the time period where the hands are not in contact with the hand rim, typically moving to prepare for the next push cycle (Ambrosia et al. 2005; VanLandewijick et al. 1994).
The stroke pattern in wheelchair propulsion subsection is presented first as the pattern types are often referred to in the manual wheelchair propulsion sections that follow. It is also worth noting that for many studies in this section, that data was collected on a variety of surfaces, often in a lab setting. In the lab settings, researchers used stationary treadmills, ergonometers, and/or dynamometers. There is some discussion within several articles related to the pros and cons of using one of these devices over the others. This discussion was felt by the chapter authors to be a research based issue and was beyond the scope of this clinical-based document therefore the article content related to this specific topic was not reviewed or included in the tables below.
The second and third subsections focus more specifically on kinetics and kinematics. Due to the large volume of research in this area the articles were separated roughly into level surfaces and non-level surfaces respectively. The non-level surfaces include surfaces such as side slopes, uneven surfaces, wheelies, curbs and inclines.