Paralympic Sports Medicine and Science

Adaptive Sports Technology and Biomechanics:

Wheelchairs
Rory A. Cooper, PhD, Arthur Jason De Luigi, DO

Wheelchair sports are an important tool in the rehabilitation of people with severe chronic
disabilities and have been a driving force for innovation in technology and practice. In this
paper, we will present an overview of the adaptive technology used in Paralympic sports
with a special focus on wheeled technology and the impact of design on performance
(defined as achieving the greatest level of athletic ability and minimizing the risk of injury).
Many advances in manual wheelchairs trace their origins to wheelchair sports. Features of
wheelchairs that were used for racing and basketball 25 or more years ago have become
integral to the manual wheelchairs that people now use every day; moreover, the current
components used on ultralight wheelchairs also have benefitted from technological ad-
vances developed for sports wheelchairs. For example, the wheels now used on chairs for
daily mobility incorporate many of the components first developed for sports chairs. Also,
advances in manufacturing and the availability of aerospace materials have driven current
wheelchair design and manufacture. Basic principles of sports wheelchair design are uni-
versal across sports and include fit; minimizing weight while maintaining high stiffness;
minimizing rolling resistance; and optimizing the sports-specific design of the chair.
However, a well-designed and fitted wheelchair is not sufficient for optimal sports per-
formance: the athlete must be well trained, skilled, and use effective biomechanics because
wheelchair athletes face some unique biomechanical challenges.
PM R 2014;6:S31-S39

INTRODUCTION
Wheelchair sports are an important tool in the rehabilitation of people with severe chronic
disabilities and have been a driving force for innovation in technology and practice.
Through adaptive sports, people with impairments learn compensatory strategies and to
transform their perceptions of self [1]. Sports and recreation for people with impairments
build strength, flexibility, stamina, and an improved outlook on life [2]. As the adaptive
sports opportunities have expanded, so have the expectations of people with impairments.
Furthermore, adaptive sports have created opportunities for greater community integra-
tion, especially with activities that allow people with and without disabilities to participate
together. The wheelchair sports movement parallels the disability rights movement, and
both have complimented each other in making advances for promoting respect, dignity,
and inclusion for people with impairments.
R.A.C. Human Engineering Research Labora-
Here we will present an overview of the adaptive technology used in Paralympic sports.
tories, Pittsburgh, PA. Address correspon-
The focus is on wheeled technology and the impact of design on performance. In the dence to: R.A.C., Director, Human Engineering
context of this paper, performance includes achieving the greatest level of athletic ability Research Laboratories, 6425 Penn Avenue,
Suite 400, Pittsburgh, PA 15206; e-mail:
and minimizing the risk of injury. The wheelchairs used for basketball, rugby, tennis,
[email protected]
softball, power wheelchair soccer, racing, and handcycling are described, along with some Disclosures outside this publication: royalties,
of the key considerations for their design and fitting to athletes. patent agreements, AT Sciences, Three Rivers
Holdings (money to author)
Many advances in manual wheelchairs trace their origins to wheelchair sports. Features
of wheelchairs that were used for racing and basketball 25 or more years ago have become A.J.D.L. Department of Rehabilitation Medi-
cine, Medstar Georgetown University Hospital,
integral to the manual wheelchairs that people now use every day [3,4]. Frame materials Washington, DC
such as aluminum, titanium, and composite materials all were first introduced in the de- Disclosure: nothing to disclose
signs of sports wheelchairs to make them lighter and stiffer but ultimately faster and more Submitted for publication January 27, 2014;
responsive. These materials are now used widely in the design of ultralight manual accepted May 22, 2014.

PM&R ª 2014 by the American Academy of Physical Medicine and Rehabilitation

1934-1482/14/$36.00 Vol. 6, S31-S39, August 2014
S31
Printed in U.S.A. http://dx.doi.org/10.1016/j.pmrj.2014.05.020
S32 Cooper and De Luigi WHEELCHAIR TECHNOLOGY FOR SPORTS

wheelchairs for much the same reasons, except instead of angle the wheels make with respect to vertical when viewed
improving sports performance they help to increase the from the rear of the chair) was introduced in wheelchair
ability to independently perform activities of daily living and basketball to increase turning responsiveness and stability,
reduce repetitive strain injuries. There are also similarities in and to prevent opposing players from getting too close. It
the principles used in frame design, which make chairs easier has the further benefit of protecting hands when 2 wheel-
to propel, allow for easier transport of the wheelchair in a chairs side swipe each other. Camber benefits wheelchair
vehicle and reduce upper limb strain. racing as well by allowing access to the greater portion of the
The principles of wheelchair design and fitting are founded pushrims without the arms hitting the tops of the wheels [7].
on the principles developed for wheelchair sports (Figure 1). In The current components used on ultralight wheelchairs
daily mobility wheelchairs as in sports wheelchairs, the driving also have benefitted from technological advances developed
principle is to create an efficient human-machine system in for sports wheelchairs. The wheels now used on chairs for
which the person and the wheelchair work in close coordination daily mobility incorporate many of the components first
[4]. This system is accomplished by fitting the wheelchair developed for sports chairs, including synthetic spokes of
closely to the body to form a fit akin to a shoe or a glove. A composite materials; high-pressure, low-resistance tires;
wheelchair is best perceived as an orthotic device and fitted to sealed high-quality bearings to include ceramic bearings; and
the user as such. This translates into making the seat fit closely, ergonomic pushrims. Ultralight wheelchair manufacturers
even snugly, to the body, ensuring that the backrest supports the also incorporate backrests and seats that use rigid, body-
spine and pelvis without imposing upon the movement of the formed surfaces and adjustable tension, which have been
scapula and arms, and the legs must be stable and the feet firmly commonplace in sports wheelchairs. Even race components
supported. Through wheelchair sports, we have learned that the such as road-crown compensators are making their way onto
large wheels used for propulsion must be brought close to the chairs designed for daily mobility.
body. This allows the arms to remain in a more neutral position, Up until the 1980s, people participated in wheelchair sports
and the shoulder to remain in a stable position throughout the by using essentially the same chairs that they used for daily
range of motion during the entire stroke-cycle [5]. mobility, sometimes with minor modifications such as smaller
The axle location of the drive wheels should be located just diameter pushrims, rear wheel camber, and lower seat height
aft of a vertical line extending downward from the combined [4]. The growing number of opportunities for sports partici-
location of the center of mass of the user and the chair pation and competition led athletes to collaborate with engi-
(Figure 1) [6]. This can be determined by adjusting the angle neers, designers, and manufacturers to create novel designs
forward and having the person sit upright and lift his or her aimed at improving sports performance. This led to revolu-
arms above the head; in this position, the chair should be on tionary changes in wheelchair design and at the same time
the brink of tipping, but still have all 4 wheels on the ground. fueled research into adaptive sport performance. Today, the
This has multiple positive effects: (1) it allows the arms to design of wheelchairs is tailored towards each specific sports,
grasp a larger portion of the pushrims to increase the stroke resulting in dramatic improvements in sports performance.
angle and reduce stroke frequency; (2) it balances the weight
on the drive wheels and casters, such that the drive wheels
PRINCIPLES OF DESIGN FOR SPORTS
carry more of the user’s weight reducing the overall rolling
resistance; and (3) it reduces the downhill turning moment of
WHEELCHAIRS
the person and chair, making it easier to propel the wheelchair There are some basic principles of sports wheelchair design
in the presence of cross-slopes and to turn the chair. that are universal across sports: (1) optimize the fit of the
Adding camber to the rear wheels was the result of ne- wheelchair to the user so that they act as one; (2) minimize
cessity in wheelchair basketball and racing. Camber (the weight while maintaining high stiffness; (3) minimize the
rolling resistance; and (4) optimizing the sports-specific design
of the chair. Most sports wheelchair frames use aluminum,
titanium, or composite materials [8]. As features and compo-
nents are added, most chairs use a variety of materials chosen
for the specific purpose. Aluminum is widely used as it is
lightweight, easy to work with, and readily available. Com-
posite materials can lead to the best results but tend to be
expensive and labor-intensive for fabrication; hence they are
primarily used by athletes competing at the highest levels.

Basketball Wheelchair Design

Figure 1. Carbon fiber ultralight daily use wheelchair (left)
Basketball is one of the oldest of wheelchair sports and is
compared to the racing wheelchair (right).
played in more than 100 countries around the world [9].
PM&R Vol. 6, Iss. 8S, 2014 S33

Basketball is played on a smooth flat court, and the purpose hence, quickness and maneuverability are critical [10].
of the game is to maneuver the ball around the other team of Because the opposing player is on the opposite side of the
players and score the most baskets. This has led to basketball net and no contact between players occurs during the game,
wheelchairs constructed with 6 wheels: 2 swivel casters in the chair can be streamlined. Therefore, tennis wheelchairs
the front; 2 drive wheels; and 2 swivel casters in the rear have a single front and rear caster, in contrast to a basketball
(Figure 2), This allows the drive wheels to be placed at or chair, which has 2 front and rear casters. Tennis chairs often
very close to the center of gravity of the basketball player, have handles on the front of the seat in order to help the
which makes the chair very responsive for turning and at the athlete stabilize their balance as they lean or extend to hit the
same time allows for efficient propulsion. Camber of up to ball with their racquet.
10 is added to increase side-to-side stability, speed, and
turning responsiveness.
To improve performance, the feet are tucked under the Softball Wheelchair Design
seat, which shortens the chair and makes it turn quicker by Wheelchair softball involves 2 teams with one on the field of
reducing the angular moment of inertia. Ratchet straps are play in a defensive posture and the other team batting and
used to hold the athlete firmly in the seat and for some attempting to score by getting players on base [11].
athletes their feet are strapped to the footrests as well; this Wheelchair softball is essentially the same as softball, with a
helps to make the athlete and wheelchair act in concert. few differences (Figure 3). The ball used in wheelchair
Shrouds are placed around the front of the frame to inhibit softball is larger and softer so that players do not need to use
the ability of an opposing player trying to hook or pick a a glove. The game is played on a firm and level surface, such
player either inadvertently or on purpose. Basketball as a parking lot. At this time, wheelchair softball players use
wheelchair design is position specific. Forwards and centers basketball or tennis chairs to play. Players positioned in the
often sit high as the rules permit for greater ease of shooting infield are more prone to using basketball wheelchairs,
at close range to the basket, whereas guards lower their because of the potential for contact with a player of their
center of gravity to improve maneuverability. own or the opposing team.

Tennis Wheelchair Design Rugby Wheelchair Design

Tennis chairs have much in common with basketball Wheelchair rugby is a high-speed and high-impact team sport
wheelchairs. The goal of tennis is to hit or return the ball [12]. Direct contact between the chairs of players is an integral
over the net such that the opponent is unable to return it; part of the game, which differentiates it from other court sports
played in wheelchairs. Furthermore, wheelchair rugby is
limited to athletes with both lower and upper extremity im-
pairments. These factors impose different design criteria on
wheelchair rugby chairs, which has resulted in 2 basic styles of
chair: offensive and defensive. Basically, players are divided into
whether their mission is to score points or to protect their goal
and prevent the other team from scoring points. Offensive
players tend to be less impaired, and thus faster and more adept
at maneuvering their chairs around the court. The basic frame
design of a rugby chair is the same as that for a guard in
wheelchair basketball. It has 6 wheels, with the drive wheels
located near the center of mass. There is typically a large pos-
terior seat angle to help hold the player in a stable position in the
chair. The “V” formed by the legs and torso also serves to cradle
the ball when being carried on a players lap and helps the player
to recover after falling forward against their legs. Because of the
frequent impact with other chairs, rugby chairs use solid wheel
covers commonly made of aluminum to protect the spokes and
to encourage other chairs to glance off upon contact.
The primary difference between offensive and defensive
wheelchair rugby chairs is in the design of the added com-
ponents (Figure 4). Offensive chairs are built with shrouds to
make it more difficult for other players to obstruct their path or
Figure 2. Wheelchair used to play basketball. to hook them to impede their progress. In contrast, defensive
S34 Cooper and De Luigi WHEELCHAIR TECHNOLOGY FOR SPORTS

halls of Walter Reed Army Hospital [13]. In the 1980s, the

racing wheelchair evolved to the point at which it was a
completely custom device designed specifically for racing
[4]. However, racing wheelchair design was limited from the
late 1940s up until the 1990s by rule restrictions that
severely inhibited design options [4]. Rule restrictions began
to be lifted because of pressure from athletes and the
growing scientific evidence that the rules may actually be
placing athletes at undue risk for injury as well as artificially
limiting the advance of the sport.
Some of the most important rule changes were as follows
(Figure 5): removing the restriction for an overall length of 120
cm (48 inches); allowing for 3 wheels; and permitting steering
gear (ie, a crown-compensator and steering lever). It turns out
that these 3 rule changes interact with each other and have
transformed racing wheelchairs. Removing the length re-
striction and allowing the use of a crown-compensator made
the 3-wheeled racing chair design possible. For racing chairs to
be stable with 3 wheels, they needed a longer wheelbase, and
the crown-compensator further helped to stabilize the chair,
especially at high speeds. This made it possible to use larger
front wheels, and simpler, lighter, and stiffer frame designs
that made racing much faster.
Racing wheelchairs currently have 3 wheels. The front
wheel is typically about 20 inches in diameter, and the rear
wheels range from 25 to 27 inches in diameter. Wheels are
most commonly made of carbon-fiber composite. A T-frame
design is most common, with one tube connecting the axles of
the rear wheels with another tube welded at 90 from the mid-
Figure 3. Batting in wheelchair softball. point of the axle tube to protrude forwards to terminate with
the head-set bearing housing (Figure 6). The fork for the front
wheel mounts to the head-set housing. The steering gear
chairs are designed with bumpers intended to capture the
mounts between the fork and the forward pointing frame tube
chairs of offensive players or at least disrupt their path.
through a spring-loaded crown-compensator. The device is
spring loaded to allow the athlete to overcome the springs for
Racing Wheelchair Design turning with their arms when using the steering lever. The
Wheelchair racing is perhaps the oldest of all wheelchair crown-compensator is used to help keep the wheelchair
sporting events. There are stories of veterans recovering from straight when on a road or track with a cross-slope, but also
their wounds in World War I racing each other around the helps the athlete to negotiate the curves of a track without

Figure 4. Wheelchairs used to play rugby with chair for defense (left) and offense (right). Players specialize in either defense or
offense depending on their abilities and talents.
PM&R Vol. 6, Iss. 8S, 2014 S35

Figure 5. Racing wheelchair on a track with the key features labeled.

steering with their hands. This permitted considerable im- above the cranks; and (4) recumbent devices in which the
provements in time as athletes could push equally with both athlete lies on his/her back with the cranks placed above their
arms around curves or in the presence of cross-slopes. chest. The most commonly used are recumbent and kneeling,
Racing wheelchairs use a kneeling position, where the and these are the only two used in the Paralympics (Figure 7).
athlete essentially leans forward with their chest close to Most hand-cycles have multiple gears, ranging anywhere from
their knees. This position allows maximum power to be 1 to 33. The different designs and availability of gears have
transferred by the arms and trunk muscles to the pushrims. made both recreational activity and racing accessible to many
Pushrims are selected based on the length of the athlete’s more people with impairments than ever before.
arms so that the athlete can reach the bottom of the push-
rims before his or her arms are fully extended. The seat of a
racing chair must fit tightly, much like a prosthetic socket, Power Wheelchair Soccer
and straps are used to firmly lock the athlete into the seat. There are few opportunities for people with high levels of
impairment who use electric-powered wheelchairs to
participate in sports, and the opportunities are even fewer
Handcycle Design
for team sports. The creation of power wheelchair soccer
Handcycles first started to be developed after World War I as opened a new avenue for people with upper and lower ex-
a means for veterans to negotiate rough terrain and to travel tremity impairments to compete in a dynamic team sport
longer distances [13]. It was not until the 1980s that races that requires little in the way of equipment or modification
began to emerge and the sport started to grow. Much of the of their wheelchairs [14]. As the sport has evolved, some
growth can be attributed to 3 factors: (1) there was a modifications to the athletes’ chairs have advanced. The
growing desire by people with impairments to participate in power soccer ball is approximately 0.5 m in diameter and is
sports and recreational activities along side of their family moved and manipulated with the athlete’s wheelchair,
and friends without disabilities; (2) many people with im- typically with a shroud placed around the footrests. The
pairments could not effectively use a racing wheelchair shroud also serves to protect the athlete’s feet. Inexpensive
because of their anatomy or impairments; and (3) triathlon shrouds can be made of plastic that are helpful for people
was emerging as a sport and some people with impairments being introduced to the sport or who play at a recreational
had a desire to participate. level. There are also custom shrouds, typically made from
Because of the origin of the sport, 4 basic designs of hand- steel, that some players choose to use. As power soccer has
cycles have emerged: (1) the arm-crank add-on unit that at- matured and players’ skills have advanced, there has become
taches to a person’s manual wheelchair; (2) upright arm-crank a demand to design or modify powered wheelchairs for
units where the person sits much like they do in their soccer (Figure 8). Athletes have discovered that rear wheel
wheelchair; (3) hand-cycles where the athlete sits in the drive chairs that are both fast and have a high rate of turning
kneeling position with the trunk upright or forward leaning enhance performance. Unfortunately, most electric-powered
S36 Cooper and De Luigi WHEELCHAIR TECHNOLOGY FOR SPORTS

and their components to meet the demands of today’s ath-

letes and wheelchair sports. The 80-pound mild-steel
wheelchair of the 1930s through the 1970s has no place in
wheelchair sports today [15]. Although there remains hand
craftsmanship in sports wheelchairs, the trend is towards
modern manufacturing processes and design tools.

Computer-Aided Design (CAD) and

Computer-Aided Manufacturing (CAM)
CAD has become ubiquitous in the engineering and machine
design communities. CAD has benefitted sports wheelchair
design in several important ways [15]; it has improved the
quality of sports wheelchairs by systematically defining
component and subsystem tolerances, providing simulations
for optimization of strength and stiffness, creating easily
retrievable documentation, and providing files for CAM
[16]. Probably the most significant contribution of CAD has
been the application of parametric design that allows a basic
design of a wheelchair to be scaled and customized to a
particular athlete [17]. This has allowed sports wheelchairs
to be fitted to meet each athlete’s particular needs, talents,
and preferences. With CAD software, a digital model can be
created that allows engineers and designers to visualize how
components fit together, to examine the final appearance,
and to study how the chair will perform.
CAM is the sibling to CAD [18]. During the past 2 de-
cades, manufacturing has transitioned from special purpose
machines and custom tooling to flexible machines and
computer programs. The market for sports wheelchairs is
small, and therefore it was not cost-effective to develop
specialized tooling and machines to fabricate sports wheel-
chairs. However, with CAM, this is no longer a barrier as
fabricators and manufacturers use machines that can build a
wide variety of components using software to guide the tool
parameters (e.g., speeds, feeds, and pathways). Today, a
single machine can make multiple parts simultaneously,
potentially for different customers. As CAM machines
become more affordable, they become accessible to local
fabricators and are becoming available by simply uploading
design drawings to a flexible manufacturer’s website.
Design also has changed as traditional processes are
Figure 6. Racing wheelchair viewed from the bottom to show
converted to modern techniques such as water-jet cutting or
the T shape of the frame.
laser cutting [19]. These machines can cut a variety of ma-
terials: cloth, metals, and plastics with little human effort.
wheelchairs are mid-wheel drive and have less power than
Through water-jet cutting or laser cutting, flat sheets can be
some models produced 15 or more years ago. Some athletes
cut in multiple parts with very complex shapes as easily as
acquire older rear-wheel drive wheelchairs and have them
cutting a straight line. This allows engineers and designers to
refurbished and modified for power soccer.
exercise greater creativity and complexity in their designs
with little or no extra cost. CAD/CAM has been adopted by
IMPACT OF ADVANCED MANUFACTURING sports wheelchair designers and manufacturers to produce
AND MATERIALS higher quality products and to improve performance. A
significant advantage has been the availability of high quality
Advances in manufacturing and the availability of aerospace sports chairs to a larger number of people, and the avail-
materials have made it possible for the design of wheelchairs ability of off-the-shelf replacement parts.
PM&R Vol. 6, Iss. 8S, 2014 S37

Figure 7. Recumbent and kneeling versions of hand-cycles.

The ubiquity of CAD has also led to a growing trend to- new techniques to fuse materials to customize the properties
wards additive manufacturing, that in some cases allows the of the resulting component. As this research progresses, it
fabrication or “printing” of parts on a desktop [20]. This has will be possible to select material properties of specific por-
allowed sports wheelchair designers to incorporate parts that tions of a part being printed using additive machining;
would have previously required castings or molds that were opening entirely new horizons for engineers and designers.
cost prohibitive given the small number of sports wheelchairs
and their parts sold. Currently, additive manufacturing is
BIOMECHANICS OF WHEELCHAIR SPORTS
primarily used for plastic parts on sports wheelchairs, but as
additive manufacturing becomes widely available and more A well-designed and fitted wheelchair is necessary for
thoroughly understood its use is likely to become more optimal sports performance but not sufficient. The athlete
widespread and expand the types of materials applied. must be well trained, skilled, and use effective biomechanics.
Wheelchair athletes face some unique biomechanical chal-
lenges. Because wheelchair athletes use their arms for their
Mixed Materials
sport as well as for mobility and activities of daily living, they
Composite materials are the most well known and frequently need to exercise caution [22]. The average manual wheel-
used of the mixed materials. Materials such as carbon-fiber, chair user propels their wheelchair with nearly 1000 strokes
Kevlar, fiber glass, S-glass, etc, are all synthetic materials that per day at a net peak force of about 70 Newtons [23]. The
use a thermal or thermo plastic binding agent to form a frequency and level of force required for daily mobility
composite that can be very light and very strong [21]. In places manual wheelchair users at risk for injuries to the
wheelchair sports, one of the most striking examples is the wrist, elbow, and shoulder. Furthermore, some wheelchair
hand-cycle used by Alex Zanardi to win a gold medal in athletes also have impaired sensation and or loss of muscle
the Paralympic Games. His hand-cycle used materials, mass in the lower extremities, which places them at risk for
designs tools, and fabrication processes adopted from auto- pressure ulcers. Wheelchair athletes also are prone to the
mobile racing with outstanding results. Through additive same types of overuse and sports-related injuries that affect
manufacturing, there are new materials being created and other athletes. There remains a paucity of information about
S38 Cooper and De Luigi WHEELCHAIR TECHNOLOGY FOR SPORTS

Figure 8. Electric powered wheelchair modified for soccer.

the biomechanics of wheelchair sports. Sports such as height, preloading the muscles before contact with the
wheelchair basketball and racing have received greater pushrim to begin the propulsion phase. This allows for
attention than other sports. maximum forces to be applied to the pushrims. However, if
the posterior muscles have insufficient strength and endur-
ance the arms begin to lower during the recovery phase, and
Propulsion Biomechanics the athlete begins to slow.
There are some common biomechanical principles that are
applicable across the sports involving pushrim wheelchairs.
Seating Biomechanics
During pushrim propulsion the stroke is divided into two
basic phases: propulsion phase and recovery phase [24]. The Seating for wheelchair sports has 3 basic goals: (1) provide a
propulsion phase is when the hands are in contact with the firm, snug, and efficient base of support for propulsion and
pushrims. The efficiency of the stroke is determined by the control; (2) maximize the balance of the user for the sport
following characteristics: the coupling of the hand with the activity; and (3) avoid promoting the development of pres-
pushrim at the beginning and ending of the propulsion sure ulcers or other soft tissue injuries. The padding in
phase; the push angle; the position of the shoulder at the sports wheelchairs is typically held to a minimum in order to
beginning and ending of the stroke; and the recovery promote the athlete and the wheelchair acting as one integral
pattern. A circular pattern is most efficient during the re- unit. The risk of soft-tissue injury is minimized by increasing
covery cycle [24]. When accelerating or turning, it is best to the surface area of the seat in contact with the body. In some
chop the stroke and reduce the recovery time. However, cases, the seat is molded to the user to form a custom seating
when going straight and fast, it is best to use a long and fluid orthotic. The large contact area and firm padding must
stroke. closely fit the contour of the athlete’s body in the seated
Maintaining muscle balance, especially around the position for the sport. Straps also are used to further hold the
shoulder complex, is essential for performance as well as athlete firmly in place. In most wheelchair sports, with the
reducing the risk of injury [25]. For example, in wheelchair notable exception of hand-cycling, athletes use seat dump
racing it is important to have a high back swing during the (posterior tilt to the seat base) to push their back against the
recovery stroke so that the wrist and elbows reach maximum backrest, thus increasing stability. Seat dump also reduces
PM&R Vol. 6, Iss. 8S, 2014 S39

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