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  • Vertical reaction forces of three different one-arm drive wheelchairs

A comparison of vertical reaction forces during propulsion of three different one-arm drive wheelchairs by hemiplegic users

The standard manual wheelchair is an effective, but inefficient means of transport. Hemiplegic users face cognitive, perceptual and physical difficulties. Although the cognitive and perceptual difficulties are difficult to address, the physical difficulties can be ameliorated by improvements in wheelchair design. Current provision includes two different types of propulsion: the ratchet arm or lever-drive mechanism and the dual-handrim mechanism. Lever arm design, such as the NuDrive (Watford, Hertfordshire, UK) or Pivot (Pivot Rio Mobility, San Francisco, CA), involves a pushing or pulling action on the end of a lever mechanism.

The second type of design is the dual handrim where the two handrims are mounted on the same side of the wheelchair. Propulsion involves gripping and rotating both rims at the same time in order to move forward in a straight line. This can be difficult for users with a small hand span or with impaired hand function. Alternatively each rim may be used in turn to propel the wheelchair forwards but this can result in a snake-like movement, which is inefficient and requires significant effort.

Literature reports that nearly 70 per cent of wheelchair users experience upper extremity pain or overuse injury at some point. Anecdotally, clinicians report that the current one-arm drive wheelchairs do not meet the needs of hemiplegic users, which may explain the high level of wheelchair abandonment.

The study was designed as a controlled, same-subject study that measured the force generated by each user during propulsion in three different one-arm drive wheelchairs.

The data being measured were vertical reaction forces at the buttock/seat interface in Newtons. These were measured using the CONFORMat® Pressure Measurement System, a portable interface pressure mapping system, which records pressure distribution under the contact area. The system includes pressure-sensing hardware and software.

The study was designed to compare the measurements taken in each wheelchair for each individual participant, with each user acting as their own control. This was considered to be an appropriate approach due to the heterogeneity of hemiplegia within the user group and the bespoke postural and pressure equipment that they used in the wheelchairs during the study.

Project timeframes

This research project ended in 2012.

Project aims

The aim of this pilot study was to compare the vertical reaction forces generated in three different Action 3 manual one-arm drive wheelchairs:

  • dual handrim
  • a lever drive
  • a Neater Uni-wheelchair (NUW).

A CONFORmat Pressure measurement mat, placed on top of the users’ prescribed cushion, measured vertical force at the buttock/seat interface on both hemiplegic and non-hemiplegic sides in each wheelchair.

Methods

Fifteen hemiplegic users were randomly assigned each wheelchair to drive around an indoor obstacle course. During propulsion of a multiple sensor, continuous measurement of force was recorded. Time taken to complete the circuit was recorded. Mean force and confidence intervals for each buttock were calculated per user per wheelchair.

Indoor-circuit-map

Indoor circuit plan

Project findings and impact

Results

The dual handrim produced the highest vertical force during propulsion under the right buttock and the lever drive produced the least force. The NUW completed the course quickest.

Conclusions

The dual-handrim wheelchair requires the greatest vertical force during propulsion. Since increases in this seat vertical reaction force may be related to the propulsive force. Further investigation is indicated as this may be a significant factor for clinicians when prescribing one-arm drive wheelchairs.

This pilot study of hemiplegic users suggests that the dualhandrim wheelchair requires more force for the propulsion compared with the lever and the NUW. Further work is indicated to explore changes in posture, and propulsive effort in the NUW and lever wheelchairs. Rehabilitation teams may wish to review their clinical reasoning in relation to prescribing wheelchairs for hemiplegic users on the evidence presented.

Research team

Associate Professor Anne Mandy

Dr Lucy Redhead

Output

Project Final Report (pdf)

Partners

Carol McCudden, Wheelchair Services, Betsi Cadwaladr University

Jon Michaelis, Neater Solutions, Buxton

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