Development of handrim wheelchair propulsion technique in the context of shoulder overload and daily activity during spinal cord injury rehabilitation: a pilot study*

Wheelchair dependency is a result of disease or trauma that irreversibly
impairs the ability to walk. Handrim wheelchair propulsion provides freedom of
mobility but also contributes to shoulder overuse injuries and pain which can
potentially lead to an inactive lifestyle. It is hypothesized that a proper
propulsion technique helps to prevent some of the strain resulting from
wheelchair use. Evidence-based guidelines for practice protocols that would
enhance the motor learning process and minimize the injury risk are missing
since the learning process of wheelchair propulsion in the early stages of
rehabilitation is unknown.

To monitor and describe the natural motor learning of handrim wheelchair
propulsion during usual care in a Dutch spinal cord injury rehabilitation
center. Motor learning is operationalized as change in mechanical efficiency,
propulsion technique and level of wheelchair-related skills over time.

Prospective longitudinal cohort pilot study to monitor and describe the
learning process of 15 wheelchair-dependent participants with recent spinal
cord injury. Additionally, 15 experienced wheelchair users with chronic spinal
cord injury will be tested cross-sectionally in order to compare the outcomes
of the wheelchair motor learning process on a short and long term comparing
unexperienced and experienced wheelchair users.

During usual care, the longitudinal cohort study participants (N=15) will
participate in a total of 8 measurement occasions. First six measurements will
take place once a week over first 6 weeks of in-patient active rehabilitation.
Last two measurements will take place at discharge and shortly after discharge
from the rehabilitation center. This last measurement will take place at the
Center for Human Movement Sciences lab. The cross-sectional participants (N=15)
will be asked to come to the rehabilitation centre for one measurement and to
the Center for Human Movement Sciences lab for one measurement. At both
laboratory sites (rehabilitation centre Beatrixoord and Center for Human
Movement Sciences lab) an emergency crash procedure is available throughout the
organization and during testing. The test battery proposed in this protocol was
also used in previous projects on very similar groups of participants and no
adverse events were reported. The risks during testing sessions are relatively
low because of thorough screening by the rehabilitation physician prior to
participation and safety precautions throughout testing. Testing in itself
brings low risk since the activities performed by the participant are similar
to the regular daily activity during usual care in the rehabilitation center.
The expected beneficial effects, including better monitoring of the wheelchair
motor learning process and gaining information necessary to construct the
evidence-based guidelines, in combination with the limited risks would clearly
justify the proposed study.