Initial Skill Acquisition of Handrim Wheelchair Propulsion: A New Perspective

To gain insight into cyclic motor learning processes, hand rim wheelchair propulsion is a suitable cyclic task, to be learned during early rehabilitation and novel to almost every individual. To propel in an energy efficient manner, wheelchair users must learn to control bimanually applied forces onto the rims, preserving both speed and direction of locomotion. The purpose of this study was to evaluate mechanical efficiency and propulsion technique during the initial stage of motor learning. Therefore, 70 naive able-bodied men received 12-min uninstructed wheelchair practice, consisting of three 4-min blocks separated by 2 min rest. Practice was performed on a motor-driven treadmill at a fixed belt speed and constant power output relative to body mass. Energy consumption and the kinetics of propulsion technique were continuously measured. Participants significantly increased their mechanical efficiency and changed their propulsion technique from a high frequency mode with a lot of negative work to a longer-slower movement pattern with less power losses. Furthermore a multi-level model showed propulsion technique to relate to mechanical efficiency. Finally improvers and non-improvers were identified. The non-improving group was already more efficient and had a better propulsion technique in the first block of practice (i.e., the fourth minute). These findings link propulsion technique to mechanical efficiency, support the importance of a correct propulsion technique for wheelchair users and show motor learning differences.