Wheelchair skill acquisition: motor learning effects of low-intensity handrim wheelchair practice

Wheelchair users depend on their upper body for mobility during daily life. However, handrim wheelchair propulsion is a physically straining form of ambulation as a consequence of a low mechanical efficiency and a high mechanical load on the shoulder complex. The research described in this thesis aims to increase our knowledge about the acquisition of wheelchair propulsion technique for the rehabilitation setting and to improve our understanding of natural motor learning processes.
The experiments in this thesis have shown that through practice participants change their propulsion technique, consequently resulting in a lower energy-expenditure. Special attention has been paid to individual differences and the importance of functional variability in the propulsion technique of individuals during practice. Furthermore, biomechanical analysis showed that contrary to the reduced energy expenditure the local load on the shoulder complex increases. Apparently whole body energy efficiency has priority over mechanical loading in the early stages of learning to propel a handrim wheelchair.
Finally we have attempted to translate some of our insights and methods to clinical practice, towards more evidence-based decision-making. Attention for motor learning processes and the systematic evaluation of propulsion technique, during clinical rehabilitation, daily live activities and adapted sports, are of great importance to enhance the mobility of wheelchair users and possibly protect them from overuse injury.