Richter W Mark, Rodriguez Russell, Woods Kevin R, Axelson Peter W
MAX Mobility LLC, Nashville, TN; Beneficial Designs Inc, Nashville, TN, USA.
Arch Phys Med Rehabil. 2007 Jan;88(1):81-7. doi: 10.1016/j.apmr.2006.09.017.
To investigate the natural stroke patterns of wheelchair users pushing on a level surface, to determine if users adapt their stroke patterns for pushing uphill, and to assess whether there are biomechanic advantages to one or more of the stroke patterns.
Case series.
Biomechanics laboratory.
Twenty-six manual wheelchair users with a spinal cord injury.
Subjects pushed their own wheelchairs at self-selected speeds on a research treadmill set to level, 3 degrees , and 6 degrees grades. Stroke patterns were measured using a motion capture system. Handrim biomechanics were measured using an instrumented wheel.
Stroke patterns were classified for both level and uphill propulsion according to 1 of 4 common classifications: arcing, semi-circular, single-looping (SLOP), and double-looping (DLOP). Biomechanic outcomes of speed, peak handrim force, cadence, and push angle were all compared across stroke classifications using an analysis of variance.
Only 3 of the 4 stroke patterns were observed. None of the subjects used the semi-circular pattern. For level propulsion, the stroke patterns were fairly balanced between arcing (42%), SLOP (31%), and DLOP (27%). Subjects tended to change their stroke pattern for pushing uphill, with 73% of the subjects choosing the arcing pattern by the 6 degrees grade. No statistically significant differences were found in handrim biomechanics or subject characteristics across stroke pattern groups.
Wheelchair users likely adapt their stroke pattern to accommodate their propulsion environment. Based on the large percentage of subjects who adopted the arcing pattern for pushing uphill, there may be benefits to the arcing pattern for pushing uphill. In light of this and other recent work, it is recommended that clinicians not instruct users to utilize a single stroke pattern in their everyday propulsion environments.
研究轮椅使用者在水平面上推动轮椅的自然划动模式，确定使用者在上坡时是否会调整划动模式，并评估一种或多种划动模式是否具有生物力学优势。
病例系列研究。
生物力学实验室。
26名脊髓损伤的手动轮椅使用者。
受试者在设置为水平、3度和6度坡度的研究跑步机上以自行选择的速度推动自己的轮椅。使用动作捕捉系统测量划动模式。使用装有仪器的轮子测量轮圈生物力学。
根据4种常见分类中的1种，对水平和上坡推进的划动模式进行分类：弧形、半圆形、单环（SLOP）和双环（DLOP）。使用方差分析比较不同划动模式下速度、轮圈峰值力、踏频和推角的生物力学结果。
仅观察到4种划动模式中的3种。没有受试者使用半圆形模式。对于水平推进，划动模式在弧形（42%）、SLOP（31%）和DLOP（27%）之间相当均衡。受试者在上坡推动时倾向于改变划动模式，73%的受试者在6度坡度时选择了弧形模式。不同划动模式组在轮圈生物力学或受试者特征方面未发现统计学上的显著差异。
轮椅使用者可能会调整划动模式以适应其推进环境。鉴于有很大比例的受试者在上坡时采用弧形模式，弧形模式在上坡推动时可能有优势。鉴于此及其他近期研究，建议临床医生不要指导使用者在日常推进环境中采用单一划动模式。
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