Abstract
BackgroundThere are approximately 1 billion people living with chronic lower limb disability, many of whom are wheelchair users.ObjectivesReview cardiometabolic and neuromuscular risk profiles of wheelchair users, benefits of regular exercise and the causes of neuromuscular upper limb and hip injuries that hinder regular adherence.MethodLiterature published between 2013 and 2017 was adopted according to the standard practices for systematic reviews (PRISMA) through Crossref Metadata and Google Scholar searches. Individual paper quality was evaluated using a modified Downs and Black Appraisal Scale.ResultsThe literature search identified 16 600 papers which were excluded if they were non-English, non-peer-reviewed or published before 2013. Finally, 25 papers were accepted, indicating that sedentary wheelchair users have poor cardiometabolic risk profiles (PCMRP) because of a lack of physical activity, limiting their quality of life, characterised by low self-esteem, social isolation and depression. Their predominant mode of physical activity is through upper limb exercises, which not only improves their cardiometabolic risk profiles but also precipitates neuromuscular upper limb overuse injuries. The primary cause of upper limb injuries was attributed to poor wheelchair propulsion related to incorrect chair setup and poor cardiorespiratory fitness.ConclusionWheelchair users have a high body mass index, body fat percentage and serum lipid, cholesterol and blood glucose concentrations. Empirical investigations illustrate exercise improves their PCMRP and cardiorespiratory fitness levels. Although literature encourages regular exercise, none discusses the need to individualise chair setup in order to eliminate wheelchair pathomechanics and upper limb neuromuscular injuries. Wheelchair users must be encouraged to consult a biokineticist or physiotherapist to review their wheelchair setup so as to eliminate possible incorrect manual wheelchair propulsion biomechanics and consequent overuse injuries.
Highlights
Many wheelchair users suffered injuries to the spinal cord, spinal nerves and cauda equina, and underwent lower limb amputation (Durstine et al 2011)
Tetraplegia is identified with neural damage to cervical vertebrae one to seven which produces impairments in both the upper and lower limbs as well as in the trunk, whereas paraplegia is identified with neural damage to the thoracic, lumbar or sacral vertebrae, precipitating trunk and lower limb dysfunction (Schuld et al 2014)
Many wheelchair users who wish to be physically active are further restricted by upper limb overuse injuries
Summary
Many wheelchair users suffered injuries to the spinal cord, spinal nerves and cauda equina, and underwent lower limb amputation (Durstine et al 2011). Tetraplegia is identified with neural damage to cervical vertebrae one to seven which produces impairments in both the upper and lower limbs as well as in the trunk, whereas paraplegia is identified with neural damage to the thoracic, lumbar or sacral vertebrae, precipitating trunk and lower limb dysfunction (Schuld et al 2014). The predisposing causes of lower limb amputation include (1) vascular and circulatory diseases precipitated through type 2 diabetes mellitus or peripheral vascular diseases, (2) trauma, (3) surgical removal of tumours and (4) congenital deformities (Durstine et al 2011). There are approximately 1 billion people living with chronic lower limb disability, many of whom are wheelchair users
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