Understanding the motor learning process in handrim wheelchair propulsio

Proficiency in wheelchair propulsion is a key to independence among manual wheelchair users. While low levels of wheelchair skill relate to social isolation and dependence on others, high levels of skill correspond to higher independence, active participation and quality of life. Even though the motor learning process of handrim wheelchair propulsion is considered highly important, it is still not well understood. The goal of this thesis was to widen the understanding of this process in order to contribute to evidence-based guidelines concerning wheelchair skill acquisition, which on the long term will enhance the quality of life and participation among wheelchair users. This thesis described physiological and biomechanical changes that take place during low-intensity wheelchair practice. The results showed that motor learning in wheelchair propulsion is a very complex process with numerous interconnected aspects. Changes in the movement pattern and shoulder load occurring due to practice can vary strongly among individuals. The emergent movement pattern is most likely a result of an interplay between the personal characteristics (e.g.pain, talent), the task requirements (wheelchair type, fitting and maintenance) and the environment (surface, obstacles). Current rehabilitation practice does not yet have a proper understanding of this important process, which makes the provision of individualized evidence-based care regarding learning to use a wheelchair impossible. The implementation of wheelchair-labs, in rehabilitation and adapted sports is suggested as a solution for the future. This novel technology could allow systematic multicenter monitoring of large patient groups and assist clinicians in providing individualized diagnosis, therapy and wheelchair fitting.