Abstract
Handrim wheelchair propulsion is a cyclic skill that needs to be learned during rehabilitation. Yet it is unclear how inter-individual differences in motor learning impact wheelchair propulsion practice. Therefore we studied how early-identified motor learning styles in novice able-bodied participants impact the outcome of a low-intensity wheelchair-practice intervention. Over a 12-minute pre-test, 39 participants were split in two groups based on a relative 10% increase in mechanical efficiency. Following the pretest the participants continued one of four different low-intensity wheelchair practice interventions, yet all performed in the same trial-setup with a total 80-minute dose at 1.11 m/s at 0.20 W/kg. Instead of focusing on the effect of the different interventions, we focused on differences in motor learning between participants over the intervention. Twenty-six participants started the pretest with a lower mechanical efficiency and a less optimal propulsion technique, but showed a fast improvement during the first 12 minutes and this effect continued over the 80 minutes of practice. Eventually these initially fast improvers benefitted more from the given practice indicated by a better propulsion technique (like reduced frequency and increased stroke angle) and a higher mechanical efficiency. The initially fast improvers also had a higher intra-individual variability in the pre and posttest, which possibly relates to the increased motor learning of the initially fast improvers. Further exploration of the common characteristics of different types of learners will help to better tailor rehabilitation to the needs of wheelchair-dependent persons and improve our understanding of cyclic motor learning processes.
Highlights
Handrim wheelchair propulsion is a cyclic bimanual form of ambulation that needs to be learned during early rehabilitation by people with a lower-limb disability
Based on a 10% relative change in mechanical efficiency out of the 39 participants 13 were classified as Initially Slow Improvers (ISI) and 26 as Initially Fast Improvers (IFI)
Concomitant with this selection an interaction effect was found between the two groups based on the repeated measures Anova on the pretest, where the ISI already had a higher mechanical efficiency in the first 4-min trial than IFI (ISI 5.5% vs. IFI 4.4%, p,0.002)
Summary
Handrim wheelchair propulsion is a cyclic bimanual form of ambulation that needs to be learned during early rehabilitation by people with a lower-limb disability. Different intervention studies have shown that, through low-intensity practice both mechanical efficiency and propulsion technique of handrim wheelchair propulsion can improve, possibly reducing the load on the wheelchair user [6,7,8,9,10,11,12,13] It is unknown how inter-individual differences in motor learning impact the outcomes of wheelchair propulsion practice in such an early stage. Inter-individual differences were found in the effect of regular physical activity on maximal oxygen consumption, submaximal heart rate response, cholesterol and systolic blood pressure [20] Correlations of these variables with age, gender or ethnic background were low. Individuals with higher baseline values and a worse physical condition showed larger reductions in heart rate and blood pressure due to training [20]
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