# Power versus Manual Wheelchair: What is the Impact of Propulsion Mechanisms on Seat Pressure among Wheelchair Users with Spinal Cord Injury?

Clémence Paquin, S. Duprey, O. Chenu, S. Ciancia, L. Dubuis, A. Gelis

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Clémence Paquin, S. Duprey, O. Chenu, S. Ciancia, L. Dubuis, et al. Power versus Manual Wheelchair: What is the Impact of Propulsion Mechanisms on Seat Pressure among Wheelchair Users with Spinal Cord Injury?. Multidisciplinary Biomechanics Journal, 2025, 50th congress of the.., 10.46298/mbj.16153. hal-05191705v2

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# Power versus Manual Wheelchair: What is the Impact of Propulsion Mechanisms on Seat Pressure among Wheelchair Users with Spinal Cord Injury?

Clémence Paquin<sup>a, b*</sup>, Sonia Duprey<sup>c</sup>, Olivier Chenu<sup>d</sup>, Sophie Ciancia<sup>e</sup>, Laura Dubuis<sup>c</sup>, Anthony Gelis<sup>f</sup>

<sup>a</sup> Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada

<sup>b</sup> School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Québec, QC, Canada

<sup>c</sup> Univ Eiffel, Univ Lyon 1, LBMC UMR_T 9406, F-69622 Lyon, France

<sup>d</sup> Texisense, Torcy; France

<sup>e</sup> Hôpital Henry Gabrielle, Hospice Civil de Lyon, Lyon, France

<sup>f</sup> EPSYLON, Montpellier, France

* Corresponding author: clemence.paquin.1@ulaval.ca

Received date: 24/03/2025

Accepted date: 27/06/2025

Publication date: 27/10/2025

**Keywords:** wheelchair, pressure injury, bodyseat interface forces, propulsion

© 2025 The Authors

Licence CC-BY 4.0

Published by Société de Biomécanique

## 1. Introduction

In 2019, the prevalence of wheelchair users in France was estimated at 9 per 1,000 inhabitants (Espagnacq, 2022), primarily due to aging, spinal cord injuries, and other motor disabilities. Manual wheelchairs (MWC) account for the majority, representing 71% of users, whereas power wheelchairs (PWC) are used by approximately 29% of the users, with this ratio increasing as wheelchair users' life expectancy rises (Espagnacq, 2022).

One key concern for wheelchair users is the risk of pressure injuries, which are influenced by the forces at the body-seat interface (Oomens, Bader, Loerakker, & Baaijens, 2015).

MWCs and PWC present significant ergonomic differences. PWC are equipped with an electric motor and thus do not require any physical effort for propulsion, whereas bimanual propulsion in MWC relies on the user pushing both rear wheels simultaneously engaging the upper limb and trunk muscles.

Since seat force and pressure distribution have been mostly studied in MWC (Paquin et al., 2023) and since MWC seatpan pressure fluctuates due to the alternating push pattern applied to the hand rims during propulsion (Andreoni, Pedotti, & Ferrarin, 2001; Paquin et al., 2023) it remains unclear what are the differences on seat pressure between MWC and PWC.

This study aims to compare seat pressure between MWC and PWC users during propulsion to find out if there are any differences in the risk of pressure sore injury.

## 2. Methods

This study was approved by the French Committee for the Protection of Persons (Ouest III, France, No. 2021-A03031-40)

### 2.1 Population

Sixteen wheelchair users (8 MWC and 8 PWC) with spinal cord injuries were recruited from two rehabilitation centers: Hôpital Henry Gabriel in Lyon and Centre Mutualiste Propara in Montpellier, France. The inclusion criterion was for the participants to be daily wheelchair users for over three months following their spinal cord injury.

### 2.2 Materials

Pressure measurements at the body-seat interface were recorded using a Texicare® pressure mat (TexiSense, Torcy, France). The mat was connected to a computer via Bluetooth, with a maximum acquisition frequency of 10 Hz, depending on the Bluetooth signal quality.

### 2.3 Procedure

Participants used their own wheelchair with their own cushion, the Texicare® mat was positioned on the latter.
A 15-minute stationary period was observed to allow for pressure redistribution, as recommended by Stinson et al. (Stinson, Crawford, & Porter-Armstrong, 2008). Each participant propelled over a 10-meter distance on an indoor smooth floor (Figure 1).

Initial and final postures were assessed using the MCPAA 2.0 verification procedure (Gagnon, Noreau, & Vincent, 2005). Participants were instructed to keep their backs in contact with the wheelchair backrests to standardize the posture. All pressure parameters from the dynamic recordings were normalized using the static spatial mean pressure from the beginning of each recording.

<figure><img src="image_3.png" /><figcaption>Figure 1: Setup of the experimental procedure.</figcaption></figure>

## 2.4 Data processing

The following variables were extracted from the Texicare® pressure mat recordings using custom Python programs: **Peak** (maximum pressure sensor over the mat) and **Spatial Mean Pressure**. The dynamic analysis was performed by studying the average and standard deviation of the recording.

## 2.5 Statistics

Statistical analyses were performed using Python's Pingouin library (v0.5.1). Data normality was assessed using the Shapiro-Wilk test to determine the appropriate statistical tests. For comparisons between MWCs and PWCs, Student's t-test was used for parametric data and Mann-Whitney U test was applied for non-parametric data.

For significant differences, Cohen's effect size was calculated to determine the magnitude of the effect.

## 3. Results and discussion

Initial and final postures were assessed as similar for both wheelchair users. No difference was found between the peak pressure average or spatial mean pressure at the seatpan between MWC and PWC in static and standard propulsion conditions.

Under standard propulsion conditions, bimanual propulsion exhibited a significantly greater standard

deviation for both parameters compared to powered propulsion (p<0.001, Cohen's d>2) (Table 1). Higher fluctuation in MWC users supports Andreoni's findings and his hypothesis that the cyclic force application on the handrims during bimanual propulsion contributes to force fluctuations. The absence of difference between MWC and PWC indicates that low-intensity propulsion does not significantly alter overall pressure distribution during activity in either a beneficial or detrimental way.

<table><caption>**Table 1.** Comparison results between MWC and PWC users. Personal data (age, weight, type of cushion) and normalized pressure parameters (% of the static spatial mean pressure).</caption><thead><tr><th rowspan="2">Input</th><th>MWC user</th><th>PWC users</th></tr><tr><th>N = 8</th><th>N = 8</th></tr></thead><tbody><tr><td>Age (years)</td><td>36 ± 10</td><td>50 ± 17</td></tr><tr><td>Weight (Kg)</td><td>75 ± 21</td><td>83 ± 18</td></tr><tr><td>Type of cushion air/foam</td><td>2/6</td><td>4/4</td></tr><tr><td>Spatial mean pressure average (%)</td><td>97 ± 5</td><td>100 ± 1</td></tr><tr><td>Spatial mean pressure standard deviation (%)</td><td>6 ± 2†</td><td>1 ± 1</td></tr><tr><td>Peak static (%)</td><td>370 ± 179</td><td>279 ± 92</td></tr><tr><td>Peak average (%)</td><td>352 ± 175</td><td>278 ± 90</td></tr><tr><td>Peak standard deviation (%)</td><td>30 ± 15†</td><td>5 ± 5</td></tr></tbody></table>

† indicates a significant difference with p<0.001 and large effect size.

## 4. Conclusions

This study highlights that MWC and PWC users experiment similar peak and mean pressure at the seatpan, indicating that they are subject to the same risk of pressure sore. Further research is needed with higher-intensity activities and/or on more typical surfaces, such as outdoor and non-smooth floors to expand the present results.

### Conflict of Interest Statement

None.

### Contributor Roles

CP: Conceptualization, Methodology, Funding acquisition, Writing original draft; SD: Methodology, Funding acquisition, Validation, Writing- review & editing; LD:
Conceptualization, Supervision, Writing-review; AG: Conceptualization, Supervision, Writing-review.

## Funding

The study was partial fund by Texisense for the PhD scholarship of Clémence Paquin.

## References

Andreoni, G., Pedotti, A., & Ferrarin, M. (2001). Pressure distribution on wheelchair cushions in static sitting and during manual propulsion. *Journal of Mechanics in Medicine and Biology, 01*(01), 33–44. https://doi.org/10.1142/S0219519401000076

Espagnacq, M. (2022). Repérer les usagers de fauteuils roulants en France et calculer leur reste à charge à partir des données du Système national des données de santé (SNDS) de 2012 à 2019. *Questions d'économie de la santé*, 272, 1–8. Retrieved from https://www.irdes.fr/recherche/2022/qes-272-reperer-les-usagers-de-fauteuils-roulants-en-france-et-calculer-leur-reste-a-charge-a-partir-des-donnees-du-snds.html

Gagnon, B., Noreau, L., & Vincent, C. (2005). Reliability of the seated postural control measure for adult wheelchair users. *Disability and Rehabilitation, 27*(24), 1479–1491. https://doi.org/10.1080/09638280500276570

Gourlan, M., Pellechia, A., Robineau, S., Foulon, B., Gault, D., Lefort, M., ... Gelis, A. (2020). “What pressure ulcers mean to me?” Representations of pressure ulcer in persons with spinal cord injury: A qualitative study. *Journal of Tissue Viability, 29*(4), 324–330. https://doi.org/10.1016/j.jtv.2020.07.002

Oomens, C. W. J., Bader, D. L., Loerakker, S., & Baaijens, F. (2015). Pressure induced deep tissue injury explained. *Annals of Biomedical Engineering, 43*(2), 297–305. https://doi.org/10.1007/s10439-014-1202-6

Paquin, C., Rozaire, J., Chenu, O., Gelis, A., Dubuis, L., & Duprey, S. (2023). Studying mechanical load at body-seat interface during dynamic activities such as wheelchair propulsion: A scoping review. *Disability and Rehabilitation: Assistive Technology*, 1–11. https://doi.org/10.1080/17483107.2023.2248184

Stinson, M. D., Crawford, S. A., & Porter-Armstrong, A. P. (2008). Interface pressure measurements: Visual interpretation of pressure maps with MS clients.

*Disability and Rehabilitation, 30*(8), 618–624. https://doi.org/10.1080/09638280701400409