000101282 001__ 101282
000101282 005__ 20230921135440.0
000101282 0247_ $$2doi$$a10.1080/17483107.2019.1630018
000101282 0248_ $$2sideral$$a123123
000101282 037__ $$aART-2021-123123
000101282 041__ $$aeng
000101282 100__ $$aSmith, B.W.
000101282 245__ $$aBimanual wheelchair propulsion by people with severe hemiparesis after stroke
000101282 260__ $$c2021
000101282 5060_ $$aAccess copy available to the general public$$fUnrestricted
000101282 5203_ $$aPurpose: Individuals who require manual wheelchairs after stroke are typically taught to ambulate with compensatory propulsion (i.e., using their non-paretic arm and foot), risking disuse of the paretic arm. We investigated whether stroke survivors can instead ambulate in a bimanual, lever-driven wheelchair that requires the paretic arm to contribute half the propulsive input. Materials and methods: Seventeen individuals with chronic stroke and severe hemiparesis (upper extremity Fugl–Meyer scores between 10 and 24) participated across two experiments. In the first experiment, participants (n = 12) ambulated in straight paths. In the second experiment, participants (n = 12) also performed turns, using an improved version of the wheelchair that incorporated handbrakes. Twelve unimpaired controls also completed the second experiment. Motion capture and EMG were used to compare biomechanics between groups. Results: Altogether, 15 of 17 participants with stroke could ambulate 30 m in straight paths, and 9 of 12 could turn 1800° entirely under the power of their paretic arm. Participants with stroke exhibited largely healthy biomechanics, with minimal shoulder hiking/leaning or trunk inclination. Their arm muscle EMG patterns were similar to those used by unimpaired participants, excepting delayed elbow extensor activation. Conclusions: Individuals with severe arm impairment in the chronic stage of stroke retain sufficient strength and coordination with their paretic arm to manoeuvre bimanual, lever-driven wheelchairs. We suggest bimanual, lever-driven propulsion should be explored in stroke rehabilitation practice as an alternative to compensatory wheelchair propulsion, as it has the potential to exercise healthy movement synergies, which may in turn help drive use-dependent motor recovery.Implications for rehabilitation Severe arm impairment arising after stroke does not generally eliminate the motor dexterity needed to bimanually propel a manual wheelchair, provided that the wheelchair is modified to remove the requirement to grasp and release the push rim. Such exercise appears a good candidate to facilitate rehabilitation outcomes because it depends on alternating muscle activity and improving elbow extension. Such wheelchair propulsion involves largely normal biomechanics; shoulder hiking and leaning are absent and trunk inclination is rare.
000101282 536__ $$9info:eu-repo/grantAgreement/ES/MINECO/HYPER-CSD2009-00067
000101282 540__ $$9info:eu-repo/semantics/openAccess$$aby-nc$$uhttp://creativecommons.org/licenses/by-nc/3.0/es/
000101282 590__ $$a1.834$$b2021
000101282 591__ $$aREHABILITATION$$b46 / 73 = 0.63$$c2021$$dQ3$$eT2
000101282 592__ $$a0.495$$b2021
000101282 593__ $$aBiomedical Engineering$$c2021$$dQ2
000101282 593__ $$aSpeech and Hearing$$c2021$$dQ2
000101282 593__ $$aPhysical Therapy, Sports Therapy and Rehabilitation$$c2021$$dQ2
000101282 593__ $$aOrthopedics and Sports Medicine$$c2021$$dQ2
000101282 594__ $$a4.0$$b2021
000101282 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/acceptedVersion
000101282 700__ $$aBueno, D.R.
000101282 700__ $$aZondervan, D.K.
000101282 700__ $$0(orcid)0000-0002-0449-2300$$aMontano, L.$$uUniversidad de Zaragoza
000101282 700__ $$aReinkensmeyer, D.J.
000101282 7102_ $$15007$$2520$$aUniversidad de Zaragoza$$bDpto. Informát.Ingenie.Sistms.$$cÁrea Ingen.Sistemas y Automát.
000101282 773__ $$g16, 1 (2021), 49-62$$tDisability and Rehabilitation: Assistive Technology$$x1748-3107
000101282 8564_ $$s2053069$$uhttps://zaguan.unizar.es/record/101282/files/texto_completo.pdf$$yPostprint
000101282 8564_ $$s775994$$uhttps://zaguan.unizar.es/record/101282/files/texto_completo.jpg?subformat=icon$$xicon$$yPostprint
000101282 909CO $$ooai:zaguan.unizar.es:101282$$particulos$$pdriver
000101282 951__ $$a2023-09-21-13:31:28
000101282 980__ $$aARTICLE