Clinical Biomechanics 25 (2010) 879–885

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Clinical Biomechanics
j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / c l i n b i o m e c h

Surface electromyography activity of upper limb muscle during wheelchair

propulsion: Influence of wheelchair configuration
N. Louis ⁎, P. Gorce
Université du Sud, Toulon, Var; Laboratoire HandiBio EA 4322, avenue de l'université, BP20132, 83957 La garde cedex, France

a r t i c l e i n f o a b s t r a c t

Article history: Background: Biomechanical studies have linked handrim wheelchair propulsion with a prevalence of upper
Received 28 January 2010 limb musculoskeletal disorders. The purpose of this study was to record upper limb muscle recruitment
Accepted 5 July 2010 patterns using surface electromyography during wheelchair propulsion. Recordings were made for various
wheelchair configurations to understand the effect of wheelchair configuration on muscle recruitment.
Keywords: Methods: Ten paraplegic and ten able-bodied subjects propelled a test wheelchair on a roller ergometer
Wheelchair configuration
system at a comfortable speed. Twelve wheelchair configurations were tested. Upper limb surface
Wheelchair propulsion
electromyography and kinematics were recorded for each configuration. Based on the hand position
Muscle recruitment
Electromyography relative to the handrim, the propulsion cycle was divided into three phases to explain the activation patterns.
Spinal cord injury Findings: Compared to the able-bodied subjects, the paraplegic subjects presented higher activation. This is
Manual wheelchair the case for all muscles in the early push phase, for the triceps brachii, pectoralis major and latissimus dorsi
in the late push phase and for the trapezius, triceps brachii and latissimus dorsi during recovery. During early
push, activation of nearly all muscles was affected by the axle position, where as seat height only affected
biceps brachii and pectoralis major activation. During late push, the deltoid anterior was affected by axle
position and the biceps brachii by seat height. During recovery, the trapezius was affected by axle position,
the deltoid posterior by seat height and the biceps brachii by both.
Interpretation: Upper limb muscle recruitment differences highlight that future studies on wheelchair
propulsion should only be done with wheelchair experienced paraplegic subjects. Furthermore, this study
provides indications on how muscle recruitment is affected by wheelchair configuration.
© 2010 Elsevier Ltd. All rights reserved.

1. Introduction
It has been widely shown, that manual wheelchair users have a
high prevalence of upper limb injuries (Bayley et al., 1987; Boninger et
al., 1999, 2004; Mulroy et al., 2004; Stainer, 1996; Veeger et al., 1998,
2002). The most frequent pathologies are shoulder impingement and
wrist carpal tunnel syndrome. Researchers that have studied the
biomechanical factors of these prevalences have underlined that the
muscles involved during propulsion are one of the major causes of the
injuries (Rao et al., 1996; Rodgers et al., 1994). Within the framework
of upper limb injuries, knowledge of the effects of wheelchair settings
on upper limb muscle recruitment during wheelchair propulsion is an
important step in the prevention of injuries.
Accordingly, scientific interest in wheelchair propulsion has been
kindled in the past three decades. Numerous studies have contributed
to a better understanding of upper limb work in sports and everyday
life activities (Cooper, 1990; Masse et al., 1992; Mulroy et al., 2004;
van der Woude et al., 2001). In literature, the effects of wheelchair
⁎ Corresponding author.
E-mail addresses: nicolas.louis@univ-tln.fr (N. Louis), gorce@univ-tln.fr (P. Gorce).
settings have been widely explored (Boninger et al., 2000; Brubaker,
1986; Hughes et al., 1992; Kotajarvi et al., 2004; Majaess et al., 1993;
Masse et al., 1992; Richter, 2001; van der Woude et al., 1989; Walsh et
al., 1986; Wei et al., 2003). To our knowledge, only two studies have
examined the effects of wheelchair settings on upper limb muscle
recruitment and activation (Masse et al., 1992; van der Woude et al.,
1989). In the study conducted by Masse, six wheelchair configurations
were tested for five paraplegic subjects. Their results indicated that for
lower and backward seat positions, muscle activation and movement
frequency were minimal and these configurations were thus more
efficient. In particular, lower activation was observed for the triceps
brachii, pectoralis major and deltoid posterior. The investigations
were made on a racing wheelchair and at an imposed speed, so they
are not necessarily extendable to wheelchair propulsion in everyday
life. The study conducted by van der Woude investigated four seat
heights for nine able-bodied subjects. The analysis of muscle
activation conducted was only qualitative and so forth does not
furnish information on the absolute effect of seat height on muscle
activation.
Therefore, the aim of this work is to analyse the influence of
wheelchair settings on muscle activation of prevalent actors in
wheelchair propulsion. The concept is to record the electromyographic

0268-0033/$ – see front matter © 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.clinbiomech.2010.07.002
880 N. Louis, P. Gorce / Clinical Biomechanics 25 (2010) 879–885
Fig. 1. Wheelchair settings adjustment system. Crosses indicate used positions in this
study.
signals (EMG) of seven upper limb muscles, that play a major role in
propulsion, for twelve wheelchair configurations, resulting from three
different seat heights and four different antero-posterior axle positions.
Variation was focused on the two main wheelchair settings: seat height
and antero-posterior axle position. These two settings are known to
influence propulsion efficiency, stability and wheelchair manageability.
Lower seat heights are known to be more efficient, forward axle
positions increase manageability and efficiency but decrease stability
(Masse et al., 1992). To test the effects of the different settings on muscle
activation, a statistical study was conducted. Results for paraplegic and
able-bodied subjects were compared.
2. Methods
2.1. Subjects
Twenty right-handed male volunteers participated in this study.
Ten were wheelchair experienced paraplegic with a mean height of
169.2 cm (SD 17.5 cm), mean mass of 69.9 kg (SD 17.6 kg), mean age
of 29 years (SD 12 years) and mean wheelchair experience of
9.3 years (SD 6.2 years) and ten were non-experienced wheelchair
able-bodied with a mean height of 175.5 cm (SD 7.4 cm), mean mass
of 70.3 kg (SD 8.0 kg), mean age of 23 years (SD 3 years) and
wheelchair experience of 0 years. Subjects were male only for
convenience in electrode placement, especially for the pectoralis
major and latissimus dorsi. All participants were free of prior injury or
pain related to the upper limb. Subjects were fully informed about the
protocol and gave their informed written consent to participate in the
experimental procedure, which was approved by the local ethics
committee.
2.2. Test procedure
The aim of this procedure was to evaluate EMG and kinematics of
the upper limb during wheelchair propulsion. The task was to propel a
manual wheelchair at a self selected speed. Results from the
Bonninger et al. study suggest that injuries stemming from wheelchair
propulsion affect upper limbs equally (Boninger et al., 1996). Thus,
measurements were taken only for the right dominant upper
extremity.
The subjects were seated in the experimental wheelchair, which
was modified in order to permit adjustment of seat height and
antero-posterior axle position (see Fig. 1). Twelve wheelchair
configurations (3 height: 44, 47 and 50 cm *4 antero-posterior axle
position: − 3.0, 0.0, 4.2 and 7.2 cm) were selected in the range
allowed by the custom built experimental chair. The original
wheelchair setting is a 47 cm height and a 0.0 cm antero-posterior
axle position. The wheelchair was secured to the ergometer by
means of large straps. Wheelchair settings were modified lifting the
wheelchair structure (with the subject seated on it) via a three Tons
hydraulic mechanism. This system permits a modification of wheel
positions (see Fig. 1), without a transfer of subjects to another chair
between each trial. Furthermore it allows the experiment to be
completed in less than 2 h per subject, including all time taken by
preparation and information of the subject. For each setting, after a
few seconds of accommodation, fifteen consecutive propulsion
cycles were recorded. To avoid learning effects, each participant
completed a propulsion sequence in which the order of settings was
randomized. Furthermore, the sequence order was different for each
participant.
2.3. EMG recordings
The EMG signals of seven muscles were recorded: the deltoid
posterior, deltoid anterior, triceps brachii, biceps brachii, pectoralis
major, latissimus dorsi and the upper part of the trapezius. These
muscles were selected for their well-known contribution to wheelchair
propulsion.SubjectswerepreparedfortheplacementofEMGelectrodes
by shaving the skin of each electrode site, cleaning it carefully with
alcohol wipe and lightly abrading it, as to achieve a low inter-electrode
resistance of b1000 Ω. Pairs of Ag.AgCl pre-gelled surface electrodes
(Blue sensor Q-00-S, Medicotest, Denmark) of 40 mm diameter with a
centerdistanceof25 mmwereappliedalongthefibersoverthebelliesof
the eight muscles for EMG data acquisition, following SENIAM
recommendations (SENIAM, 1999). Electrode placement was verified
by voluntary muscle contraction. The electrodes were secured with
surgical tape and cloth wrap to minimize displacement during
movement. A ground electrode was placed on a bony site over the
clavicula.
2.4. Kinematic recordings
The kinematics data of the right upper limb were recorded using a
six optoelectronic camera system: VICON 460 (Vicon System, Oxford
Metrics Inc., United Kingdom). The experimental wheelchair was
equipped with 14 reflective markers that permitted to model the
wheelchair. Subjects were equipped with 32 reflecting markers (see
Figs. 2 and 3) that permitted modelling of the right upper limb as four
rigid-body segments: the clavicula, arm, forearm and hand, the trunk
as two rigid-body segments: thorax and pelvis and the thigh as one
rigid-body. We assumed that the segments are articulated by
frictionless joints with three degree-of-freedom. Kinematics data
were mainly used to detect push and recovery phases of the
propulsion cycle.
2.5. Data analysis
EMG signals were pre-amplified close to detection site (Common
Mode Rejection Ratio, CMRR = 100 dB; Z input = 10 G; gain = 600,
bandwidth frequency = from 6 Hz to 1600 Hz).
EMG data from each muscle and kinematics data were collected
during 15 cycles for each wheelchair setting. The maximal voluntary
isometric contractions (MVIC) were performed according to the
manual strength testing position as previously documented (Kendall
et al., 1993; Ludewig et al., 2004) for each muscle to normalize the
EMG data. MVIC tests were executed in three trials for each position
 N. Louis, P. Gorce / Clinical Biomechanics 25 (2010) 879–885
Fig. 2. Back view of subject propelling the experimental wheelchair.
with simultaneous surface EMG recordings. For each muscle, trials
were processed, and the one producing the highest EMG signal was
used for further reference (Heintz and Gutierrez-Farewik, 2007).
The raw EMG data was exported to Matlab (The Mathworks, Inc,
Natick,MA,USA)forsignalanalysisandpost-acquisitionprocessing.Raw
EMGsignalsfromthewheelchairpropulsionmovementsandMVICtrials
were high-pass filtered by a Butterworth 10th order filter at 20 Hz, full-
waverectified,andlow-passfilteredwithathirdorderButterworthfilter
at 5 Hz (Heintz and Gutierrez-Farewik, 2007). Muscle activation was
described as the linear envelope of the EMG signal (Hof et al., 2005). This
type of treatment eliminates ambient noise through the high-pass filter,
and smoothens the curve through full-wave rectification and the low-
passfilter,thuscreatingthelinearenvelope(Bonnefoyetal.,2009;Ducet
al., 2008; Heintz and Gutierrez-Farewik, 2007). Muscle activation was
regarded quantitatively using integrated electromyography, EMGi
(Bonnefoy et al., 2009; Masse et al., 1992) and by interpreting the EMG
peak during the movement. Significant EMG activity was defined as
activity of more than 5% MVIC during more than 5% of a complete
propulsioncycle(Mulroyetal.,2004,1996;Yangetal.,2006).Toenablea
just comparison between the various wheelchair configurations, the
propulsion cycle was normalized to 100% for each subject. A cycle was
defined as starting with handrim contact and finishing with the next
contact. A propulsion cycle is composed of two main phases: push and
recovery.Foreachconfiguration,dataforeachsubjectwasnormalizedto
thegroupmeanpercentageofthepushphaseofthepropulsioncycle.The
mean percentage of the push phase for each group and each setting was
calculated. In a second step, the push phase was normalized for each
881
setting of each subject as departing from 0 to the calculated mean
percentage. The recovery phase was defined as the same mean
percentage to 100%. For a more precise analysis, the push phase was
divided in two parts: early push and late push with the transition when
the hand passed at handrim vertex (Newsam et al., 1999). Handrim
vertex corresponds to the highest point of the rim. Phase detection was
automaticallydoneconsideringrelativepositionofthehandtothewheel
and analyse of wheel angular velocity and acceleration, furthermore, a
visual verification was done. For each subjects and for each wheelchair
configuration, propulsion muscle activation pattern results of fifteen
consecutives cycles averaged together.
2.6. Statistical analysis
In this study, means and standard deviations were used to
represent the average and the typical spread of values of the studied
variables. The Normal Gaussian distribution of the data was verified
by the Shapiro–Wilk test. The compound symmetry, or sphericity, was
checked using the Mauchley test (Winter et al., 2001). When the
assumption of sphericity was not met, the significance of F-ratios was
adjusted according to the Greenhouse–Geisser procedure when the
epsilon correction factor was b0.75, or according to the Huyn–Feld
procedure when the epsilon correction factor was N0.75 (Vincent,
1999). A three-way analysis of variance (ANOVA) for repeated
measures was used to compare the effect of experience in wheelchair,
seat height and antero-posterior axle position on muscle activations
(peak and EMGi). To detect significant differences, Newman–Keuls
post-hoc tests were used (Howell, 1997). When the normality of
distribution was not met, a non parametric ANOVA of Friedman was
used and Wilcoxon matched pairs test was used as post-hoc test
(Vincent, 1999). The threshold for significance was set at the 0.05
level of confidence.
This statistical analysis was realized with the use of the STATISTICA
6.0 software for PC (Statsoft, Tulsa, USA).
3. Results
3.1. Timing of propulsion phases
Between the two groups there is no significant difference for push
percentage over cycle propulsion. Early push is significantly longer for
the paraplegic group (15.3% SD 7.7) than for the able-bodied group
(7.6% SD 7.7) (P = 0.006). For the two groups, propulsion percentage
increased with anterior axle position (P = 0.001) and decreased with
seat height augmentation (P b 0.0001).
3.2. Main effect: experience in wheelchair
Muscle activation and recruitment are different between the
paraplegic group (see Fig. 4) and the able-bodied group (see Fig. 5).
During the three phases of the propulsion cycle, the paraplegic group
present a higher muscle activation (see Table 1). More particularly,
during recovery, the paraplegic group present higher muscle activa-
tions for the trapezius. Effectively, for the trapezius, we can observe a
peak of activation at the end of this phase, corresponding to 90%–100%
of the propulsion cycle (see Fig. 4).
3.3. Main effect: seat height
During early push, when seat height was augmented, biceps
brachii and pectoralis major EMGi decreased (P = 0.005 and P = 0.01
respectively). During late push, biceps brachii peak decreased with
seat height augmentation (P = 0.04). During recovery, deltoid
posterior peak and EMGi and biceps brachii peak and EMGi decreased
with increasing seat height (P = 0.02, P = 0.0002, P b 0.0001 and
P = 0.0005 respectively).
882 N. Louis, P. Gorce / Clinical Biomechanics 25 (2010) 879–885
Fig. 3. Vicon marker's placement for the subject.
3.4. Main effect: antero-posterior axle position
During early push, when axle position is moved forward, deltoid
anterior peak and EMGi (P b 0.0001 and P = 0.0004), deltoid posterior
peak and EMGi (P N 0.0001 for both), trapezius peak and EMGi
(P = 0.01 and P b 0.0001), triceps brachii peak and EMGi (P = 0.002
and P b 0.0001), biceps brachii peak and EMGi (P b 0.0001 for both)
and pectoralis major EMGi (P b 0.0001) increased. During late push,
the deltoid anterior peak augment with antero-posterior axle position
(P = 0.04). During recovery, trapezius peak and EMGi and biceps
brachii peak increased for forward axle positions (P = 0.04 for all).
3.5. Main effect: propulsion phase
Deltoid anterior peak and EMGi, deltoid posterior EMGi and
latissimus dorsi EMGi activation are significantly higher in recovery
than in the two push phases and significantly higher in the late push
than in the early push phase (P b 0.0001 for all). For deltoid anterior
peak activation, no difference was found. Latissimus dorsi peak
activation is lower in early push than in the other propulsion phases
(P = 0.0002). Trapezius peak and EMGi are lower in late push than in
the other phases (P b 0.0001 and P = 0.0002). Triceps brachii peak
activation is higher in late push than in the two other phases and in
recovery than in early push (P b 0.0001). Triceps brachii EMGi is lower
in early push than in other two phases (P b 0.0001). Biceps brachii
peak is higher in recovery than in early push (P = 0.01) and EMGi is
higher in recovery than in other phases (P = 0.003). Pectoralis major
peak and EMGi are higher in late push than the other phases
(P b 0.0001 for both), furthermore peak is higher in early push than in
recovery.
3.6. Interaction effects
Significant interactions effects were found between experience in
wheelchair and propulsion phase for trapezius peak and EMGi
(P b 0.0001 and P = 0.002), for triceps brachii EMGi (P = 0.001), for
pectoralis major EMGi (P = 0.005) and for latissimus dorsi EMGi
(P = 0.02). A post-hoc test revealed that the effect is in the early and
recovery phases for trapezius, in late push and recovery for triceps
brachii, in late push for pectoralis major and in all phases for
latissimus dorsi.
4. Discussion
In this study, our intention was to investigate how muscle
activation was affected by the changes in seat height and antero-
posterior axle position, that are commonly made in the clinical
personalization of wheelchairs. To our knowledge, of all studies that
have focused on the effects of wheelchair configuration, only two have
focused on muscle activation (Masse et al., 1992; van der Woude et al.,
1989). Furthermore in these two studies, only few configurations
were tested:, three seat height and two antero-posterior in the Masse
study and only four seat height in the van der Woude study. In
addition, the Masse study was realized on a racing wheelchair. To be
complete, in 2003 a study conducted by Wei focused on wrist muscles
only for six wheelchair configurations. This study thus presents new
information on the effect of wheelchair configuration on muscle
activation during everyday life situations. The results permit a better
understanding of the effects of wheelchair settings and will contribute
to the identification of less constraining wheelchair configurations.
 N. Louis, P. Gorce / Clinical Biomechanics 25 (2010) 879–885 883

Fig. 4. Paraplegic group average upper limb muscle activation patterns for all wheelchair configurations. For each setting, cycle has been normalized to 0% contact to 100% next
contact. First bar represent passage at handrim vertex (end of early push and start of late push phases) second bar represent handrim release (end of late push and start of recovery
phases). The x-axis represents the percentage of propulsion cycle from 0 to 100% and the y-axis represents the normalized muscle activation level from 0 to 1.

Concerning timing parameters, our results show that for the two
groups, propulsion phase percentages are similar, the only differences
are in early and late push repartitions. These differences can be
explained by differences in upper limb patterns that have already
been shown (Brown et al., 1990; Kotajarvi et al., 2004). All able-bodied
subjects used an arcing pattern whereas paraplegic subjects mostly
used SemiCircular or Single Looping Over Propulsion patterns, as
described by Shimada et al. (Boninger et al., 2002; Shimada et al., 1998).
Nevertheless, in accordance with literature, for the two groups we have
shown thatpropulsion pushingpercentageincreaseswhen the seatis in
alowerposition(Boningeretal.,2000;Kotajarvietal.,2004;Masseetal.,
1992; Richter, 2001; Wei et al., 2003) as when the axle position is
advanced (Boninger et al., 2000; Masse et al., 1992).
For EMG parameters, as in Dubowsky study, our results indicate
that the paraplegic group presents higher muscle activation than the
able-bodied group (Dubowsky et al., 2009). This difference can be
explained by kinematic differences, such as a greater shoulder joint
amplitude during push phases (Brown et al., 1990; Kotajarvi et al.,
2004) or a faster self chosen propulsion speed in the paraplegic group
(2.97 N 2.46 km h− 1, P = 0.034). An analysis of covariance (ANCOVA)
statistical study was conducted to remove the effects of speed but a
lack in statistical power does not permit to show differences between
the two groups.
Concerning the effects of seat height, our results show that during
push phases, muscle activation is increased for lower seat positions.
We explained this increase by the fact that in lower positions,
shoulder joint amplitude and use of the push rims are increased
(Kotajarvi et al., 2004; Richter, 2001). Nevertheless, these results are
opposed to results achieved by Masse (Masse et al., 1992) who found
that “in lowering seat position, less IEMG was recorded”. If focusing on
the recovery phase muscle activation, in particular for biceps brachii
and deltoid posterior, our results agree with this statement. In a
complete propulsion cycle, triceps brachii peak EMG and EMGi
(P = 0.04 and P = 0.27) are lowest for low seat positions. Thus, these
overall results are in agreement with the results achieved by Masse
(Masse et al., 1992).
For the antero-posterior axle position setting, results show that
forward axle positions increase muscle activation, in particular during
early push. This also seems to be in contradiction with Masse, who
said that seat “Backward-Low position had the lowest overall IEMG”
(Masse et al., 1992). Muscle activation during a complete propulsion
cycle results are also different from results of the Masse study.
884 N. Louis, P. Gorce / Clinical Biomechanics 25 (2010) 879–885

Fig. 5. Able-bodied group average upper limb muscle activation patterns for all wheelchair configurations. For each setting, cycle has been normalized to 0% contact to 100% next
contact. First bar represent passage at handrim vertex (end of early push and start of late push phases) second bar represent handrim release (end of late push and start of recovery
phases). The x-axis represents the percentage of propulsion cycle from 0 to 100% and the y-axis represents the normalized muscle activation level from 0 to 1.

The difference in results could be explained by differences in the brachii bursts in late recovery and early push are significantly greater
wheelchair used for testing: racing for Masse and everyday life in this than in the able-bodied group. This is in agreement with the pattern
study, or by differences between subjects: in the Masse study, the five differences between these two groups (Boninger et al., 2002; Shimada
subjects were all physically active whereas in this study subjects are
active paraplegics but not involved in wheelchair sports.
Concerningable-bodiedsubjects,ourresultsagreedwithqualitative
Table 1
results from Van der Woude who found that trapezius, pectoralis major Differences in muscle activations between the two groups. Sign + (−) indicate that
and deltoid anterior tended to have a “shorter active period with activation is higher (lower) for the paraplegic group. When the difference is significant
increasing seat height” (van der Woude et al., 1989). Nevertheless, they p-value is in bold. ns is for non-significant difference.
have also found that “with increasing seat height, the m. triceps tends to
Early push Late push Recovery
start sooner in relative terms, and prolong its activity”. Our results for
EMGi Peak EMGi Peak EMGi Peak
able-bodied have shown no significant effect of seat height on triceps
brachii but for the paraplegic group, we have also found that triceps Deltoid + ns ns ns ns ns
brachii peak activity increase with seat height (P = 0.019). Differences Anterior 0.030 0.085 0.912 0.280 0.352 0.302
Deltoid + ns ns ns ns ns
with Van der Woude study are probably due that their results are only Posterior 0.040 0.657 0.739 0.419 0.158 0.238
qualitative, they retained only muscle activity superior than 50% of the Trapezius + + ns ns + +
maximum activity and they imposed propulsion speed. 0.009 0.008 0.456 0.454 0.010 0.005
The EMG patterns recorded in this study show activation bursts of Triceps + + + + + +
Brachii 0.002 0.001 0.03 0.009 0.004 0.010
pectoralis major, triceps brachii and deltoid anterior during late push
Biceps + ns ns ns ns ns
that are in accordance with Cooper (Cooper, 1990) who postulated Brachii 0.030 0.181 0.302 0.121 0.100 0.104
that these are the prime actors in wheelchair racing. Amplitude Pectoralis + ns ns + ns ns
differences with the able-bodied group could be explained by a Major 0.006 0.095 0.134 0.04 0.101 0.461
greater efficiency of the paraplegic group or partially by the greater Latissimus + + + + + +
Dorsi 0.002 0.040 0.010 0.003 0.030 0.040
self selected speed. In the paraplegic group, trapezius and biceps
 N. Louis, P. Gorce / Clinical Biomechanics 25 (2010) 879–885
et al., 1998). This could also explain the interaction effect that was
found between the groups and propulsion phases.
5. Conclusion
This study is a first step in a better comprehension of muscle
recruitment and the effect of wheelchair settings on recruitment
during wheelchair propulsion. We have shown that differences exist
between able-bodied and paraplegic subjects. Moreover we have
shown that the effects of wheelchair settings are different for these
two groups. The first conclusion is that future studies investigating
wheelchair propulsion with a focus on upper limb overuse injuries
linked to propulsion should limit recruitment to experienced
paraplegic subjects. We have also shown that the effects of settings
are not the same during early push, late push, recovery or the
complete cycle. We therefore recommend that future studies
differentiate push phases from recovery phases.
Results from this study are a contribution on wheelchair
propulsion mechanism and a first step in musculoskeletal disorder
prevention. Future investigations will be conducted on upper limb
kinematics and force application to the hand rims during push phases.
Moreover, it would be interesting to test other settings, such as wheel
and handrim sizes, seat width or wheel camber.
Acknowledgements
The authors would like to thank all the subjects, and more
particularly paraplegic subjects, who took part in this study for their
patience and implication in the protocol.
References
Bayley, J.C., Cochran, T.P., Sledge, C.B., 1987. The weight-bearing shoulder. The
impingement syndrome in paraplegics. J. Bone Joint Surg. Am. 69, 676–678.
Boninger, M.L., Robertson, R.N., Wolff, M., Cooper, R.A., 1996. Upper limb nerve
entrapments in elite wheelchair racers. Am. J. Phys. Med. Rehabil. 75, 170–176.
Boninger, M.L., Cooper, R.A., Baldwin, M.A., Shimada, S.D., Koontz, A., 1999. Wheelchair
pushrim kinetics: body weight and median nerve function. Arch. Phys. Med.
Rehabil. 80, 910–915.
Boninger, M.L., Baldwin, M., Cooper, R.A., Koontz, A., Chan, L., 2000. Manual wheelchair
pushrim biomechanics and axle position. Arch. Phys. Med. Rehabil. 81, 608–613.
Boninger, M.L., Souza, A.L., Cooper, R.A., Fitzgerald, S.G., Koontz, A.M., Fay, B.T., 2002.
Propulsion patterns and pushrim biomechanics in manual wheelchair propulsion.
Arch. Phys. Med. Rehabil. 83, 718–723.
Boninger, M.L., Impink, B.G., Cooper, R.A., Koontz, A.M., 2004. Relation between median
and ulnar nerve function and wrist kinematics during wheelchair propulsion. Arch.
Phys. Med. Rehabil. 85, 1141–1145.
Bonnefoy, A., Louis, N., Gorce, P., 2009. Muscle activation during a reach-to-grasp movement
in sitting position: Influence of the distance. J. Electromyogr. Kinesiol. 19, 269–275.
Brown, D.D., Knowlton, R.G., Hamill, J., Schneider, T.L., Hetzler, R.K., 1990. Physiological and
biomechanical differences between wheelchair-dependent and able-bodied subjects
during wheelchair ergometry. Eur. J. Appl. Physiol. Occup. Physiol. 60, 179–182.
Brubaker, C.E., 1986. Wheelchair prescription: an analysis of factors that affect mobility
and performance. J. Rehabil. Res. Dev. 23, 19–26.
Cooper, R.A., 1990. Wheelchair racing sports science: a review. J. Rehabil. Res. Dev. 27,
295–312.
Dubowsky, S.R., Sisto, S.A., Langrana, N.A., 2009. Comparison of kinematics, kinetics,
and EMG throughout wheelchair propulsion in able-bodied and persons with
paraplegia: an integrative approach. J. Biomech. Eng. 131, 021015.
885
Duc, S., Bertucci, W., Pernin, J.N., Grappe, F., 2008. Muscular activity during uphill
cycling: effect of slope, posture, hand grip position and constrained bicycle lateral
sways. J. Electromyogr. Kinesiol. 18, 116–127.
Heintz, S., Gutierrez-Farewik, E.M., 2007. Static optimization of muscle forces during
gait in comparison to EMG-to-force processing approach. Gait Posture 26, 279–288.
Hof, A.L., Elzinga, H., Grimmius, W., Halberstsma, J.P.K., 2005. Detection of non-standard
EMG profiles in walking. Gait Posture 21, 171–177.
Howell, D., 1997. Statistical Methods for Psychology, 4th ed. Belmont, CA, Duxbury.
Hughes, C.J., Weimar, W.H., Sheth, P.N., Brubaker, C.E., 1992. Biomechanics of
wheelchair propulsion as a function of seat position and user-to-chair interface.
Arch. Phys. Med. Rehabil. 73, 263–269.
Kendall, F.P., McCreary, E.K., Provance, P.G., 1993. Muscles, Testing and Function: With
Posture and Pain, Baltimore.
Kotajarvi, B.R., Sabick, M.B., An, K.N., Zhao, K.D., Kaufman, K.R., Basford, J.R., 2004. The
effect of seat position on wheelchair propulsion biomechanics. J. Rehabil. Res. Dev.
41, 403–414.
Ludewig, P.M., Hoff, M.S., Osowski, E.E., Meschle, S.A., Rundquist, P.J., 2004. Relative
balance of serratus anterior and upper trapezius muscle activity during push-up
exercices. Am. J. Sports Med. 32, 484–493.
Majaess, G.G., Kirby, R.L., Ackroyd-Stolarz, S.A., Charlebois, P.B., 1993. Influence of seat
position on the static and dynamic forward and rear stability of occupied
wheelchairs. Arch. Phys. Med. Rehabil. 74, 977–982.
Masse, L.C., Lamontagne, M., O'Riain, M.D., 1992. Biomechanical analysis of wheelchair
propulsion for various seating positions. J. Rehabil. Res. Dev. 29, 12–28.
Mulroy, S.J., Gronley, J.K., Newsam, C.J., Perry, J., 1996. Electromyographic activity of
shoulder muscles during wheelchair propulsion by paraplegic persons. Arch. Phys.
Med. Rehabil. 77, 187–193.
Mulroy, S.J., Farrokhi, S., Newsam, C.J., Perry, J., 2004. Effects of spinal cord injury level
on the activity of shoulder muscles during wheelchair propulsion: an electromyo-
graphic study. Arch. Phys. Med. Rehabil. 85, 925–934.
Newsam, C.J., Rao, S.S., Mulroy, S.J., Gronley, J.K., Bontrager, E.L., Perry, J., 1999. Three
dimensional upper extremity motion during manual wheelchair propulsion in men
with different levels of spinal cord injury. Gait Posture 10, 223–232.
Rao, S.S., Bontrager, E.L., Gronley, J.K., Newsam, C.J., Perry, J., 1996. Three-dimensional
kinematics of wheelchair propulsion. IEEE Trans. Biomed. Eng. 4, 152–160.
Richter, W.M., 2001. The effect of seat position on manual wheelchair propulsion
biomechanics: a quasi-static model-based approach. Med. Eng. Phys. 23, 707–712.
Rodgers, M.M., Gayle, G.W., Figoni, S.F., Kobayashi, M., Lieh, J., Glaser, R.M., 1994.
Biomechanics of wheelchair propulsion during fatigue. Arch. Phys. Med. Rehabil.
75, 85–93.
SENIAM, 1999. European Recommendations for Surface ElectroMyoGraphy, Deliverable
of the SENIAM Project. In: Hermens, H.J.E.A. (Ed.), Roessingh Research and
Development B.V.
Shimada, S.D., Robertson, R.N., Bonninger, M.L., Cooper, R.A., 1998. Kinematic
characterization of wheelchair propulsion. J. Rehabil. Res. Dev. 35, 210–218.
Stainer, P., 1996. Les pathologies générées aux membres supérieurs par l'utilisation du
fauteuil roulant: revue de la littérature. Mémoire en vue de l'obtention du Diplôme
Universitaire d'Appareillage des Handicapés Moteurs. DUAHM, Nancy, France.
Nancy 1.
van der Woude, L.H., Veeger, D.J., Rozendal, R.H., Sargeant, T.J., 1989. Seat height in
handrim wheelchair propulsion. J. Rehabil. Res. Dev. 26, 31–50.
van der Woude, L.H., Veeger, H.E., Dallmeijer, A.J., Janssen, T.W., Rozendaal, L.A., 2001.
Biomechanics and physiology in active manual wheelchair propulsion. Med. Eng.
Phys. 23, 713–733.
Veeger, H.E., Meershoek, L.S., van der Woude, L.H., Langenhoff, J.M., 1998. Wrist motion
in handrim wheelchair propulsion. J. Rehabil. Res. Dev. 35, 305–313.
Veeger, H.E., Rozendaal, L.A., van der Helm, F.C., 2002. Load on the shoulder in low
intensity wheelchair propulsion. Clin. Biomech. 17, 211–218.
Vincent, W.J., 1999. Statistics in Kinesiology. Champaign.
Walsh, C.M., Marchiori, G.E., Steadward, R.D., 1986. Effect of seat position on maximal
linear velocity in wheelchair sprinting. Can. J. Appl. Sport Sci. 11, 186–190.
Wei, S.H., Huang, S., Jiang, C.J., Chiu, J.C., 2003. Wrist kinematic characterization of
wheelchair propulsion in various seating positions: implication to wrist pain. Clin.
Biomech. 18, S46–S52.
Winter, E.M., Eston, R.G., Lamb, K.L., 2001. Statistical analyses in the physiology of
exercise and Kinanthropometry. J. Sports Sci. 19, 761–775.
Yang, Y.S., Koontz, A.M., Triolo, R.J., Mercer, J.L., Boninger, M.L., 2006. Surface
electromyography activity of trunk muscles during wheelchair propulsion. Clin.
Biomech. 21, 1032–1041.