Manual Wheelchair Configuration in Unilateral Upper- and Lower-Extremity Propulsion: A Randomized Crossover Study to Assess Effects of Rear Wheel Axle Position and Frame Type

Objective: To evaluate independence and exertion when using a lightweight wheelchair in comparison with ultra-lightweight wheelchairs (rigid and folding) for individuals with brain injury using a hemipropulsion technique.

Design: Randomized cross-over.

Setting: Rehabilitation hospital.

Participants: Individuals diagnosed with brain injury resulting in hemiplegia using a hemipropulsion technique to mobilize in a manual wheelchair for at least 4 hours per day were recruited for this study.

Interventions: Eighteen participants were randomly assigned to complete skills and endurance testing in 3 different wheelchair configurations over a 3-week period: lightweight wheelchair; ultra-lightweight folding wheelchair; and ultra-lightweight rigid wheelchair.

Main outcome measures: The primary outcome in this study was the percentage capacity score from the modified Wheelchair Skills Test 4.1. Secondary outcomes included the Wheelchair Propulsion Test, 100-m Push Test, heart rate, and rate of perceived exertion.

Results: Significant differences were found in the Wheelchair Skills Test (total score, low rolling resistance score, and the goal attainment score) favoring the ultra-lightweight wheelchairs over the lightweight wheelchair (P=.002, .001, and .016, respectively). Time to complete the 100-m push test was significantly faster for the ultra-lightweight rigid frame in comparison with the lightweight frame (P=.001; 30.89 seconds faster). Significance differences were not seen with the Wheelchair Propulsion Test measures across any of the wheelchair frames. Heart rate change and of perceived exertion were significantly lower for the ultra-lightweight rigid group in comparison with the lightweight group (P=.006 and .013, respectively).

Conclusions: These data suggest that using an ultra-light weight wheelchair may lead to improved ability to complete wheelchair skills needed for successful mobility and a decrease in the actual and perceived physiological burden associated with propulsion in comparison to a lightweight wheelchair. A rigid frame may also enable faster mobility in comparison to a folding frame when hemi-propelling.