Shoulder kinetics during start-up and propulsion with a manual wheelchair within the initial phase of uninstructed training. 2018

Samuel Hybois, and Alice Siegel, and Joseph Bascou, and Nicolas Eydieux, and Philippe Vaslin, and Hélène Pillet, and Pascale Fodé, and Christophe Sauret
a Arts et Me´tiers ParisTech , Institut de Biome´canique Humaine Georges Charpak , Paris , France.

Wheelchair locomotion is constraining for the upper limbs and involves a set of motor tasks that need to be learnt by a novice user. To understand this integration process, we investigated the evolution of shoulder kinetics during start-up and propulsion within the initial phase of low-intensity uninstructed training. Seventeen novice able-bodied subjects performed a 120-min uninstructed practice distributed over 4 weeks. During the initial and final sessions, upper limbs kinematics and hand-rim kinetics were continuously collected. Inverse kinematics and dynamics coupled to a three-dimensional linked-segment model were used to compute shoulder net moments. Participants increased the speed of the wheelchair with practice. In average, an increase of shoulder net moments and mechanical work during the push phase was observed. Conversely, during the recovery phase, participants slightly increased shoulder power but maintained a similar level of shoulder loading. However, individual evolutions allowed the definition of two groups defined as: "increasers", who increased shoulder loading and mechanical work versus "decreasers", who managed to limit shoulder loading while improving the wheelchair speed. These findings underline that individual adaptation strategies are essential to take into account when designing a rehabilitation protocol for wheelchair users. Implications for Rehabilitation The learning process of manual wheelchair locomotion is essential for the assimilation of motor tasks leading individuals to select their propulsion technique. Novice users display different learning strategies: some people increase shoulder loading very early but others spontaneously manage to increase the wheelchair speed while maintaining a constant level of shoulder loading. Wheelchair rehabilitation programs should be individualized to take into account the subject-specific learning strategy.

UI MeSH Term Description Entries
D007858 Learning Relatively permanent change in behavior that is the result of past experience or practice. The concept includes the acquisition of knowledge. Phenomenography
D008297 Male Males
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D001696 Biomechanical Phenomena The properties, processes, and behavior of biological systems under the action of mechanical forces. Biomechanics,Kinematics,Biomechanic Phenomena,Mechanobiological Phenomena,Biomechanic,Biomechanic Phenomenas,Phenomena, Biomechanic,Phenomena, Biomechanical,Phenomena, Mechanobiological,Phenomenas, Biomechanic
D012782 Shoulder Part of the body in humans and primates where the arms connect to the trunk. The shoulder has five joints; ACROMIOCLAVICULAR joint, CORACOCLAVICULAR joint, GLENOHUMERAL joint, scapulathoracic joint, and STERNOCLAVICULAR joint. Shoulders
D014910 Wheelchairs Chairs or seating mounted on wheels and designed to be controlled or propelled by the occupant. Medicare Part B (Medical Insurance) covers power-operated vehicles (scooters), walkers, and wheelchairs as durable medical equipment. Wheel Chairs,Chair, Wheel,Chairs, Wheel,Wheel Chair,Wheelchair
D062211 Spatio-Temporal Analysis Techniques which study entities using their topological, geometric, or geographic properties and include the dimension of time in the analysis. Space-Time Geography,Spatial Temporal Analysis,Spatiotemporal Analysis,Analyses, Spatial Temporal,Analyses, Spatio-Temporal,Analyses, Spatiotemporal,Analysis, Spatial Temporal,Analysis, Spatio-Temporal,Analysis, Spatiotemporal,Geographies, Space-Time,Geography, Space-Time,Space Time Geography,Space-Time Geographies,Spatial Temporal Analyses,Spatio Temporal Analysis,Spatio-Temporal Analyses,Spatiotemporal Analyses,Temporal Analyses, Spatial,Temporal Analysis, Spatial
D026741 Physical Therapy Modalities Therapeutic modalities frequently used in PHYSICAL THERAPY SPECIALTY by PHYSICAL THERAPISTS or physiotherapists to promote, maintain, or restore the physical and physiological well-being of an individual. Physical Therapy,Physiotherapy (Techniques),Group Physiotherapy,Neurological Physiotherapy,Neurophysiotherapy,Physical Therapy Techniques,Group Physiotherapies,Modalities, Physical Therapy,Modality, Physical Therapy,Physical Therapies,Physical Therapy Modality,Physical Therapy Technique,Physiotherapies (Techniques),Physiotherapies, Group,Physiotherapy, Group,Physiotherapy, Neurological,Techniques, Physical Therapy,Therapy, Physical

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