목적 : 척수손상 환자를 대상으로 시각피이드백을 이용한 휠체어 추진이 척수손상 환자의 균형 특성에 미치는 영향을 알아보고자 하였다. 연구방법 : 척수 완전 손상 환자 38명을 대상으로 휠체어 추진 시뮬레이션 장치와 휠체어를 추진하지 않는 경우와 추진하는 경우 시각피이드백 이용유무에 따른 둔부와 대퇴부의 압력분포와 압력중심이동 변화를 측정하기 위해 좌석시트 압력분포 측정도구인 FSA를 사용하였다. 이들 실험도구들을 이용하여 얻은 결과는 다음과 같다. 결과 : 1) 시각피이드백 이용 없이 휠체어를 추진하지 않는 경우와 추진하는 경우에 압력중심의 흔들림이 유의한 차이가 있었다(p<.05). 2) 휠체어 추진 시 시각피이드백을 이용하지 않은 경우보다 시각피이드백을 이용한 경우에 척수손상 레벨에 상관없이 압력중심의 흔들림이 모두 감소되었다. 시각피이드백 이용 유무에 따라 흉수상부 손상, 흉수하부 손상, 요수 손상 환자에 있어서는 유의한 차이를 보였다(p<.05). 3) 경수 손상 환자의 부위별 좌석시트 압력분포 평균을 보았을 때, 휠체어 추진 시 둔부전방 > 둔부후방 > 대퇴부 후방 > 대퇴부 전방 순으로 압력이 분포되었으며, 휠체어를 추진하면서 시각피이드백을 이용한 경우의 부위별 압력 증가비율을 계산한 결과, 둔부전방과 대퇴부 부위로 더 많은 압력증가가 생겼다. 4) 흉수상부 손상 환자의 부위별 좌석시트 압력분포 평균을 보았을 때 휠체어 추진 시 둔부전방 > 대퇴부 후방 > 둔부후방 > 대퇴부 전방 순으로 압력이 분포되었으며, 휠체어를 추진하면서 시각피이드백을 이용한 경우의 부위별 압력 증가비율을 계산한 결과 둔부전방과 대퇴부 부위로 더 많은 압력증가가 생겼다. 5) 흉수하부 손상 환자의 부위별 좌석시트 압력분포 평균을 보았을 때 휠체어 추진 시 둔부전방 > 대퇴부 후방 > 둔부후방 > 대퇴부 전방 순으로 압력이 분포되었으며, 휠체어를 추진하면서 시각피이드백을 이용한 경우의 부위별 압력 증가비율을 계산한 결과 대퇴부 부위로 더 많은 압력증가가 생겼다. 6) 요수 손상 환자의 부위별 좌석시트 압력분포 평균을 보았을 때 휠체어 추진 시 둔부전방 > 둔부 후방 > 대퇴부 후방 > 대퇴부 전방 순으로 압력이 분포되었으며, 휠체어를 추진하면서 시각피이드백을 이용한 경우의 부위별 압력 증가비율을 계산한 결과 둔부후방으로의 압력 증가비율이 가장 많이 증가하고, 다음으로 대퇴부 전방, 그리고 대퇴부 후방 순이었다. 결론 : 시각피이드백을 이용한 휠체어 추진 시 척수손상 레벨에 상관없이 압력중심의 흔들림이 모두 감소하였다. 또한, 전방 또는 전후방으로의 압력분포 변화를 통해 균형의 향상을 가져올 수 있는 움직임이 더 증가하는 경향이 있었다. 이를 통해 시각피이드백을 이용한 휠체어 추진이 척수손상 환자의 균형능력 향상에 도움을 줄 수 있음을 보여주었다.

Pressure ulcers are serious complications of tissue damage that can develop in patients with diminished pain sensation and diminished mobility. Pressure ulcers can result in irreversible tissue damage caused by ischemia resulting from external loading. There are many intrinsic and extrinsic contributors to the problem, including interface tissue pressure, shear, temperature, moisture, hygiene, nutrition, tissue tolerance, sensory and motor dysfunction, disease and infection, posture, and body support systems. The purposes of this study were to investigate the relationship between buttock interface pressure and seating position, wheelchair propulsion speed. Seated-interface pressure was measured using the Force Sensing Array pressure mapping system. Twenty subjects propelled wheelchair handrim on a motor-driven treadmill at different velocities (40, 60, 80 m/min) and seating position used recline (, , ) with a wheelchair simulator. Interface pressure consists of average (mean of the pressure sensor values) and maximum pressure (highest individual sensor value). The results of this study were as follows; No significant correlation in maximum/average pressure was found between a static position and a 40 m/min wheelchair propulsion (p>.05). However, a significant increase in maximum/average pressure were identified between conditions of a static position and 60 m/min, and 80 m/min wheelchair propulsion (p<.05). No significant correlation in maximum pressure were found between a recline (neutral position) and a , , or recline of the wheelchair back (p>.05). No significant difference in average pressure was found between conditions of a recline and both a and recline of wheelchair back. However, a significant reduction in average pressure was identified between conditions of a and recline of wheelchair back (p<.05). This study has shown some interesting results that reclining the seat by reduced average interface pressure, including the reduction or prevention in edema. And interface pressure was greater during dynamic wheelchair propulsion compared with static seating. Therefore, the optimal seating position and seating system ought to provide postural control and pressure relief. We need an education on optimal seating position and a suitable propulsion speeds for wheelchair users.

Individuals who propel wheelchairs have a high prevalence of upper extremity injuries (i.e., carpal tunnel syndrome, elbow/shoulder tendonitis, impingement syndrome). Musculoskeletal injuries can result from overuse or incorrect use of manual wheelchairs, and can hinder rehabilitation efforts. To better understand the mechanisms of upper extremity injuries, this study investigates the motion of the wrist during wheelchair propulsion. This study also examines changes in the variables that occur with fatiguing wheelchair propulsion to determine how the time parameters of wheelchair propulsion and the state of fatigue influence the risk of injury. A two dimensional (2-D) analysis of wrist movement during the wheelchair stroke was performed. Twenty subjects propelled a wheelchair handrim on a motor-driven treadmill at two different velocities (50, 70 m/min). The results of this study were as follows; The difference in time parameters of wheelchair propulsion (cadence, cycle time, push time, recovery time, and PSP ratio) at two different velocities was statistically significant. The wrist kinematic characteristics had statistically significant differences at two different velocities, but wrist radial deviation and elbow flexion/extension had no statistically significant differences. There were statistically significant differences in relation to fatigue in the time parameter of wheelchair propulsion (70 m/min) between initial 1 minute and final 1 minute. The wrist kinematic characteristics between the initial 1 minute and final 1 minute in relation to fatigue had statistically significant differences but the wrist flexion-extension (50 m/min) had no statistically significant differences. According to the results, the risk of musculoskeletal injuries is increased by fatigue from wheelchair propulsion. To prevent musculoskeletal injuries, wheelchair users should train in a muscle endurance program and consider wearing a splinting/grove. Moreover, wheelchair users need education on propulsion posture, suitable joint position, and proper recovery patterns of propulsion.

This study was carried out to help the comprehensive rehabilitation of spinal cord injuries by measuring propulsion force and endurance exerted on wheelchair handrims, and predicting the differences among three different rear axle positions. The BTE (Baltimore Therapeutic Exerciser) work simulator was used on 9 paraplegia to test the force and endurance during wheelchair propulsion. The 141 large wheel of the BTE work simulator and a standard wheelchair with removed handrims were used for simulating wheelchair propulsion. The neurological and demographical characteristics of the patients were collected by personal interviews and direct examinations. The Kruskal-Wallis test was used to compare force and endurance among the groups. The strongest maximum isometric strength was produced when the rear axle of the wheelchair and the acromion process were on the same coronal plane. Although there were no significant differences statistically, moving the rear axle forward did result in greater isotonic strength. The research suggests that better functional activity of persons with paraplegia is possible when the rear axle of the wheelchair is appropriately adjusted.

Objectives: The purpose of this study was to investigate the effects of wheelchair propulsion speed changes on the shoulder impingement syndrome. Method: EMG activity of 5 muscles (biceps brachii, pectoralis major, deltoid anterior, triceps brachii, and trapezius) were recorded with surface electrodes in 24 males during propulsion of three different speed levels on a motor-driven wheelchair treadmill. EMG signal was analysed using root mean square (RMS) values. In order to assure the statistical significance of the results, the one-way ANOVA and a Post Hoc Multiple Comparison were applied at the 0.05 level of significance. Results: The results of this study were as follows: Biceps brachii, and pectoralis RMS value variations of wheelchair propulsion speed between 45m/min and 60m/min, and between 60m/min and 75m/min were not statistically different (p>0.05). Triceps brachii, deltoid anterior and trapezius RMS value variations of wheelchair propulsion speed between 45m/min and 75m/min were statistically different (p<0.05). Conclusions: The risk of impingement syndrome has increased from deltoid muscle contraction growth and trapezoid, triceps brachial muscle endurance decrease when wheelchair propulsion speed rises. To prevent from impingement syndrome wheelchair users should strengthen and endure shoulder muscles. Besides we need education on propulsion posture and suitable position for wheelchair users.

The purpose of this paper is to provide the reader with a pertinent information and research trends of biomechanics in wheelchair propulsion. Biomechanical studies for wheelchair propulsion mainly focus on the most suitable propulsion performance and methods for preventing upper extremity injuries. Recent issues have concentrated on wheelchair propulsion style and cycle mainly because of the high prevalence of repetitive strain injuries in the upper extremely such as shoulder impingement and carpel tunnel syndrome. Optimizing wheelchair propulsion performances as well as medical reflections are presented throughout the review. Information on the underlying musculoskeletal mechanisms of wheelchair propulsion has been introduced through a combination of data collection under experimental conditions and a more fundamental mathematical modelling approach. Through a synchronized analysis of the movement pattern and muscular activity pattern, insight has been gained in the wheelchair propulsion dynamics of people with a different level of disability (various level of physical activity and functional potential). Through mathematical modelling simulation, and optimization (minimizing injury and maximizing performance), underlying musculoskeletal mechanisms during Wheelchair propulsion is investigated.