# Biomechanics of Pediatric Manual Wheelchair Mobility

## TL;DR

This study explores how children and teens with spinal cord injuries use their upper bodies to move manual wheelchairs, finding that different tasks like starting and stopping place unique stress on joints.

## Contribution

The study introduces a quantitative rehabilitation approach to assess upper extremity biomechanics in pediatric manual wheelchair users during various functional tasks.

## Key findings

- Joint demands vary significantly across tasks, with the shoulder most stressed during starting.
- Children use multiple propulsion stroke patterns, some differing from adult norms.
- Participants showed lower physical health but higher mental health than typical.

## Abstract

Currently, there is limited research of the biomechanics of pediatric manual wheelchair mobility. Specifically, the biomechanics of functional tasks and their relationship to joint pain and health is not well understood. To contribute to this knowledge gap, a quantitative rehabilitation approach was applied for characterizing upper extremity biomechanics of manual wheelchair mobility in children and adolescents during propulsion, starting, and stopping tasks. A Vicon motion analysis system captured movement, while a SmartWheel simultaneously collected three-dimensional forces and moments occurring at the handrim. A custom pediatric inverse dynamics model was used to evaluate three-dimensional upper extremity joint motions, forces, and moments of 14 children with spinal cord injury (SCI) during the functional tasks. Additionally, pain and health-related quality of life outcomes were assessed. This research found that joint demands are significantly different amongst functional tasks, with greatest demands placed on the shoulder during the starting task. Propulsion was significantly different from starting and stopping at all joints. We identified multiple stroke patterns used by the children, some of which are not standard in adults. One subject reported average daily pain, which was minimal. Lower than normal physical health and higher than normal mental health was found in this population. It can be concluded that functional tasks should be considered in addition to propulsion for rehabilitation and SCI treatment planning. This research provides wheelchair users and clinicians with a comprehensive, biomechanical, mobility assessment approach for wheelchair prescription, training, and long-term care of children with SCI.