Relationship between hand contact angle and shoulder loading during manual wheelchair propulsion by individuals with paraplegia

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Study investigated the relationships of hand contact angle with propulsion characteristics, pushrim forces, and shoulder kinetics during wheelchair propulsion (WCP) in individuals with paraplegia from spinal cord injury (SCI). Biomechanical data were collected from 222 individuals with paraplegia during WCP on a stationary ergometer at a self-selected speed. Multivariate linear regression analysis examined the association between: (1) location of the hand on the pushrim at initial contact and hand release during the push phase of the WCP cycle and (2) propulsion characteristics, pushrim forces, and shoulder kinetics. Results indicated that increased push arc was associated with greater velocity and cycle distance and reduced cadence. Initial contact angle and hand release angles were equally associated with cycle distance and cadence, whereas a more anterior release angle was associated with greater velocity. When controlling for body weight, a more posterior initial contact angle was associated with greater posterior shoulder net joint force and greater flexor net joint moment, whereas a more anterior hand release angle was significantly associated with increased vertical and greater lateral pushrim forces; greater shoulder net joint forces in all 3 planes (posterior, superior, and medial); and greater external rotator and adductor net joint moments. It is recommended that participants reach back to initiate contact with the pushrim to maximize push arc but avoid a more anterior hand position at release, because this could increase shoulder load during the push phase of WCP

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