In recent years the popularity of disabled sports and competition among disabled athletes has grown considerably. With this rise in exposure of, and participation in wheelchair sports comes an increase in related stressors, including musculoskeletal load. External mechanical loading may increase the risk of shoulder complaints. The objective of this literature review was to 1) identify and describe the prevalence and/or incidence of shoulder complaints in wheelchair athletes in the literature, to 2) examine the factors and underlying mechanisms that could be potentially involved, and 3) provide some insights into the development of preventative measures. A literature search was conducted using PubMed, Scopus and Embase databases, to identify relevant published articles. All articles in the English language that contained any type of shoulder complaint in relation with a wheelchair sports player, at any level of status (recreational to elite), of any sport, were included. Articles were excluded if they did not include any statistical analysis. Articles that included studies with wheelchair athletes in combination with athletes of other disability sports were excluded in order to be able to differentiate between the two. Narrative, exploratory and case studies were also excluded. Two reviewers independently assessed articles for inclusion. Thirteen articles matched the selection criteria. These were judged on their quality by use of an adapted version of the Webster checklist. Of the included studies the overall quality was low. A relatively high prevalence of complaints was found, ranging from 16% to 76%. Pain was found to be a common complaint in wheelchair athletes. Based on the current literature the cause of shoulder problems is difficult to identify and is likely multifactorial, nevertheless characteristics of the user (i.e. increased years of disability, age and BMI) were shown to increase risk. Preventative measures were indistinct. There may be a role for balanced strength training regimens to decrease risk. Shoulder complaints in wheelchair athletes are a common problem that must be addressed further. Future studies on shoulder overuse injuries of wheelchair athletes should be directed towards biomechanical modeling to develop knowledge of load and its effects.

The purpose of this study was to evaluate the effect of wheelchair mass, solid vs. pneumatic tires and tire pressure on physical strain and wheelchair propulsion technique. 11 Able-bodied participants performed 14 submaximal exercise blocks on a treadmill with a fixed speed (1.11 m/s) within 3 weeks to determine the effect of tire pressure (100%, 75%, 50%, 25% of the recommended value), wheelchair mass (0 kg, 5 kg, or 10 kg extra) and tire type (pneumatic vs. solid). All test conditions (except pneumatic vs. solid) were performed with and without instrumented measurement wheels. Outcome measures were power output (PO), physical strain (heart rate (HR), oxygen uptake (VO2), gross mechanical efficiency (ME)) and propulsion technique (timing, force application). At 25% tire pressure PO and subsequently VO2 were higher compared to 100% tire pressure. Furthermore, a higher tire pressure led to a longer cycle time and contact angle and subsequently lower push frequency. Extra mass did not lead to an increase in PO, physical strain or propulsion technique. Solid tires led to a higher PO and physical strain. The solid tire effect was amplified by increased mass (tire × mass interaction). In contrast to extra mass, tire pressure and tire type have an effect on PO, physical strain or propulsion technique of steady-state wheelchair propulsion. As expected, it is important to optimize tire pressure and tire type.

The purpose of the current study was to assess the inter-trial reliability and construct validity (talented juniors vs. international adult players) of four wheelchair tennis field tests using inertial measurement units (IMUs). Twenty-one elite wheelchair tennis players completed four tests, which evaluate the sprinting and manoeuvrability abilities in wheelchair tennis. During all tests 3 IMUs were attached to both wheels and the frame of the athlete’s wheelchair. The IMUs enabled analysis of individual test dynamic characteristics, i.e. the linear/rotational velocity and acceleration data, as well as detected pushes. All tests showed high ICCs (0.95–0.99) for the inter-trial reliability for the IMU-based end times and also the construct validity was good, i.e. talented juniors could be discriminated from international adults. Also, velocities and accelerations during the tests could be consistently visualized, meaning that differences in test performance among participants could be designated. Within the experimental context, the field tests could be regarded as reliable and valid. With the use of IMUs it is possible to verify more detailed performance characteristics, visualize the test execution, as well as differentiate between a talented junior and international adult group and within individuals over time.

To gain insight into cyclic motor learning processes, hand rim wheelchair propulsion is a suitable cyclic task, to be learned during early rehabilitation and novel to almost every individual. To propel in an energy efficient manner, wheelchair users must learn to control bimanually applied forces onto the rims, preserving both speed and direction of locomotion. The purpose of this study was to evaluate mechanical efficiency and propulsion technique during the initial stage of motor learning. Therefore, 70 naive able-bodied men received 12-min uninstructed wheelchair practice, consisting of three 4-min blocks separated by 2 min rest. Practice was performed on a motor-driven treadmill at a fixed belt speed and constant power output relative to body mass. Energy consumption and the kinetics of propulsion technique were continuously measured. Participants significantly increased their mechanical efficiency and changed their propulsion technique from a high frequency mode with a lot of negative work to a longer-slower movement pattern with less power losses. Furthermore a multi-level model showed propulsion technique to relate to mechanical efficiency. Finally improvers and non-improvers were identified. The non-improving group was already more efficient and had a better propulsion technique in the first block of practice (i.e., the fourth minute). These findings link propulsion technique to mechanical efficiency, support the importance of a correct propulsion technique for wheelchair users and show motor learning differences.

Handrim wheelchair propulsion is a complex bimanual motor task. The bimanually applied forces on the rims determine the speed and direction of locomotion. Measurements of forces and torques on the handrim are important to study status and change of propulsion technique (and consequently mechanical strain) due to processes of learning, training or the wheelchair configuration. The purpose of this study was to compare the simultaneous outcomes of two different measurement-wheels attached to the different sides of the wheelchair, to determine measurement consistency within and between these wheels given the expected inter- and intra-limb variability as a consequence of motor control.

The purpose of this study was to examine the propulsion asymmetries of wheelchair athletes while sprinting on an instrumented, dual‐roller ergometer system. Eighteen experienced wheelchair rugby players (8 low point (LP) (class ≤1.5) and 10 high point (HP) (class ≥2.0)) performed a 15‐second sprint in their sports wheelchair on the instrumented ergometer. Asymmetry was defined as the difference in distance and power output (PO) between left and right sides when the best side reached 28 m. Propulsion techniques were quantified based on torque and velocity data. HP players covered an average 3 m further than the LP players (P = .002) and achieved faster sprint times than LP players (6.95 ± 0.89 vs 8.03 ± 0.68 seconds, P = .005) and at the time the best player finished (5.96 seconds). Higher peak POs (667 ± 108 vs 357 ± 78 W, P = .0001) and greater peak speeds that were also evident were for HP players (4.80 ± 0.71 vs 4.09 ± 0.45 m/s, P = .011). Greater asymmetries were found in HP players for distance (1.86 ± 1.43 vs 0.70 ± 0.65 m, P = .016), absolute peak PO (P = .049), and speed (0.35 ± 0.25 vs 0.11 ± 0.10 m/s, P = .009). Although HP players had faster sprint times over 28 m (achieved by a higher PO), high standard deviations show the heterogeneity within the two groups (eg, some LP players were better than HP players). Quantification of asymmetries is important not only for classifiers but also for sports practitioners wishing to improve performance as they could be addressed through training and/or wheelchair configuration.