Abstract
Objectives. To quantify the association between performance-based manual wheelchair propulsion tests (20 m propulsion test, slalom test, and 6 min propulsion test), trunk and upper extremity (U/E) strength, and seated reaching capability and to establish which ones of these variables best predict performance at these tests. Methods. 15 individuals with a spinal cord injury (SCI) performed the three wheelchair propulsion tests prior to discharge from inpatient SCI rehabilitation. Trunk and U/E strength and seated reaching capability with unilateral hand support were also measured. Bivariate correlation and multiple linear regression analyses allowed determining the best determinants and predictors, respectively. Results. The performance at the three tests was moderately or strongly correlated with anterior and lateral flexion trunk strength, anterior seated reaching distance, and the shoulder, elbow, and handgrip strength measures. Shoulder adductor strength-weakest side explained 53% of the variance on the 20-meter propulsion test-maximum velocity. Shoulder adductor strength-strongest side and forward seated reaching distance explained 71% of the variance on the slalom test. Handgrip strength explained 52% of the variance on the 6-minute propulsion test. Conclusion. Performance at the manual wheelchair propulsion tests is explained by a combination of factors that should be considered in rehabilitation.
Highlights
Many individuals who have sustained sensorimotor impairments that challenge their walking ability will use a manual wheelchair as their primary means of mobility
For large shoulder muscles that originate from the trunk to maximally contribute to manual wheelchair propulsion, trunk strength appears essential since no more force can be exerted on a distal segment (i.e., upper extremities (U/E)) larger than the amount that can be counteracted proximally to ensure seated postural stability [16]
In terms of the strength-generating capability of the individual trunk muscle groups, the anterior and left lateral flexors presented a good association with the 20 m MWPTMAX, whereas only the left lateral flexors presented a good association with the MWPTSLALOM
Summary
Many individuals who have sustained sensorimotor impairments that challenge their walking ability will use a manual wheelchair as their primary means of mobility. Numerous kinetic [1,2,3,4,5], electromyographic [6,7,8,9,10], and musculoskeletal modelling [11] studies have confirmed substantial solicitation of key shoulder muscles (i.e., flexor, adductor, and internal and external rotators), especially of the shoulder flexors found to be the greatest contributor, and of elbow muscles (i.e., flexor and extensor), to generate the propulsive force. Manual wheelchair propulsion performance is rarely assessed during inpatient rehabilitation, even though simple and inexpensive performance-based manual wheelchair propulsion tests (MWPTs) are available [18,19,20,21,22,23]
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