Motor learning outcomes of handrim wheelchair propulsion during active spinal cord injury rehabilitation in comparison with experienced wheelchair users

Marika T. Leving*, Sonja de Groot, Ferry A.B. Woldring, Marga Tepper, Riemer J.K. Vegter, Lucas H.V. van der Woude

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Purpose: To investigate changes in wheelchair propulsion technique and mechanical efficiency across first five weeks of active inpatient spinal cord injury rehabilitation and to compare the outcomes at discharge with experienced wheelchair users with spinal cord injury. Methods: Eight individuals with recent spinal cord injury performed six weekly submaximal exercise tests. The first and last measurement additionally contained a wheelchair circuit and peak graded exercise test. Fifteen experienced individuals performed all above-mentioned tests on one occasion. Results: Mechanical efficiency and propulsion technique did not change during the five weeks of inpatient rehabilitation. Peak power output during peak graded test and performance time on the wheelchair circuit improved between the first and the last week. No difference in propulsion technique, peak power output, and performance time was found between the persons with a recent injury and the experienced group. Mechanical efficiency was higher after the correction for the difference in relative power output in the experienced group. Conclusion: The group with a recent injury did not improve mechanical efficiency and propulsion technique over the period of active rehabilitation, despite significant improvements on the wheelchair circuit and in work capacity. The only significant difference between the groups was found in mechanical efficiency.Implications for rehabilitation The lack of time-dependent changes in mechanical efficiency and propulsion technique in the group with a recent spinal cord injury, combined with the lack of differences in technique, work capacity and on the wheelchair circuit between the groups, suggest that important adaptations of motor learning may happen even earlier in rehabilitation and emphasize that the group in active rehabilitation was relatively skilled. Standardized observational analyses of handrim wheelchair propulsion abilities during early spinal cord injury rehabilitation provide detailed understanding of wheelchair technique, skill as well as wheelchair propulsion capacity. Measurement of external power output is critical to interpretation of gross efficiency, propulsion technique, and capacity. Wheelchair quality and body weight–next to wheelchair fitness and skill–require careful consideration both in early rehabilitation as well as in the chronic phase of spinal cord injury.

Original languageEnglish
Pages (from-to)1429-1442
JournalDisability and Rehabilitation
Volume43
Issue number10
DOIs
Publication statusAccepted/In press - 1 Jan 2019
Externally publishedYes

Funding

Purchase of two sets of Activ8 Professional Activity Monitors, as well as the travel costs of the participants to the measurement location were supported by Stichting Beatrixoord Noord-Nederland. The sponsor had no influence on the content of this manuscript or the decision to submit it to a journal. Firstly, we would like to thank all the participants for their effort in performing the measurements. Secondly, we would like to acknowledge that this study would not be possible without the assistance of many undergraduate students and technical support staff from the Center for Human Movement Sciences. Lastly, we would like to thank the physiotherapists from the UMCG Center for Rehabilitation, for their assistance in identifying several patients eligible for inclusion in the study.

FundersFunder number
Center for Human Movement Sciences
Stichting Beatrixoord Noord-Nederland

    Keywords

    • in-patient rehabilitation
    • skill acquisition
    • wheelchair provision
    • wheelchair skill
    • Wheeled mobility

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