Rice Ian, Gagnon Dany, Gallagher Jere, Boninger Michael
University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
J Spinal Cord Med. 2010;33(1):33-42. doi: 10.1080/10790268.2010.11689672.
BACKGROUND/OBJECTIVE: As considerable progress has been made in laboratory-based assessment of manual wheelchair propulsion biomechanics, the necessity to translate this knowledge into new clinical tools and treatment programs becomes imperative. The objective of this study was to describe the development of a manual wheelchair propulsion training program aimed to promote the development of an efficient propulsion technique among long-term manual wheelchair users.
Motor learning theory principles were applied to the design of biomechanical feedback-based learning software, which allows for random discontinuous real-time visual presentation of key spatiotemporal and kinetic parameters. This software was used to train a long-term wheelchair user on a dynamometer during 3 low-intensity wheelchair propulsion training sessions over a 3-week period. Biomechanical measures were recorded with a SmartWheel during over ground propulsion on a 50-m level tile surface at baseline and 3 months after baseline.
Training software was refined and administered to a participant who was able to improve his propulsion technique by increasing contact angle while simultaneously reducing stroke cadence, mean resultant force, peak and mean moment out of plane, and peak rate of rise of force applied to the pushrim after training.
The proposed propulsion training protocol may lead to favorable changes in manual wheelchair propulsion technique. These changes could limit or prevent upper limb injuries among manual wheelchair users. In addition, many of the motor learning theory-based techniques examined in this study could be applied to training individuals in various stages of rehabilitation to optimize propulsion early on.
背景/目的：鉴于在基于实验室的手动轮椅推进生物力学评估方面已取得显著进展，将这些知识转化为新的临床工具和治疗方案变得势在必行。本研究的目的是描述一种手动轮椅推进训练计划的制定，该计划旨在促进长期手动轮椅使用者发展高效的推进技术。
运动学习理论原则被应用于基于生物力学反馈的学习软件的设计，该软件允许随机不连续实时视觉呈现关键时空和动力学参数。该软件用于在3周内的3次低强度轮椅推进训练课程中，在测力计上训练一名长期轮椅使用者。在基线和基线后3个月，使用智能轮在50米水平瓷砖表面进行地面推进时记录生物力学测量数据。
训练软件经过改进并应用于一名参与者，该参与者能够通过增加接触角同时降低划频、平均合力、平面外峰值和平均力矩以及训练后施加在轮辋上的力的峰值上升速率来改善其推进技术。
所提出的推进训练方案可能会导致手动轮椅推进技术出现有利变化。这些变化可能会限制或预防手动轮椅使用者的上肢损伤。此外，本研究中检验的许多基于运动学习理论的技术可应用于康复各阶段的个体训练，以便尽早优化推进技术。
