Preliminary Outcomes of the SmartWheel Users' Group Database: A Proposed Framework for Clinicians to Objectively Evaluate Manual Wheelchair Propulsion

Cowan RE, Boninger ML, Sawatzky BJ, Mazoyer BD, Cooper RA. Preliminary outcomes of the SmartWheel Users' Group database: a proposed framework for clinicians to objectively evaluate manual wheelchair propulsion. Objectives: To describe a standard clinical protocol for the objective assessment of manual wheelchair propulsion; to establish preliminary values for temporal and kinetic parameters derived from the protocol; and to develop graphical references and a proposed application process for use by clinicians. Design: Case series. Setting: Six research institutions that collect kinetic wheelchair propulsion data and contribute that data to an international data pool. Participants: Subjects with spinal cord injury (N=128). Interventions: Subjects propelled a wheelchair from a stationary position to a self-selected velocity across a hard tile surface, a low pile carpet, and up an Americans with Disabilities Act-compliant ramp. Unilateral kinetic data were obtained from subjects using a force and moment sensing pushrim. Main Outcome Measures: Differences in self-selected velocity, peak resultant force, push frequency, and stroke length across all surfaces, relationship between (1) weight-normalized peak resultant force and self-selected velocity and (2) push frequency and self-selected velocity. Results: Graphical references were generated for potential clinical use based on the relation between body weight-normalized peak resultant force, push frequency, and velocity. Self-selected velocity decreased (ramp < carpet < tile), peak resultant forces increased (ramp > carpet > tile), and push frequency and stroke length remained unchanged when compared across the different surfaces. Weight-normalized peak resultant force was a significant predictor of velocity on tile and ramp. Push frequency was a significant predictor of velocity on tile, carpet, and ramp. Conclusions: We present preliminary data generated from a clinically practical manual wheelchair propulsion evaluation protocol and we describe a proposed method for clinicians to objectively evaluate manual wheelchair propulsion.