A new method to quantify demand on the upper extremity during manual wheelchair propulsion

Arch Phys Med Rehabil. 2004 Jul;85(7):1151-9. doi: 10.1016/j.apmr.2003.10.024.


Objective: To use an ergonomics-based rating that characterizes both demand on, and capacity of, upper-extremity muscle groups during wheelchair propulsion to help identify the muscle groups most at risk for pain or overuse injury in a relatively demanding wheelchair propulsion task.

Design: Case series.

Setting: Biomechanics research laboratory.

Participants: Sixteen manual wheelchair users with complete (American Spinal Injury Association grade A) T6-L2 paraplegia.

Interventions: Not applicable.

Main outcome measures: Internal peak joint moments required by each of the major upper-extremity muscle groups for propelling a wheelchair up a ramp; isometric strength of each of the muscle groups in positions simulating wheelchair propulsion; and wheelchair propulsion strength rating (WPSR) for each muscle group, calculated by normalizing the joint demands to their capacity.

Results: The largest joint moment was for shoulder flexion, at 39.7+/-13.9Nm. Shoulder flexion also accounted for the peak WPSR value of 66.5%+/-20.3%. Supination and pronation movements had low peak moment requirements (3.4Nm, 5.0Nm, respectively) but high WPSR values (41%, 53%, respectively).

Conclusions: Even a relatively benign ramp (2.9 degrees ) places a large demand on the musculature of the upper extremity, as assessed by using the WPSR to indicate muscular demand.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Arteriovenous Malformations / physiopathology
  • Biomechanical Phenomena
  • Disabled Persons / rehabilitation
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multiple Sclerosis / physiopathology
  • Multiple Sclerosis / rehabilitation
  • Paraplegia / physiopathology*
  • Paraplegia / rehabilitation*
  • Shoulder Joint / physiopathology*
  • Spinal Cord Injuries / physiopathology
  • Spinal Cord Injuries / rehabilitation
  • Task Performance and Analysis
  • Wheelchairs*
  • Wrist Joint / physiopathology