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There is evidence that manual wheelchair users are among the least physically active in society. However, the current cut points for quantifying physical activity intensity based on steps per minute have been developed for ambulatory adults from the general population and other clinical populations and may not be appropriate or applicable for manual wheelchair users. This study examined the association between push rate (an analog of step rate) and energy expenditure across three speeds of treadmill wheelchair propulsion among manual wheelchair users and further generated a push-rate cut point for quantifying moderate-to-vigorous physical activity. Persons who used manual wheelchairs (N = 17) performed three, 6-min bouts of manual wheelchair propulsion on a motor-driven treadmill at speeds of 0.7, 1.3, and 2.0 m/sec. Push rate per trial was measured using SMARTwheels, and the rate of oxygen consumption per trial was measured using a portable metabolic system. The mean (SD) R2 value for the relationship between push rate and energy expenditure was 0.78 (0.14). The mean (SD) push-rate cut point for quantifying moderate-to-vigorous physical activity was 55.05 (26.06) pushes/min. This preliminary study provides the first push-rate cut point for quantifying moderate-to-vigorous physical activity among a heterogeneous sample of manual wheelchair users. This threshold may be important for public health promotion and individual-level monitoring and prescription of free-living physical activity behavior among manual wheelchair users.

This paper studies non-state militant group emulation and development of a special operation capability that stands in stark contrast to the normal repertoire of guerilla and terror tactics. Buildi...

Systematic review and meta-analysis. Traditional forms of upper-body moderate intensity exercise consistently provide little cardiovascular benefits for persons with spinal cord injury (PwSCI). Explorations of new training methods are vital to improve cardiovascular fitness among PwSCI. This study sought to evaluate the effectiveness of vigorous training on cardiorespiratory fitness in PwSCI. Database search through PubMed, Web of Science, Scopus, SportDiscus, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) was conducted from the databases’ inception to November 2020 to identify relevant exercise studies with PwSCI. Two independent reviewers screened articles for inclusion. Data were extracted from included studies and methodological quality evaluated. Sixteen trials (eight pre-post trials and eight controlled trials [CTs]) with a total of 145 participants were analyzed. Results from pre-post studies revealed significant improvements in cardiorespiratory fitness following high-intensity interval training (HIIT) (Peak Oxygen Uptake [VO2peak], standardized mean difference [SMD] = 0.81; 95% CI 0.23–1.39; P

This chapter discusses four main areas that clinicians should understand to improve the effectiveness of orthopedic rehabilitation. The first part is about the biomechanical factors that affect orthopedic rehabilitation process. The second part is about the types of exercises during orthopedic rehabilitation and their underlying biomechanical principles. The third part is about how to apply these biomechanical principles to manage common orthopedic disorders. The fourth part is about the biomechanical guidelines for the use of assistive devices during orthopedic rehabilitation.

Context/objective: To examine personal (athletic classification, age, sex, body mass index, duration of disability, tactile sensation of lower extremities) and wheelchair (kneeling plate angle) factors associated with increased pretibial skin pressures in elite wheelchair racers. Design: Cross-sectional study. Setting: University-based laboratory in Champaign, USA. Participants: A convenience sample of elite wheelchair races with traumatic spinal cord injury and spinal disease were recruited for participation. Interventions: Interface pressure mapping was used to examine athletes’ average and peak pretibial skin pressures in their own racing wheelchairs during static and dynamic (propulsive) conditions on a dynamometer. Outcome measures: The study examined associations between personal and wheelchair factors and pressure, differences in pressure between static and dynamic conditions, and the influence of athletic classification (T53 vs. T54) on kneeling plate angle preference and skin pressure magnitudes. Results: Increased kneeling plate angle was moderately associated with dynamic pressures. T53 athletes utilized more vertical kneeling angles and experienced larger average and peak pressures during propulsion. Duration of disability was negatively associated with all measures of pressure. Overall, mean dynamic peak pressure was significantly greater than mean static peak pressure. Conclusion: This pilot study represents a first step in understanding the influence of user interface on potentially injurious skin pressures in wheelchair racers. Vertical kneeling plate configurations were associated with increased pressures while increased years with disability was associated with lower pretibial pressures. In addition, T53 athletes with less trunk function may be at a greater risk for experiencing larger interface pressures than T54 athletes.

Technologies capable of projecting injury and performance metrics to athletes and coaches are being developed. Wheelchair athletes must be cognizant of their upper limb health; therefore, systems must be designed to promote efficient transfer of energy to the handrims and evaluated for simultaneous effects on the upper limbs. This article is brief review of resources that help wheelchair users increase physiologic response to exercise, develop ideas for adaptive workout routines, locate accessible facilities and outdoor areas, and develop wheelchair sports-specific skills.

This pilot study investigated the relationship between personal and wheelchair factors on skin pressures at the ischial tuberosity in wheelchair basketball players. Seventeen wheelchair basketball players (7 male and 10 female) were evaluated during static and dynamic propulsive conditions while peak pressure index and peak pressure gradient were recorded with an interface pressure mat. The results showed that greater seat dump angles and backrest heights were negatively associated with the peak pressure index. Therapeutic cushion use was moderately associated with a reduced peak pressure gradient. Higher-class players used chair configurations associated with augmented pressure; however, classification status alone was not associated with pressure magnitude. Body mass index was negatively correlated with the static peak pressure gradient at levels approaching significance (p

Adapted sports are increasingly recognized as a potent rehabilitative tool for persons with disabilities (PWD), facilitating optimal levels of health and wellbeing. At the same time, increased participation in adapted sports stimulates concomitant growth in technology and innovation worldwide. Success in wheelchair sports is said to be dependent on three factors: the athlete, the wheelchair, and the interaction between the athlete and the wheelchair. Proper use of technology has the potential to impact all the three factors significantly. In recent years, researchers have focused on the investigation of technologies impacting user interface, equipment customization, injury prevention, and performance improvement. This article presents a review of recent publications with a technological focus, selected for their importance and relevance to the field of wheelchair sports (wheelchair rugby, basketball, tennis, handcycling, and wheelchair racing) and for their potential to inform the decision-making process of athletes, coaches, and other healthcare professionals active in the arena of adaptive sports.

To describe a structured, short-term, transfer training intervention for full-time pediatric wheelchair users, investigate the impact of training on transfer skills, and to examine similarities and differences in response to training compared to those seen in adult wheelchair users.Randomized clinical trial.Participants were first randomized into an intervention (IG) or control group (CG). After completing surveys and demographic intake forms, all participants performed two sets of level transfers (from wheelchair to bench and back to wheelchair = one set) at three time points. Each time point composed of two transfer sets were scored using the Transfer Assessment Instrument (TAI) and averaged to produce a final transfer score per time point. No feedback or training were given to participants prior to time points one and two however the IG received structured training prior to transfer assessment # 3. TAI scores were compared at transfer assessment #3 using a Mann-Whitney test.Transfer Assessment Instrument (TAI) and Self-Perception Profile for Children (SPPC).Intervention group participants demonstrated significant improvements among TAI scores (9.06 ± 1.01) compared to the control group (7.15 ± 1.67), P = 0.030, d = 1.385. No significant differences were found among SPPC scores.Pediatric wheelchair users transfer skills were found to improve immediately after training with TAI score changes similar to those seen in adult wheelchair users after training. Such improvements may be a factor in long-term upper extremity preservation. Further testing is needed to examine the long-term impact of improved transfer skills.

The purpose of this case study was to investigate the influence of a training load (TL), oxygen saturation (SO2) and blood pressure (BP) on mood states in a wheelchair marathoner during (7 weeks at sea level (SL), 5 weeks at 3860 m altitude, 1 week returning to SL). TL was obtained with Foster’s equation while mood states were obtained with the Profile of Mood States Questionnaire (POMS). Furthermore, SO2 and BP were assessed upon wakening. SO2 (%) decreased at altitude, compared to SL (88.31 ± 2.46 vs. 98.52 ± 0.11) and increased until the last week at altitude (92.64 ± 1.12). Systolic pressure (SP) increased at altitude compared to pre-altitude (126.0 ± 5.1 vs. 107.6 ± 4.4 mmhg), and was not different from the last week at altitude. Controlling for SO2 and SP, differences were also observed in fatigue (97.66 ± 18.92 vs. 17.39 ± 13.71) and vigor (73.23 ± 8.62 vs. 26.48 ± 11.89) as a function of altitude. Upon return to SL, fatigue, vigor, SO2 and SP returned to pre values. This case study demonstrated the POMS was sensitive to worsening patterns in fatigue and vigor at altitude through a practical survey approach combined with daily physiological assessment.

Purpose: To examine if wheelchair fit influenced the effectiveness of video-based propulsion technique training.Method: Based on a cross sectional design, able-bodied participants (n = 21) received an optimally configured wheelchair (OCW; n = 11) or a nonoptimally configured wheelchair (NOCW; n = 10) to determine if propulsion technique was influenced by configuration before and after training. Outcome variables collected during steady-state treadmill propulsion at 1.1 m/s included peak resultant force (peak Fr; N), peak torque (N), contact angle (CA; degrees), stroke frequency (SF; strokes/s), power output (PO; W), and braking torque (BT; N m). Results: Significant group by time interactions were observed for PO (p = 0.05) and peak torque (p = 0.01), while CA, SF, and BT were significant by time (p < 0.05).Conclusion: Results suggest similar benefits from training regardless of rear axle position except for PO and peak torque where configuration was influential. Results suggest the combined effects of optimal configuration with training were most effective; however, those receiving training in a nonoptimal configuration can still improve. Although findings are preliminary, clinicians and end users should be alert to the interplay of configuration andtraining when attempting to modify technique.

Background: People with advanced multiple sclerosis (MS) are less physically active than those with milder forms of the disease, and wheelchair use has a negative association with physical activity participation. Thus, wheelchair users with MS are doubly disadvantaged for accruing the benefits of physical activity and exercise. Appropriate physical activity and exercise interventions are needed for this population. Methods: We undertook a qualitative study to explore the meanings, motivations, and outcomes of physical activity in wheelchair users with MS. We sought to understand daily opportunities to accumulate physical activity and exercise, and to identify perceived barriers, facilitators, and benefits that might inform the design of future interventions. Results: We interviewed 15 wheelchair users (mean age, 52 ± 8.8 years; n = 12 women). Data were transcribed and analyzed to identify and explore common themes. Our first theme was the reduced opportunity to participate in physical activity due to participants' dependence on mobility devices, environmental adaptations, and tangible support. Our second theme was the importance of incorporating physical activity and exercise into the everyday environment, highlighting the need for adaptive exercise and accessible environments. This indicated the need to incorporate behavior change modulators into physical activity and exercise interventions for those with advanced MS. Health-care professionals played an important role in promoting increased physical activity and exercise participation in those with advanced MS. Conclusions: Our findings may inform future interventions to increase initiation and maintenance of physical activity and exercise among people with advanced MS.

An estimated 3.26 million manual wheelchair users (MWUs) exist in the United States [1]. MWUs report a high incidence of upper extremity joint pain largely attributed to wheelchair propulsion, which exposes the upper limbs to high forces and torques repetitively over time [2]. There exists a clear need for assistive wheelchair technologies capable of reducing the loads experienced by the upper extremity joints during propulsion. IntelliWheels, Inc. has developed multi-geared wheel systems, including both low and high gear systems, where a planetary gear train connects the wheel hub to the wheel hand rim. Decreasing gear ratio, we hypothesize, may reduce the forces and torques required by the user during propulsion. To evaluate this claim, we constructed and validated an instrumented wheelchair hand rim system capable of use on either geared or standard wheelchair wheels. Commercially available devices exist to perform wheelchair kinetics, such as the SmartWheel (SW) (Three River Holdings LLC; Mesa, AZ, USA), however, these devices require the use of a manufacturer specified wheel. As a result, a custom solution was required to interface with the geared wheels used in this study.

Full time manual wheelchair users are at high risk for developing upper limb injuries and pain due to their reliance on the upper limbs to perform a wide variety of functional activities of daily living. Critical to survival and living well with a disability, even small decrements in functional mobility can lead to depression, social isolation and reduced quality of life. Treatment strategies to manage pain and injury are often not successful therefore engagement in preventative measures is critical to prevent the disruption of normal activities and performance of necessary social roles. This narrative review highlights key evidenced based training interventions and educational protocols focused on preventing and managing upper limb pain and injury among full time manual wheelchair users.

Purpose: The purpose of this study was to investigate university students with physical disabilities’ (SWD) perceptions of physical activity (PA) and how these perceptions may influence activity levels. Methods: Using reliable and validated surveys with in-depth interviews, researchers examined the perspectives of 13 undergraduate SWD regarding PA in the context of their university environment. Four quantitative surveys were used to understand participants’ health practices (SRAHP), exercise self-efficacy (EXSE), barriers to PA (BARSE), and outcome expectations for PA (MOEES). To gather richer, exploratory data, interviews were focused on answering how do SWD perceive and define PA, and what factors influence their PA participation? Correlational analysis and independent t-tests were used to examine survey outcomes. Interviews were analyzed using thematic analysis and line-by-line coding strategies. Results: Quantitative analysis revealed correlations between all MOEES surveys, as well as the EXSE, BARSE, and SRAHP. Analysis of the surveys and interviews resulted in two primary themes and seven subthemes. The first primary theme, personal perceptions of PA, had two subthemes: Personal definitions and personal practices. The second theme, influences on PA participation, consisted of five subthemes: University assistive resources, aspects of personal well-being, symptoms and physical limitations, time and scheduling, and social inclusion. Conclusions: Results from this study helped to understand how SWD identified with PA and identified both motivations and barriers to PA unique to SWD. Data from this study can be used to improve accessibility and disability programming for SWD to promote PA.

Objective To examine whether differences in propulsion technique as a function of intraindividual variability occur as a result of shoulder pain and physical activity (PA) level in full-time manual wheelchair users (MWUs). Design Observational study. Setting Research laboratory. Participants Adults (N=14) with spinal cord injury (mean age: 30.64±11.08) who used a wheelchair for >80% of daily ambulation and were free of any condition that could be worsened by PA. Interventions Not applicable. Main Outcome Measures PA level was measured using the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), and shoulder pain was measured using the Wheelchair User's Shoulder Pain Index (WUSPI) survey. Mean and intraindividual variability propulsion metrics were measured for propulsion analysis. Results WUSPI scores indicated participants experienced low levels of shoulder pain. The results of the Spearman rank-order correlation revealed that PASIPD scores were significantly related to mean contact angle ( r s =−.57) and stroke frequency ( r s =.60) as well as to coefficient of variation of peak force ( r s =.63), peak torque ( r s =.59), contact angle ( r s =.73), and stroke frequency ( r s =.60). WUSPI scores were significantly correlated with only mean peak force ( P =.02). No significant correlations were observed between PASIPD, WUSPI, and body mass index scores. Conclusions Differences in propulsion technique were observed on the basis of PA levels. Participants with higher PASIPD scores used a more injurious stroke technique when propelling at higher speeds. This may indicate that active individuals who use injurious stroke mechanics may be at higher risk of injury. A strong relation was found between peak propulsion forces and shoulder pain. Rehabilitation professionals should emphasize the use of a protective stroke technique in both inactive and active MWUs during exercise and faster propulsion.

Our purpose was to examine the influence of glove type on kinetic and spatiotemporal parameters at the handrim in elite wheelchair racers. Elite wheelchair racers (n=9) propelled on a dynamometer in their own racing chairs with a force and moment sensing wheel attached. Racers propelled at 3 steady state speeds (5.36, 6.26 & 7.60 m/s) and performed one maximal effort sprint with 2 different glove types (soft & solid). Peak resultant force, peak torque, impulse, contact angle, braking torque, push time, velocity, and stroke frequency were recorded for steady state and sprint conditions. Multiple nonparametric Wilcoxon matched pair’s tests were used to detect differences between glove types, while effect sizes were calculated based on Cohen’s d. During steady state trials, racers propelled faster, using more strokes and larger contact angle, while applying less impulse with solid gloves compared to soft gloves. During the sprint condition, racers achieved greater top end velocities, applying larger peak force, with less braking torque with solid gloves compared to soft gloves. Use of solid gloves may provide some performance benefits to wheelchair racers during steady state and top end velocity conditions.

Ten full-time adolescent wheelchair users (ages 13–18) completed a total of three propulsion trials on carpet and tile surfaces, at a self-selected velocity, and on a concrete surface, at a controlled velocity. All trials were performed in their personal wheelchair with force and moment sensing wheels attached bilaterally. The first two trials on each surface were used as pre-intervention control trials. The third trial was performed after receiving training on proper propulsion technique. Peak resultant force, contact angle, stroke frequency, and velocity were recorded during all trials for primary analysis. Carpet and tile trials resulted in significant increases in contact angle and peak total force with decreased stroke frequency after training. During the velocity controlled trials on concrete, significant increases in contact angle occurred, as well as decreases in stroke frequency after training. Overall, the use of a training video and verbal feedback may help to improve short-term propulsion technique in adolescent wheelchair users and decrease the risk of developing upper limb pain and injury.

Objective To examine the efficacy and feasibility of a multifactorial intervention to increase lifestyle physical activity in nonambulatory persons with multiple sclerosis (MS) based on wheelchair optimization, propulsion skill/technique training, and behavioral strategies based on social cognitive theory. Design Randomized controlled trial, 3-month postintervention follow-up. Setting Home and general community, and university research laboratory. Participants Nonambulatory individuals with MS (N=14; mean age ± SD, 53.6±8.7y) were randomly assigned to an intervention group (IG) or a control group (CG). Interventions After baseline testing, the IG participants received custom-fit, ultralightweight manual wheelchairs with propulsion/skills training, followed by 3 months of at-home use with the custom ultralightweight wheelchair and weekly phone calls to deliver support through a multifactorial intervention. The CG participants received no training and used their own wheelchairs at home during this time. Main Outcome Measures All subjects were assessed at baseline and 3 months later for fatigue (Fatigue Severity Scale), upper extremity strength (digital handheld dynamometer), and propulsion technique (on a treadmill [0.5m/s] with instrumented wheels). Two 1-week bouts of physical activity were measured in both groups from home with wrist-worn accelerometry at the beginning (IG and CG in own wheelchairs) and end (IG in study wheelchair, CG in own) of the 3-month period of home use. Results The intervention was well tolerated, and no adverse events were reported. The IG demonstrated increased strength ( P =.008) and a trend toward less fatigue ( P =.068), both with large effect sizes ( d >0.8), as well as reduced application of braking torque during propulsion ( P =.003) with a moderate/large effect size ( d =.73), compared with the CG. Conclusions Findings suggest a 3-month physical activity intervention based on manual wheelchair propulsion and training is safe and feasible for some wheelchair users living with MS and may produce secondary benefits in strength, fatigue, and propulsion technique.

This is an experimental design.This study examined the association between rates of energy expenditure (that is, oxygen consumption (VO2)) and accelerometer counts (that is, vector magnitude (VM)) across a range of speeds during manual wheelchair propulsion on a motor-driven treadmill. Such an association allows for the generation of cutoff points for quantifying the time spent in moderate-to-vigorous physical activity (MVPA) during manual wheelchair propulsion.The study was conducted in the University Laboratory.Twenty-four manual wheelchair users completed a 6-min period of seated rest and three 6-min periods of manual wheelchair propulsion on a motor-driven wheelchair treadmill. The 6-min periods of wheelchair propulsion corresponded with three treadmill speeds (1.5, 3.0 and 4.5 mph) that elicited a range of physical activity intensities. Participants wore a portable metabolic unit and accelerometers on both wrists. Primary outcome measures included steady-state VO2 and VM, and the strength of association between VO2 and VM was based on the multiple correlation and squared multiple correlation coefficients from linear regression analyses.Strong linear associations were established between VO2 and VM for the left (R=0.93±0.44; R2=0.87±0.19), right (R=0.95±0.37; R2=0.90±0.14) and combined (R=0.94±0.38; R2=0.88±0.15) accelerometers. The linear relationship between VO2 and VM for the left, right and combined wrists yielded cutoff points for MVPA of 3659 ±1302, 3630±1403 and 3644±1339 counts min(-1), respectively.We provide cutoff points based on the linear association between energy expenditure and accelerometer counts for estimating time spent in MVPA during manual wheelchair propulsion using wrist-worn accelerometry. The similarity across wrist location permits flexibility in selecting a location for wrist accelerometry placement.