A Wheelchair Propulsion Training Program
Condition: Spinal Cord Injuries; Multiple Sclerosis; Amputation; Spina Bifida
MeSH terms: Multiple Sclerosis; Spinal Cord Injuries; Spinal Dysraphism
Study type: Interventional

Summary: 
      The overall purpose of this project is to test the feasibility of a manual wheelchair
      propulsion program which aims to reduce the chance of development of upper limbs pain and
      injury.
    

Detailed description: 
      The purpose of this project is to develop a feasible wheelchair propulsion training that can
      fit into an in-patient rehabilitation schedule, and determine the effectiveness of the
      training protocol. This project consists of a randomized control trial (RCT) for manual
      wheelchair users (MWUs) that examines the number of manual wheelchair propulsion repetitions
      required to produce change. For the RCT, we will recruit twenty individuals who use manual
      wheelchairs as their primary means of mobility and who do not follow the recommended clinical
      guidelines for propulsion. Participants will be randomized into two independent groups: motor
      learning repetitions overground (Training Group; n =10), and general education on recommended
      propulsion techniques (Education Group; n =10). Demographics, cognition, shoulder strength,
      participation, and wheelchair seating may only be assessed at baseline. Participants then may
      be assessed from the kinematics of their wheelchair performance overground and on a motorized
      treadmill. Participants may be tested on their wheelchair propulsion techniques in and
      outside of the lab, upper extremity pain at baseline, post-intervention, and three-week
      follow-up; participants may also be asked qualitative questions regarding the intervention
      experience, the experience with the equipment and the laboratory research, the monitoring
      setting, and the general experience with the research study.

      The primary research question is that will repetition of proper propulsion technique
      practiced overground result in improved manual wheelchair propulsion biomechanics?
    

Intervention name(s): In-person wheelchair propulsion training program; 30-minute education session
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The wheelchair propulsion (WP) intervention is based on our previous pilot work and the best available evidence on WP training. The CPGs recommend minimizing the force and frequency of pushes while using long strokes during propulsion. Each training session will include massed practice with repetitions overground. Each session is organized to limit the number of variables (i.e., long push strokes and dropping the hands down below axle) presented to the participant at one time. Propulsion Set A will focus on using longer push strokes. Propulsion Set B will focus on dropping the hand down toward the axle. Propulsion Set C will focus on both A and B.; Both groups will receive a 30-minute education session regarding the CPGs. This education session will follow the instructions provided in Rice and colleagues. (L. A. Rice et al., 2014). It consists of the importance of practicing biomechanical efficient propulsion. The material lists out the consequences and the impact of upper limb pain and injury. It provides a detailed step by step on how to propel properly. They will view the video that shows the biomechanics of efficient and inefficient propulsion.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: manual wheelchair; wheelchair propulsion; motor learning