Public Release: 

Wheelchair technology & spinal cord injury

Veterans Affairs Research Communications

The current issue of the Journal of Rehabilitation Research and Development (JRRD) is dedicated to spinal cord injury and wheelchair technology. Full-text articles are available, free, online at

Excess weight, push technique contribute to upper limb injury in users of manual wheelchairs

This study makes recommendations for wheelchair propulsion and setup that may reduce the risk of developing shoulder and wrist injuries. Over 60 manual wheelchair users with paraplegia propelled their manual wheelchair on a stationary roller system at self-selected, slow, and moderately fast speeds. Participants also underwent extensive medical tests to evaluate upper-limb repetitive strain injuries. Investigators recommend using smooth, long strokes and letting the hand drift below the pushrim when not in contact with the wheel. They warn that weight gain can increase injury risk and suggest using a light-weight wheelchair with a forward-adjusted rear axle to ease propulsion and lessen stress on the upper limbs.

Rehabilitation improves wheelchair propulsion capacity in persons with spinal cord injury

This study describes the effect of rehabilitation to increase the ability of persons with spinal cord injury (SCI) to push a wheelchair. One hundred and thirty-two persons with SCI were tested three times during rehabilitation. Overall, wheelchair propulsion ability increased from the start of rehabilitation to the end of clinical rehabilitation. Men, younger persons, persons with paraplegia, and persons with incomplete lesions had greater ability to push a wheelchair. Older persons and women were found to have a lower rate of improvement. Persons with tetraplegia and paraplegia showed the same amount of improvement.

People with spinal cord injury report lower quality of life

This study reviews literature on the quality of life (QOL) of individuals with spinal cord injury (SCI) and discusses the validity of some QOL measurement tools. Three types of definitions of QOL are used in health services and medical and rehabilitation research. Published research indicates that people with SCI tend to indicate that their achievements and statuses are lower than those of their peers. Furthermore, they reported their well-being as having less value, and others consider their health status as less desirable. Investigators note that problems exist with some of the measurement instruments, and in certain instances, their use with a SCI group has not been justified.

Literature review indicates best practices following spinal cord injury

This study reviews select recovery outcomes and measures from multicenter studies and a large spinal cord injury (SCI) database to show that future SCI treatment strategies should be based on demonstrated effective interventions. Investigators found that an accurate examination in the first days following injury is critical to neurological recovery. Neurological recovery following SCI is often associated with an increase in function, walking, and self care. The Walking Index for Spinal Cord Injury has recently demonstrated validity and an increased sensitivity and responsiveness to change in neurological/walking function in patients with SCI.

Functional electrical stimulation reverses muscle degeneration

This study investigates muscle recovery induced by a new system of life-long functional electrical stimulation training in permanent denervated human muscle. Needle biopsies of long-term denervated muscles showed severe dystrophy beginning two years after spinal cord injury. The excitability of denervated muscles was first improved by twitch-contraction training. Then, stimulation against a progressively increased load was performed. Muscle biopsies show that this progressive training almost reversed long-term muscle atrophy/dystrophy.

Manual wheelchair skill influences social participation

This study describes the relationship between manual wheelchair skill and social participation in persons with spinal cord injury (SCI) one year after injury. Eighty-one persons with SCI in the Netherlands performed a wheelchair- skills test. Social participation was moderately related to the number of wheelchair tasks that a person could perform and to the amount of time and physical strain required to perform these tasks, with the strongest association for performance time. Investigators conclude that wheelchair-skills training must be a top rehabilitation goal and that maintenance of those skills following discharge from rehabilitation should be encouraged.

Injury, bed rest, rehabilitation length linked to functional ability in patients with spinal cord injury

This study describes the rehabilitation length and functional outcome in the Netherlands for patients with spinal cord injury (SCI). Data from 157 patients from eight rehabilitation centers were analyzed. Level and completeness of injury, bed rest because of pressure sores, and length of stay were predictors of function. Length of stay in the Netherlands is very long, compared with length of stay in the U.S., but the outcomes are not necessarily better. Functional outcome appears slightly better in persons with complete tetraplegia, but not in persons with complete paraplegia. Investigators argue that international studies are necessary to reveal strengths and weaknesses of SCI rehabilitation systems in different countries.

Low-impact wheelchair propulsion: Achievable and acceptable

This study investigates the performance and user acceptance of a low-impact wheelchair pushrim. A low-impact pushrim is one that absorbs shock as the hand impacts it at the beginning of the push, important as this has been associated with the development of repetitive stress injuries among wheelchair users. Seventeen volunteers propelled their wheelchairs using the Variable Compliance Handrim Prototype set to each of three shock-absorption levels through a maneuverability test course and on various treadmill grades. Investigators found an optimal level of shock absorption where user acceptance was high and impact was reduced. The results of this study have shown that low-impact wheelchair propulsion is both achievable and acceptable to users.

Childhood-onset wheelchair users report less shoulder pain than adult-onset users

This study examines whether the prevalence of shoulder pain in adult wheelchair users who began using their wheelchairs during childhood is similar to those who began using their wheelchairs as adults. Investigators compared reports of shoulder and overall pain and physical activity levels in 31 childhood-onset and 22 adult-onset wheelchairs users. Shoulder pain was greater in adult-onset wheelchair users than compared with child-onset wheelchair users even though lifestyles were similar. Investigators suggest that a possible reason may be that the immature skeleton may respond to the repetitive forces of wheeling better than those who began using a wheelchair after their skeletal structure was developed.

About the Journal

JRRD has been a leading research journal in the field of rehabilitation medicine and technology for over 40 years. JRRD, a peer-reviewed, scientifically indexed journal, publishes original research papers, review articles, as well as clinical and technical commentary from U.S. and international researchers on all rehabilitation research disciplines. JRRD's mission is to responsibly evaluate and disseminate scientific research findings impacting the rehabilitative healthcare community. For more information about JRRD, visit


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