Motor Learning Approach for Manual Wheelchair Users

The project objective is to conduct a pilot randomized control trial (RCT) examining (1) the
number of task-specific repetitions required to produce change in wheelchair propulsion
techniques and (2) identifying the most conducive surface (overground or on a stationary
device such as rollers) for implementing a repetition-based manual wheelchair propulsion
training program. The long-term goals of this research are to minimize upper extremity pain
and chronic overuse injury and to increase mobility efficiency in in persons with SCI who use
MWCs for everyday mobility. The current project goal is to test the effects of a
repetition-based manual wheelchair propulsion training program that emphasizes the
recommended clinical practice guidelines (CPG). The expected outcome will be evidence to use
in training MWUs with SCI in proper propulsion techniques in order to prevent or delay pain
and chronic overuse injuries and maximize mobility through efficient wheelchair propulsion
techniques. The long-term impact will be implementing evidence-based MWC propulsion training
in appropriate amounts to facilitate a reduction in pain and dysfunction, a reduction in
health costs, and prolonged participation in major life activities for MWUs with SCI.

Our research aims are to:

1. Compare wheelchair propulsion kinematics, kinetics, and wheelchair performance changes
among three independent groups (Roller Group, Overground Group, Wheelchair Skills
Group).

2. Characterize the dose-response relationship of repetition-based propulsion practice.

3. Evaluate the long-term impact of propulsion training on performance in the lived
environment.

A single-blind pilot RCT will be conducted. Forty-eight individuals with SCI who use MWCs and
who do not follow the recommended clinical guidelines for propulsion will be recruited. Each
participant will be randomized into one of three independent groups: motor learning
repetitions on a roller system (RG), motor learning repetitions overground (OG), or the
placebo-controlled group receiving conventional MWC skills training (WSG). The WSG will
operate as a placebo by receiving basic MWC skills training—the current standard of
rehabilitation care. Participants' kinematics (video motion analysis), kinetics (SmartWheel),
and wheelchair performance overground (Wheelchair Propulsion Test) will be assessed
pre-intervention (Baseline), immediately following intervention (Follow-up), and three
months' post-intervention (3-Month Follow-up).

Inclusion Criteria:

- Participants must be 18 to 60 years of age

- Have a mobility limitation due to SCI, which requires the use of a manual wheelchair
(MWC)

- Be able to self-propel a MWC bilaterally with their upper extremities

- Plan to use a MWC for at least 75% of activities throughout the day

- Live in the community

- Understand English at a sixth-grade level or higher

- Be able to follow multi-step instructions

- Participants must be able to provide informed consent independently

- Be able to tolerate propelling their wheelchair independently for 10 meters

- Be willing to participate in three assessments and up to 13 training sessions at the
Enabling Mobility in the Community Laboratory (EMC Lab).

Exclusion Criteria:

- People will be excluded if they maneuver their MWC with their lower extremities or
with only one upper extremity.

- Individuals who display the proper MWC propulsion techniques during the screening
process, who already follow the CPG, or whose MWC position inhibits them from
following the CPG will be excluded.

- Potential participants also will be excluded if they have bilateral incoordination due
to strength inequality or neurological involvement that impairs propulsion in a
steady, straight line. Specifically, if a person demonstrates upper extremity strength
inequalities resulting in a 12-inch deviation from a marked pathway, he or she will be
excluded.

- Other exclusionary criteria include surgeries compromising the integrity of the upper
extremities or cardiovascular complications within the past year.

- Potential participants will also be excluded if upper extremity or overall bodily pain
is rated 8/10 or higher per the Wong-Baker FACES Numeric Pain Scale (FACES). -In
addition, potential participants will be excluded if they are currently receiving
medical treatment for an acute upper extremity injury, have a Stage IV pressure
injury, or are currently hospitalized.