Wheelchair Handrims
Traditionally, handrims on lightweight and ultralight weight wheelchairs consist of a metal hoop rigidly mounted to the wheel. During propulsion, this hand rim is contacted with each push stroke. Research suggests that the use of rigid hand rims may be a contributing factor to developing repetitive strain injuries of the hand, elbow and shoulder. The studies in this subsection examined the use of flexible hand rims as a means to reduce forces and minimize risk on upper extremity injury.
| Author YearCountry Research DesignScore Total Sample Size |
Methods | Outcome |
| Richter et al. 2006USA
Post Test NInitial=24; NFinal=23 |
Population: Mean age: 35.0 yr; Gender: males =18, females=6; Mean weight: 71.4 kg; Level of injury: paraplegia=22, spina bifida=2; Mean duration of w/c use: 16 yr; Chronicity=chronic.Intervention: Propulsion of personal wheelchair on a treadmill with varying inclines (level, 3°, 6°) and using a standardized uncoated handrim (SUH) and a high friction flexible handrim (HFH).
Outcome Measures: Electromyographic data-maximum voluntary contraction, Total muscle exertion, Peak and total muscle exertion per push. |
1. HFH decreased peak muscle activation and total muscle exertion.2. An 11.8% reduction in peak muscle activation (p=0.026), and a 14.5% (p=0.016) reduction in total muscle exertion, were apparent with use of the HFH versus the SUH. |
| Richter & Axelson 2005USA
Post Test N=17 |
Population: Mean age: 37 yr; Gender: males=10, females=7; Injury etiology: SCI=16, spina bifida=1.Intervention: Part 1: Participants used their own manual wheelchair with their rear wheels replaced with the Variable Compliance Hand-Rim Prototype (VCHP) test wheels. Participants completed a mobility activity test course (uphill, downhill, slalom, level sprint, pushing and carpet) in three different hand rim compliance settings (ridged, C1, C2, C3); testing stopped once the participant found the hand rim compliance to be too soft. Part 2: Participants propelled their own manual wheelchairs with the rear wheels replaced with a propulsiometer on a treadmill for up to 5 min using each hand-rim condition (rigid, C1, C2, C3) for four grade/speed combinations with a 15 min rest period between each test combination.
Outcome Measures: Peak hand-rim force, Metabolic demand and rate of loading at impact, Participant feedback related to acceptability of different hand rim compliance levels. |
1. Participants felt that the use of the compliant hand rims did not compromise their ability to maneuver/control the wheelchair.2. No participants found C1 too soft; C2 and C3 were too soft for 29% and 47% of participants, respectively; 24% felt the hand rim could be softer than C3.
3. C1 was the only hand-rim condition that had a statistically significant difference from rigid hand-rim for push angle (an additional 3.5° angle on 2% grade compared to the rigid rim). 4. Push angle, push frequency and recovery time tended to decrease with an increase in grade; push time increased with increasing grade 5. No statistically significant differences were found between the rigid hand rim and any of the other conditions (C1, C2 or C3) for peak resultant and in-plane resultant force relationships. 6. For all hand-rim conditions, the trend was an increasing peak hand-rim force as the grade increased. 7. No statistically significant differences were found between the compliant and rigid hand rims in terms of: 1) resulting peak wheel moment and estimated contribution of tangential force. 8. No significant differences were found for metabolic demand between the rigid and C3 hand-rims. |
Summarized Level 5 Evidence Studies
The following level 5 evidence studies have been reviewed, and their overarching findings are highlighted here. As noted at the start of this chapter, these types of studies are not included in the discussion or in the conclusions.
Dieruf et al. (2008) surveyed 87 people who purchased a specific ergonomic contoured hand rim to gain their perspective on the impact the hand rims had on their propulsion. Participants reported improved comfort in propulsion, reduced upper extremity symptoms and for people over the age of 50, improved ability to maintain functional abilities for those experiencing wrist or hand pain. The survey results indicated that there was greater satisfaction with the contoured hand rims the longer they were used; only nine participants reported negative changes following use of the contoured hand rims, and only seven participants had stopped using the rims.
Discussion
Richter et al. (2006) investigated finger and wrist flexor activity when using a flexible handrim as compared to a standard handrim. The flexible hand rim consisted of high friction urethane spanning between a standard tubular handrim and the wheel. The urethane takes the shape of the hand when gripping. 24 subjects pushed their own wheelchairs on a level surface and at three- and six-degree grades using both types of handrims. Use of the flexible handrim significantly reduced wrist and finger flexor activity when averaged across all grade conditions. This suggests that over a period of years flexible handrims may be a factor in preserving upper extremity health.
Richter et al. (2005) explored the balance between compliance hand rims and the acceptability of this type of rim to 17 participants who propel manual wheelchairs. They note previous research indicating that compliant rims reduce the impact loading during the push phase but are found to be an unfavourable option by people who propel manual wheelchairs. This study found that participants were accepting of a moderately compliant hand rim. It also found that compliant hand rims did not differ greatly from rigid hand rims in relation to push frequency, push angle, push timing, and peak forces. Where differences were noted was in the forces that contribute to impact loading, and subsequently increase the risk of repetitive strain injuries. Impact forces, with an equal or decreased peak rate of rise at impact loading of hand on the rim and a decrease in the average rate of rise of the contact force. The authors suggest that moderately complaint rims are acceptable to most people who propel manual wheelchairs and have been shown to reduce the impact forces associated with propulsion in comparison to standard rigid hand rims.
Conclusions
There is level 4 evidence (from one pre-post study and one post-test study: Richter et al. 2005; Richter et al. 2006) that a flexible or compliant hand rim can reduce impact forces and reduce wrist and finger flexor activity during wheelchair propulsion.
There is level 4 evidence (from one pre-post study and one post-test study: Richter et al. 2005; Richter et al. 2006) that flexible or compliant hand rims are found to be acceptable to people who propel manual wheelchairs, with perceived benefits of comfort, reduced upper extremity pain and improved propulsion.
