A novel push-pull central-lever mechanism reduces peak forces and energy-cost compared to hand-rim wheelchair propulsion during a controlled lab-based experiment

Background Hand-rim wheelchair propulsion is straining and mechanically inefficient, often leading to upper limb complaints. Previous push-pull lever propulsion mechanisms have shown to perform better or equal in efficiency and physiological strain. Propulsion biomechanics have not been evaluated thus far. A novel push-pull central-lever propulsion mechanism is compared to conventional hand-rim wheelchair propulsion, using both physiological and biomechanical outcomes under low-intensity steady-state conditions on a motor driven treadmill. Methods In this 5 day (distributed over a maximum of 21 days) between-group experiment, 30 able-bodied novices performed 60 min (5 x 3 x 4 min) of practice in either the push-pull central lever wheelchair (n = 15) or the hand-rim wheelchair (n = 15). At the first and final sessions cardiopulmonary strain, propulsion kinematics and force production were determined in both instrumented propulsion mechanisms. Repeated measures ANOVA evaluated between (propulsion mechanism type), within (over practice) and interaction effects. Results Over practice, both groups significantly improved on all outcome measures. After practice the peak forces during the push and pull phase of lever propulsion were considerably lower compared to those in the handrim push phase (42 +/- 10 & 46 +/- 10 vs 63 +/- 21N). Concomitantly, energy expenditure was found to be lower as well (263 +/- 45 vs 298 +/- 59W), on the other hand gross mechanical efficiency (6.4 +/- 1.5 vs 5.9 +/- 1.3%), heart-rate (97 +/- 10 vs 98 +/- 10 bpm) and perceived exertion (9 +/- 2 vs 10 +/- 1) were not significantly different between modes. Conclusion The current study shows the potential benefits of the newly designed push-pull central-lever propulsion mechanism over regular hand rim wheelchair propulsion. The much lower forces and energy expenditure might help to reduce the strain on the upper extremities and thus prevent the development of overuse injury. This proof of concept in a controlled laboratory experiment warrants continued experimental research in wheelchair-users during daily life.