UBC Theses and Dissertations
Effects of motor skill-based wheelchair propulsion training on biomechanics, gross mechanical efficiency, and variability in older adults MacGillivray, Megan Kathleen
Older adults are the largest cohort of manual wheelchair users (MWUs); yet, no studies have examined the effects of wheelchair propulsion training with this population. Various practice and training protocols have demonstrated mixed results related to biomechanics and efficiency when applied to younger able-bodied populations; however, their validity for older adult MWUs is unknown. Older adult MWUs are at risk of decreased participation, low confidence, and wheelchair abandonment; therefore, effective training strategies are needed for this population. The objectives of this study were to: (1) examine the effectiveness of existing handrim wheelchair propulsion practice and training protocols; (2) determine the effect of motor skill-based wheelchair propulsion training in older adults on (i) wheeling biomechanics, (ii) gross mechanical efficiency (GME), and (iii) intercycle variability; and (3) determine the effect of motor-skill based wheelchair propulsion training for older adults with mobility disabilities. Methods: Studies evaluating the effect of wheelchair propulsion practice or training protocols were systematically reviewed and meta-analyzed. The effect of motor skill-based training in able-bodied older adults compared to active (uninstructed practice) and inactive control groups was examined with a 3-arm RCT (n=34). The effect of motor skill-based training was compared to uninstructed practice in two individuals with mobility-related disabilities within a single subject research design study. Results: Significant medium effects of practice and training protocols for pre-post design studies were observed for push angle, push frequency, and GME. The motor skill-based training resulted in increased push angle and decreased push frequency, which were transferable to over-ground wheeling and retained two-weeks post training. Although there were no improvements in GME, a trend towards increased work per push following training was observed. Intercycle variability did not change based on training; however, nearly all participants in the training group modified their wheeling pattern from the arc to semi-circular pattern. Lastly, both older adult participants with mobility disabilities increased their push angles and decreased their push frequencies and peak negative forces. Conclusion: Motor skill-based wheelchair propulsion training is an effective means of improving handrim wheelchair propulsion biomechanics among novice older adult MWUs, which may help reduce overuse injuries in older MWUs.
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