Hand rim wheelchair propulsion training using biomechanical real-time visual feedback based on motor learning theory principles

Abstract

Background/objective: As considerable progress has been made in laboratory-based assessment of manual wheelchair propulsion biomechanics, the necessity to translate this knowledge into new clinical tools and treatment programs becomes imperative. The objective of this study was to describe the development of a manual wheelchair propulsion training program aimed to promote the development of an efficient propulsion technique among long-term manual wheelchair users.

Methods: Motor learning theory principles were applied to the design of biomechanical feedback-based learning software, which allows for random discontinuous real-time visual presentation of key spatiotemporal and kinetic parameters. This software was used to train a long-term wheelchair user on a dynamometer during 3 low-intensity wheelchair propulsion training sessions over a 3-week period. Biomechanical measures were recorded with a SmartWheel during over ground propulsion on a 50-m level tile surface at baseline and 3 months after baseline.

Results: Training software was refined and administered to a participant who was able to improve his propulsion technique by increasing contact angle while simultaneously reducing stroke cadence, mean resultant force, peak and mean moment out of plane, and peak rate of rise of force applied to the pushrim after training.

Conclusions: The proposed propulsion training protocol may lead to favorable changes in manual wheelchair propulsion technique. These changes could limit or prevent upper limb injuries among manual wheelchair users. In addition, many of the motor learning theory-based techniques examined in this study could be applied to training individuals in various stages of rehabilitation to optimize propulsion early on.

Figures

Figure 1

Schematic representation of the contact angle which includes the initial (A) and final (B) hand contact with the pushrim during the propulsive phase of manual wheelchair propulsion.

Figure 2

Schematic representation of realtime feedback variable presentation during training. Sixty-second rest periods followed each 55-second propulsion period and 2 minutes of rest occurred after each block of training. Within a propulsion period a subject was given 5 seconds to acclimate and then received visual feedback for 10 seconds, no feedback for 15 seconds, feedback for 10 seconds, and no feedback for the remaining 15 seconds. A training block was considered presentation of all combinations of variables with a target velocity or at a selected speed.

Figure 3

An example of an actual real-time screen display where all feedback variables are presented. Speed is presented in the first 5 seconds to help the subject acclimate and reach the steady-state target speed and then all of the variables are visible for 10 seconds and disappear for 15 seconds while the subject continues propulsion. The bars on the left of each block have a green target area in the middle; the red upper range indicates above target, while the lower yellow region indicates below target. The blue bars to the right of the target are the wheelchair users' real-time data streamed from the instrumented wheel at 240 Hz.

Figure 4

Summary of the kinetic and spatio-temporal outcomes measured before and after training during manual wheelchair propulsion at a predetermined (1.5 m/s) and at a self-selected speeds. Solid bars correspond to mean values measured at baseline, before training, whereas dotted bars represent mean values reached 3 months after baseline after 3 training sessions.