Date of Award

Summer 2017

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Biomedical Engineering

First Advisor

Harris, Gerald F.

Second Advisor

Riedel, Susan A.

Third Advisor

Slavens, Brooke A.

Abstract

Pediatric manual wheelchair users face substantial risk of orthopaedic injury to the upper extremities, particularly the shoulders, during transition to wheelchair use and during growth and development. Propulsion strategy can influence mobility efficiency, activity participation, and quality of life. The current forefront of wheelchair biomechanics research includes translating findings from adult to pediatric populations, improving the quality and efficiency of care under constrained clinical funding, and understanding injury mechanisms and risk factors. Typically, clinicians evaluate wheelchair mobility using marker-based motion capture and instrumentation systems that are precise and accurate but also time-consuming, inconvenient, and expensive for repeated assessments. There is a substantial need for technology that evaluates and improves wheelchair mobility outside of the laboratory to provide better outcomes for wheelchair users, enhancing clinical data. Advancement in this area gives physical therapists better tools and the supporting research necessary to improve treatment efficacy, mobility, and quality of life in pediatric wheelchair users. This dissertation reports on research studies that evaluate the effect of physiotherapeutic training on manual wheelchair mobility. In particular, these studies (1) develop and characterize a novel markerless motion capture-musculoskeletal model systems interface for kinematic assessment of manual wheelchair propulsion biomechanics, (2) conduct a longitudinal investigation of pediatric manual wheelchair users undergoing intensive community-based therapy to determine predictors of kinematic response, and (3) evaluate propulsion pattern-dependent training efficacy and musculoskeletal behavior using visual biofeedback.Results of the research studies show that taking a systems approach to the kinematic interface produces an effective and reliable system for kinematic assessment and training of manual wheelchair propulsion. The studies also show that the therapeutic outcomes and orthopaedic injury risk of pediatric manual wheelchair users are significantly related to the propulsion pattern employed. Further, these subjects can change their propulsion pattern in response to therapy even in the absence of wheelchair-based training, and have pattern-dependent differences in joint kinematics, musculotendon excursion, and training response. Further clinical research in this area is suggested, with a focus on refining physiotherapeutic training strategies for pediatric manual wheelchair users to develop safer and more effective propulsion patterns.

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