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Logo for the Journal of Rehab R&D
Vol. 35 No. 3, July 1998
Pages 305-313

Wrist motion in handrim wheelchair propulsion

DirkJan H.E.J. Veeger, PhD; L.S. Meershoek; Lucas H.V. van der Woude, PhD; J.M. Langenhoff

Institute of Fundamental and Clinical Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

This project is based upon work supported by the Institute of Fundamental and Clinical Human Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands.
    Address all correspondence and requests for reprints to: H.E.J. Veeger, PhD, Institute of Fundamental and Clinical Human Movement Sciences, Vrije Universiteit Amsterdam, v.d. Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; email: h_e_j_veeger@fbw.vu.nl.


Abstract--Prevalent rates of carpal tunnel syndrome (CTS) in the wheelchair user population are high. One of the possible causes of CTS in this population is the movement pattern of the wrist during handrim wheelchair propulsion, which could include large wrist joint angles and wrist/finger flexor activity. Combined with the repetitive character of the movement, this could, in time, be detrimental to the soft tissue of the wrist.
To study peak wrist joint angles and their relationship with wrist- and finger-flexor activity, a three dimensional (3-D) analysis of wrist movement during the push phase was performed. Nine subjects (five nonimpaired controls, four wheelchair users) propelled a handrim wheelchair on a treadmill at three different velocities (0.83, 1.11, and 1.39 m/s) and three slopes (1, 2, and 3%), while the surface EMGs of the wrist- and finger-flexor group were recorded.
Average peak wrist joint angles during the push phase were: ulnar deviation, -24 ± 11° radial deviation, 13 ± 12° flexion, -14 ± 18° extension, 34 ± 16°. The values for ulnar and radial deviation were close to normal values for maximal range of motion (ROM) found in the literature. Peak extension was approximately 50% of ROM. The peak angles which occurred with concurrent activity of the wrist flexors were: ulnar deviation, -22 ± 11° radial deviation, 13 ± 10° flexion, -16 ± 15° extension, 32 ± 16°. The large deviation and extension angles, especially those recorded simultaneously with wrist flexor activity, are serious risk factors for CTS. This finding may help explain the high rates of CTS in the wheelchair user population.

Key words: biomechanics, carpal tunnel syndrome, handrim wheelchair propulsion, kinematics, 3-D motion analysis, wrist.


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