Load on the upper extremity in manual wheelchair propulsion.

To study joint contributions in manual wheelchair propulsion, we developed a three-dimensional model of the upper extremity. The model was applied to data collected in an experiment on a wheelchair ergometer in which mechanical advantage (MA) was manipulated. Five male able-bodied subjects performed two wheelchair exercise tests (external power output P(ext) = 0.25-0.50 W · kg(-1)) against increasing speeds (1.11-1.39-1.67 m.s(-1)), which simulated MA of 0.58-0.87. Results indicated a decrease in mechanical efficiency (ME) with increasing MA that could not be related to applied forces or joint torques. Increase in P(ext) was related to increases in joint torques. On the average, the highest torques were noted in shoulder flexion and adduction (35.6 and 24.6 N · m at MA = 0.58 and P(ext)= 0.50 W · kg(-1)). Peak elbow extension and flexion torques were -10.6 and 8.5 N · m. Based on the combination of torques and electromyographic (EMG) records of upper extremity muscles, anterior deltoid and pectoralis muscles are considered the prime movers in manual wheelchair propulsion. Coordinative aspects of manual wheelchair propulsion concerning the function of (biarticular) muscles in directing the propulsive forces and the redistribution of joint torques in a closed chain are discussed. We found no conclusive evidence for the role of elbow extensors in direction of propulsive forces.