Wheelchair propulsion: you need to learn it

Study is performed in the Netherlands. 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.

Rationale: 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.

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

In this observational study 15 longitudinal participants will be tested on their wheelchair skills at the beginning of active in-patient rehabilitation, 6 weeks later, at discharge from clinical in-patient rehabilitation and shortly after discharge. The testing will include (sub)maximal exercise tests in a wheelchair on a treadmill, a number of specific wheelchair skills test and a set of questionnaires. Additionally, during the first 6 weeks of active rehabilitation, the mechanical efficiency and propulsion technique will be determined weekly during a submaximal wheelchair exercise test on a treadmill. At regular intervals wheelchair-related daily activity will be systematically monitored to evaluate the amount of actual wheelchair practice during rehabilitation. 15 Experienced wheelchair users will be tested cross-sectionally at two occasions, once on the full test battery and once with only a submaximal wheelchair exercise test, during which the joint compression force in the shoulder will be evaluated and compared to the unexperienced participants.

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.