Wheeled mobility: An ergonomics perspective

Objective. To present an ergonomics perspective on manual wheeled mobility and provision, and highlight today's international research on manual wheelchair propulsion in the context of rehabilitation and sports. Major content of paper. Those with lower-limb disabilities are often dependent on manually propelled wheelchairs for their mobility, in Europe today some 3.3 million people. This implies a transfer from leg to arm work for daily ambulation and in all other activities. Compared to the legs, arm work is less efficient and more straining, and allows a considerably lower physical work capacity. Also, there is a major risk of mechanical overuse. Problems of long-term wheelchair use are not only pain or discomfort, but also a risk of physical inactivity. Subsequently, serious secondary impairments (obesity, cardiovascular problems) may eventually emerge. Overuse and disuse in turn may again impact mobility. Results. Continued experimental study and monitoring of the wheelchair usercombination in rehabilitation and sports practice have improved wheelchair quality, fitting and provision, as well as understanding functional mobility over the past decades. Wheelchair quality, including the ergonomic fitting to the individual, plays a preventive role in musculoskeletal overuse as well as disuse or inactivity. In addition, the understanding of the underlying mechanisms of learning, training, rehabilitation, active and sports is proven to be crucial on long term health, functioning and wellbeing. The 'International Classification of Functioning, Health and Disability' model, the stress-strain-work capacity model, as well as an ergonomics model that relates human-activity-assistive technology are instrumental to guide research and practice into optimal wheeled mobility. Apart from empirical developments and innovations from within wheelchair sports and industry, systematic ergonomics-oriented research plays a role in wheelchair development and design in three important areas: (1) the vehicle mechanics, (2) the wheelchair-user interface, and (3) the human movement system (skill learning, work capacity). Exemplary research findings and practical developments in hand rim wheelchairs and handcycles are discussed. Conclusion. An increasingly strong research effort over the past decades has provided initial guidelines for wheelchair design and fitting as well as a basic understanding of overuse problems in hand rim wheelchair use. Yet, guidelines for individualized optimization of the wheelchair-user combination and principles of skill acquisition and training are still lacking.