Handrim wheelchair propulsion training effect on overground propulsion using biomechanical real-time visual feedback

Objective: To compare the effects of 2 manual wheelchair propulsion training programs on handrim kinetics, contact angle, and stroke frequency collected during overground propulsion. Design: Randomized controlled trial comparing handrim kinetics between 3 groups: a control group that received no training, an instruction-only group that reviewed a multimedia presentation, and a feedback group that reviewed the multimedia presentation and real-time visual feedback. Setting: Research laboratory. Participants: Full-time manual wheelchair users (N=27) with spinal cord injury living in the Pittsburgh area. Interventions: Propulsion training was given 3 times over 3 weeks, and data were collected at baseline, immediately after training, and at 3 months. Main Outcome Measures: Contact angle, stroke frequency, peak resultant force, and peak rate of rise of resultant force. Results: Both feedback and instruction-only groups improved their propulsion biomechanics across all surfaces (carpet, tile, and ramp) at both target and self-selected speeds compared with the control group. While controlling for velocity, both intervention groups showed long-term reductions in the peak rate or rise of resultant force, stroke frequency, and increased contact angle. Conclusions: Long-term wheelchair users in both intervention groups significantly improved many aspects of their propulsion technique immediately after training and 3 months from baseline. Furthermore, training with a low-cost instructional video and slide presentation was an effective training tool alone.