Assessment of Longitudinal Changes in Manual Wheelchair Handrim Forces and Stroke Patterns in Children with Spinal Cord Injury

Research Objectives To identify changes in handrim kinetics and propulsive stroke patterns over time in pediatric manual wheelchair users. Design Longitudinal, prospective. Setting Motion Analysis Lab at Shriners Hospital for Children- Chicago. Participants Six pediatric manual wheelchair users with spinal cord injury. To be eligible, participants were required to be under 21 years of age during their first visit and use a manual wheelchair as their primary mode of mobility. Interventions Participants were evaluated in two separate data collection sessions, approximately one year apart. Participants propelled their wheelchair along a 15-meter, tile walkway at a self-selected speed and stroke pattern for multiple trials while kinetic and kinematic data were collected using a Vicon motion capture system and a Smartwheel affixed to their personal wheelchair. Main Outcome Measures Handrim peak force, variance of force, and stroke patterns. Results Over half of the participants increased their maximum rate of rise (F/t) of resultant force between visits. No trends were observed in the change in average peak resultant force per stroke cycle between visits, though one participant had a large decrease and another had a large increase. The variance of peak resultant force decreased notably in the three oldest participants and decreased in the three youngest participants. The number of types of stroke patterns used for propulsion and the frequency with which each pattern was used changed for all but one participant between visits. Conclusions Changes in handrim kinetics and stroke patterns were observed in most participants between visits. This is concerning, as some of these changes, such as decreased variance of peak resultant force and increased maximum rate of rise, have been correlated with shoulder pain and pathology in adults. Additional research using a larger cohort of pediatric manual wheelchair users is indicated to observe changes that could lead to musculoskeletal pain and pathology. Author(s) Disclosures None.