{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T11:25:50Z","timestamp":1775129150294,"version":"3.50.1"},"reference-count":43,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2019,10,25]],"date-time":"2019-10-25T00:00:00Z","timestamp":1571961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/2.zoppoz.workers.dev:443\/https\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Manual wheelchair propulsion results in physical demand of the upper limb extremities that, because of its repetitive nature, can lead to chronic pathologies on spinal cord injury patients. The aim of this study was to design and test a methodology to compare kinematic and kinetic variables of the upper limb joints when propelling different wheelchairs. Moreover, this methodology was used to analyze the differences that may exist between paraplegic and tetraplegic patients when propelling two different wheelchairs. Five adults with paraplegia and five adults with tetraplegia performed several propulsion tests. Participants propelled two different wheelchairs for three minutes at 0.833 m\/s (3 km\/h) with one minute break between the tests. Kinematic and kinetic variables of the upper limb as well as variables with respect to the propulsion style were recorded. Important differences in the kinetic and kinematic variables of the joints of the upper limb were found when comparing paraplegic and tetraplegic patients. Nevertheless, this difference depends on the wheelchair used. As expected, in all tests, the shoulder shows to be the most impacted joint.<\/jats:p>","DOI":"10.3390\/s19214643","type":"journal-article","created":{"date-parts":[[2019,10,25]],"date-time":"2019-10-25T11:05:18Z","timestamp":1572001518000},"page":"4643","update-policy":"https:\/\/2.zoppoz.workers.dev:443\/https\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["A Systematic Methodology to Analyze the Impact of Hand-Rim Wheelchair Propulsion on the Upper Limb"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/2.zoppoz.workers.dev:443\/https\/orcid.org\/0000-0001-9516-2843","authenticated-orcid":false,"given":"Blanca","family":"Larraga-Garc\u00eda","sequence":"first","affiliation":[{"name":"Escuela T\u00e9cnica Superior de Ingenieros de Telecomunicaci\u00f3n, Universidad Polit\u00e9ncia de Madrid, Av. Complutense 30, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vicente","family":"Lozano-Berrio","sequence":"additional","affiliation":[{"name":"Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Finca La Peraleda, 45071 Toledo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/2.zoppoz.workers.dev:443\/https\/orcid.org\/0000-0001-8926-5328","authenticated-orcid":false,"given":"\u00c1lvaro","family":"Guti\u00e9rrez","sequence":"additional","affiliation":[{"name":"Escuela T\u00e9cnica Superior de Ingenieros de Telecomunicaci\u00f3n, Universidad Polit\u00e9ncia de Madrid, Av. Complutense 30, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c1ngel","family":"Gil-Agudo","sequence":"additional","affiliation":[{"name":"Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Finca La Peraleda, 45071 Toledo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/2.zoppoz.workers.dev:443\/https\/orcid.org\/0000-0001-6215-2593","authenticated-orcid":false,"given":"Antonio","family":"del-Ama","sequence":"additional","affiliation":[{"name":"Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Finca La Peraleda, 45071 Toledo, Spain"},{"name":"Rey Juan Carlos University, Calle Tulip\u00e1n, 0, 28933 M\u00f3stoles, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,10,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1016\/j.apmr.2006.04.022","article-title":"Trends in Life Expectancy After Spinal Cord Injury","volume":"87","author":"Strauss","year":"2006","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1038\/sj.sc.3100802","article-title":"Upper extremity pain after spinal cord injury","volume":"37","author":"Dylan","year":"1999","journal-title":"Spinal Cord"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1038\/sj.sc.3101490","article-title":"Shoulder pain and its consequences in paraplegic spinal cord-injured, wheelchair users","volume":"42","author":"Samuelsson","year":"2004","journal-title":"Spinal Cord"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1016\/j.apmr.2003.11.016","article-title":"Relation between median and ulnar nerve function and wrist kinematics during wheelchair propulsion","volume":"85","author":"Boninger","year":"2004","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_5","unstructured":"Van Drongelen, S. (2005). Upper Extremity Load during Wheelchair-Related Tasks in Subjects with a Spinal Cord Injury, Digital Printing Partners Utrecht."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Jayaraman, C., Moon, Y., Rice, I.M., Wecksler, E.T.H., Beck, C.L., and Sosnoff, J.J. (2014). Shoulder Pain and Cycle to Cycle Kinematic Spatial Variability during Recovery Phase in Manual Wheelchair Users: A Pilot Investigation. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0089794"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fbioe.2015.00105","article-title":"Variability in wheelchair propulsion: A new window into an old problem","volume":"3","author":"Sosnoff","year":"2015","journal-title":"Front. Bioeng. Biotechnol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Leving, M.T., Vegter, R.J.K., De Vries, W.H.K., De Groot, S., and Van der Woude, L.H.V. (2018). Changes in propulsion technique and shoulder complex loading following low-intensity wheelchair practice in novices. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0207291"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Kirby, R.L., Mitchell, D., Sabharwal, S., McCranie, M., and Nelson, A.L. (2016). Manual Wheelchair Skills Training for Community-Dwelling Veterans with Spinal Cord Injury: A Randomized Controlled Trial. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0168330"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Paralyzed Veterans of America Consortium for Spinal Cord Medicine (2005). Preservation of Upper Limb Function Following Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals. J. Spinal Cord Med., 28, 434\u2013470.","DOI":"10.1080\/10790268.2005.11753844"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.clinbiomech.2018.04.008","article-title":"Upper-limb biomechanical analysis of wheelchair transfer techniques in two toilet configurations","volume":"55","author":"Tsai","year":"2018","journal-title":"Clin. Biomech."},{"key":"ref_12","first-page":"73","article-title":"To compare the physiological effects of standard and light weight wheelchair design during propulsion by persons with spinal cord injury (SCI)","volume":"39","author":"Singh","year":"2008","journal-title":"Indian J. Occup. Ther."},{"key":"ref_13","first-page":"281","article-title":"Limitations of Kinematics","volume":"75","author":"Sanderson","year":"1995","journal-title":"Phys. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1038\/sc.2014.128","article-title":"Wheelchair appropriateness in patients with spinal cord injury: A Turkish experience","volume":"52","author":"Ekiz","year":"2014","journal-title":"Spinal Cord"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1093\/ptj\/79.2.146","article-title":"Energy cost of propulsion in standard and ultralight wheelchairs in people with spinal cord injuries","volume":"79","author":"Beekman","year":"1999","journal-title":"Phys. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1186\/s12984-018-0450-3","article-title":"Manual wheelchair downhill stability: An analysis of factors affecting tip probability","volume":"15","author":"Thomas","year":"2018","journal-title":"J. NeuroEng. Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1016\/j.medengphy.2013.03.019","article-title":"Effect of wheelchair mass, tire type and tire pressure on physical strain and wheelchair propulsion technique","volume":"35","author":"Vegter","year":"2013","journal-title":"Med Eng. Phys."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1097\/00002060-199104000-00005","article-title":"Standard v Lightweight Wheelchair propulsion in spinal cord injured patients","volume":"1","author":"Parziales","year":"1991","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1080\/00140138608967269","article-title":"Wheelchair ergonomics and physiological testing of prototypes","volume":"29","author":"Woude","year":"1986","journal-title":"Ergonomics"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1016\/S0003-9993(00)90043-1","article-title":"Manual Wheelchair Biomechanics and Axle Position","volume":"81","author":"Boninger","year":"2000","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1053\/mr.2000.3845","article-title":"User assessment of manual wheelchair ride comfort and ergonomics","volume":"81","author":"DiGiovine","year":"2000","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/j.gaitpost.2014.02.001","article-title":"Gait & Posture Summary measures for clinical gait analysis: A literature review","volume":"39","author":"Cimolin","year":"2014","journal-title":"Gait Posture"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3362","DOI":"10.3390\/s140203362","article-title":"Gait analysis methods: An overview of wearable and non-wearable systems, highlighting clinical applications","volume":"14","year":"2014","journal-title":"Sensors"},{"key":"ref_24","unstructured":"Invacare (2019, October 24). Invacare\u00aeAction\u00ae3 Range User Guide. Available online: https:\/\/2.zoppoz.workers.dev:443\/https\/www.invacare.co.uk\/sites\/uk\/files\/product_documents\/779d3d93a3b91c1e5ac9881d82eca33706bcecc6_Action_3NG_User_manual_29112017.pdf."},{"key":"ref_25","unstructured":"Ottobock (2019, October 24). Ventus\u2014Instructions for Use. Available online: ottobock.com.au\/media\/documents\/mobility\/ventus\/ventus-instructions-for-use.pdf."},{"key":"ref_26","unstructured":"(2018, May 10). American Spinal Injury Association The premier North American Organization in the Field of Spinal Cord Injury Care, Education, and Research. Available online: https:\/\/2.zoppoz.workers.dev:443\/https\/asia-spinalinjury.org\/wp-content\/uploads\/2019\/04\/ASIA-ISCOS-IntlWorksheet_2019.pdf."},{"key":"ref_27","first-page":"35","article-title":"Kinescan\/IBV v11: Valoraci\u00f3n biomec\u00e1nica en tiempo real","volume":"11","author":"Vilela","year":"2013","journal-title":"Rev. Biomec\u00e1nica"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1038\/sc.2009.126","article-title":"Shoulder joint kinetics during wheelchair propulsion on a treadmill at two different speeds in spinal cord injury patients","volume":"48","year":"2010","journal-title":"Spinal Cord"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1080\/03093640903082126","article-title":"SMARTWheel: From concept to clinical practice","volume":"33","author":"Cooper","year":"2009","journal-title":"Prosthetics Orthot. Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1016\/j.medengphy.2016.04.005","article-title":"Shoulder Pain and Time Dependent Structure in Wheelchair Propulsion Variability","volume":"38","author":"Jayaraman","year":"2016","journal-title":"Med. Eng. Phys."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1016\/j.jbiomech.2004.05.042","article-title":"ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion\u2014Part II: Shoulder, elbow, wrist and hand","volume":"38","author":"Wu","year":"2005","journal-title":"J. Biomech."},{"key":"ref_32","unstructured":"Hall, S.J. (2012). Basic Biomechanics, McGraw-Hill Companies. [6th ed.]."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1243\/0954411041932791","article-title":"A kinematic model of the wirst based on maximization of joint contact area","volume":"218","author":"Sirkett","year":"2004","journal-title":"Proc. Inst. Mech. Eng. Part H: J. Eng. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/S0895-4356(98)00168-1","article-title":"Increasing Physicians\u2019 Awareness of the Impact of Statistics on Research Outcomes: Comparative Power of the t-test and Wilcoxon Rank-Sum Test in Small Samples Applied Research","volume":"52","author":"Bridge","year":"1999","journal-title":"J. Clin. Epidemiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1854","DOI":"10.1016\/j.apmr.2004.03.033","article-title":"Assessing the influence of wheelchair technology on perception of participation in spinal cord injury","volume":"85","author":"Chaves","year":"2004","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1865","DOI":"10.1016\/j.apmr.2004.04.043","article-title":"Impact of a pushrim-activated power-assisted wheelchair on the metabolic demands, stroke frequency, and range of motion among subjects with tetraplegia","volume":"85","author":"Algood","year":"2004","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/j.humov.2011.05.006","article-title":"Effect of increased load on scapular kinematics during manual wheelchair propulsion in individuals with paraplegia and tetraplegia","volume":"31","author":"Raina","year":"2012","journal-title":"Hum. Mov. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2508","DOI":"10.1016\/j.jbiomech.2010.05.021","article-title":"Upper limb joint kinetics during manual wheelchair propulsion in patients with different levels of spinal cord injury","volume":"43","year":"2010","journal-title":"J. Biomech."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/S0003-9993(99)90285-X","article-title":"Shoulder Pain in Wheelchair Users With Tetraplegia and Paraplegia","volume":"80","author":"Curtis","year":"1999","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1097\/00002060-199607000-00010","article-title":"Temporal\u2013spatial characteristics of wheelchair propulsion\u2014Effects of level of spinal cord injury, terrain, and propulsion rate","volume":"75","author":"Newsam","year":"1996","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_41","unstructured":"Brodwin, M.G., Siu, F.W., Howard, J., and Brodwin, E.R. (2009). Medical, Psychosocial and Vocational Aspects of Disability, Elliott and Fitzpatrick, Inc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1016\/S0003-9993(99)90082-5","article-title":"Wheelchair pushrim kinetics: Body weight and median nerve function","volume":"80","author":"Boninger","year":"1999","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/S0268-0033(03)00084-6","article-title":"Wrist kinematic characterization of wheelchair propulsion in various seating positions: Implication to wrist pain","volume":"18","author":"Wei","year":"2003","journal-title":"Clin. Biomech."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/2.zoppoz.workers.dev:443\/https\/www.mdpi.com\/1424-8220\/19\/21\/4643\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:29:18Z","timestamp":1760189358000},"score":1,"resource":{"primary":{"URL":"https:\/\/2.zoppoz.workers.dev:443\/https\/www.mdpi.com\/1424-8220\/19\/21\/4643"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,25]]},"references-count":43,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2019,11]]}},"alternative-id":["s19214643"],"URL":"https:\/\/2.zoppoz.workers.dev:443\/https\/doi.org\/10.3390\/s19214643","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,25]]}}}