BJMB
Brazilian Journal of Motor Behavior
Current Opinion
van der Woude et
al.
2022
VOL.16
N.2
94 of 97
Power output and energy cost: crucial measures to understand motor skill learning in
handrim wheelchair propulsion
LUCAS H. V. VAN DER WOUDE
1,2,4
| RACHEL E. COWAN
3
| VICKY GOOSEY-TOLFREY
4
| FÉLIX CHÉNIER
5
| URSINA
ARNET
6
| RIEMER J. K. VEGTER
1,4
1
University of Groningen, University Medical center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands.
2
University Medical Center Groningen, Department of Rehabilitation, Groningen, The Netherlands.
3
University of Alabama at Birmingham, School of Medicine, Department of Physical Medicine & Rehabilitation, Birmingham, Alabama, USA.
4
Peter Harrison Center for Disability Sport, School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK.
5
Department of Physical Activity Science, Université du Québec à Montréal (UQAM), Montreal, Canada.
6
Swiss Paraplegic Research, Notwill, Switzerland.
Correspondence to: Lucas H. V. van der Woude. University of Groningen, University Medical center Groningen, Center for Human Movement Sciences, Groningen, The
Netherlands.
email: l.h.v.van.der.wo[email protected]
https://doi.org/10.20338/bjmb.v16i2.261
ABBREVIATIONS
J Work
ME Mechanical efficiency
N Force
W Speed
PUBLICATION DATA
Received 18 09 2021
Accepted 26 11 2021
Published 01 06 2022
BACKGROUND: This current opinion is a call for standardization of measurements of manual wheeling ability
among larger and diverse populations to support our understanding of motor control and learning.
VIEW OF THE PAST: Handrim wheelchair propulsion remains the most common mode of wheeled ambulation
and has stood the test of time as a practical upper-body alternative to walking.
CURRENT STATE: Two theoretical models appeared useful in understanding the demands on the wheelchair-
user combination and the role of motor skill acquisition: Power Balance Model and Constraint-based Approach.
FUTURE PERSPECTIVE: Power output and energy cost measures are crucial mediators in the development of
a motor control theory of cyclic motions in rehabilitation, adapted sports and beyond.
KEYWORDS: Handrim | Wheelchair | Skill | Rehabilitation | Adapted sports
Following World War-II and being recognized as crucial mobility modalities for lower
limb disabled individuals, biophysical sciences became worldwide involved in research on
stress, strain, work capacity and ergonomic design of manually propelled wheelchairs
1
.
Studies in the 1960ties compared wheeling modes, using cardio-respiratory strain measures
during (sub)maximal (steady state) wheelchair exercise on a motor driven treadmill or
ergometer. Outcomes of oxygen-uptake, energy cost and heart-rate underscored the
relatively high upper-body strains of handrim wheelchairs, compared to lever and crank
propulsion
1
. These early studies sometimes already measured drag force(N), work(J) or
power (=drag force x speed(W)) using adapted bicycle ergometers or treadmill drag tests.
Today, handrim wheelchair propulsion remains the most common mode of wheeled
ambulation and has stood the test of time as a practical upper-body alternative to walking.
Yet, it is a relatively complex bimanual discontinuous form of upper-body work, as the hands
cyclically contact the rotating rims outside the visual field, requiring appropriate wheeling
skills from the user. This complexity is illustrated by the low gross mechanical efficiency (ME
(%)) and high relative physical strains on the upper-body, often causing upper-body overuse
injuries and/or risks for inactivity. Hence, there is a continued need for research on
ergonomic innovations, but especially on optimal motor skill acquisition and performance
building
2
. Natural motor skill development was first stressed in observational cohort studies
among wheelchair users with a spinal cord injury during and after rehabilitation. Repeated
measures of power output and energy cost during individually standardized bouts of
BJMB Current Opinion
Brazilian Journal of Motor Behavior
van der Woude et
al.
2022
VOL.16
N.2
95 of 97
(sub)maximal wheelchair exercise on a motor driven treadmill, showed increments in peak
work capacity over time, while submaximal energy cost dropped (and ME↑)
3
.
Two theoretical models appeared useful in understanding the demands on the
wheelchair-user combination and the role of motor skill acquisition. First, the Power Balance
Model for cyclic movements
4
provides equations from exercise physiology, biomechanics
and engineering to understand the generation and dissipation of power output. Detailed
measures of power output, energy cost and propulsion technique, incorporated in this model,
helped to understand motor control and performance in the context of environmental energy
dissipation, wheelchair-user interfacing and individual abilities in manual wheelchair
propulsion
2
. Secondly, the constraint-based approach places energy cost as the central
optimization criterion of cyclic motor skills, within the potential and limitations of the user,
task and environment
5
. Indeed, different handrim wheelchair learning studies in novices
confirmed the reduction of energy cost at constant submaximal power and speed
Interestingly, individual differences in learning occurred
6
.
Similar to gait labs, wheelchair research is evolving towards detailed combined
biomechanical and physiological measurements and modelling of upper-body function for
clinical or sports performance decision-making. The Dutch Wheel-I project was a first
example for a standardized monitoring and feedback lab-approach during rehabilitation, in
which technology and standardization provide a time-dependent picture of energy cost,
performance and skill evolution
7
. Yet, such labs are scarce and technical infrastructure,
guidelines for testing and fitting of wheelchairs in combination with handrim propulsion
training are (inter)nationally unstandardized and data provide a limited evidence-base
8.
Fortunately, technological advances such as commercial wheelchair ergometers and inertial
measurement units lay a strong foundation for future more standardized wheeling
performance and skill observations among much larger collaborative study populations
3
.
Therefore, this current opinion is a call for standardization of measurements of
manual wheeling ability among larger and diverse populations to support our understanding
of motor control and learning. This knowledge could guide clinical decision making on the
fitting of wheelchairs and training of wheelchair-users, to obtain healthy functioning and
participation in daily-life as advocated with WHO’s ICF model
9
. To that end, proper
measures of power output and energy cost are key components of the wheelchair-user
combination’s performance-evaluation. Technical means are there, but the challenge is to
get all relevant parties on the same page to develop and maintain a commonly shared
knowledge-base and technical infrastructure to interpret individual results.
With the growing interest in wheeled motor learning and motor skill acquisition,
power output and energy cost measures are crucial mediators in the development of a motor
control theory of cyclic motions in rehabilitation, adapted sports and beyond
5, 6, 8, 10
.
Questions that may drive the future research agenda on wheeling motor skill development
are e.g.:
What dose-characteristics drive natural optimization of cyclic motor behavior and
how is this expressed in energy cost and mechanical efficiency and in the
coordination of power production?
How are physiological adaptation and motor skill acquisition connected, and how
does this evolve over different time scales, feedback forms and retention periods in
the context of environmental complexity, inter-individual diversity and the dynamical
systems theory
5
?
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al.
2022
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How does this interact with ergonomics of the wheelchair-user interface and with the
continuum of power-assist handrim, daily and lightweight sports wheelchairs?
Indeed, intriguing questions that ideally may be answered with systematic
standardized power output and energy cost measures in manual wheeled mobility.
REFERENCES
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6. Vegter RJK, Lamoth CJ, Groot S, Veeger DHEJ, van der Woude LHV. Inter-individual
differences in the initial 80 minutes of motor learning of handrim wheelchair propulsion.
PLoS One. 2014;9(2):e89729. doi: /10.1371/journal.pone.0089729
7. Groot S, Vegter R, Vuijk C, van Dijk F, Plaggenmarsch C, Sloots M, et al. WHEEL-I:
development of a wheelchair propulsion laboratory for rehabilitation. J Rehabil Med.
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8. de Klerk R. Development of a wheelchair propulsion laboratory. 2021, Universiteit van
Groningen: Groningen.
9. WHO. International Classification of Functioning, Disability and Health. 2001, World Health
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83. doi: 10.1007/s004229900075
BJMB Current Opinion
Brazilian Journal of Motor Behavior
van der Woude et
al.
2022
VOL.16
N.2
97 of 97
Citation: van der Woude LHV, Cowan RE, Goosey-Tolfrey V, Chénier F, Arnet U, Vegter RJK. (2022). Power output
and energy cost: crucial measures to understand motor skill learning in handrim wheelchair propulsion. Brazilian
Journal of Motor Behavior, 16(2):94-97.
Editors: Dr Fabio Augusto Barbieri - São Paulo State University (UNESP), Bauru, SP, Brazil; Dr José Angelo Barela -
São Paulo State University (UNESP), Rio Claro, SP, Brazil; Dr Natalia Madalena Rinaldi - Federal University of
Espírito Santo (UFES), Vitória, ES, Brazil.
Section Editors (Current Opinion): Dr Luis Augusto Teixeira - University of São Paulo (USP), São Paulo, SP, Brazil;
Dr Tibor Hortobágyi - University of Groningen, The Netherlands; Dr Renato de Moraes - University of São Paulo
(USP), Ribeirão Preto, SP, Brazil.
Copyright:© 2022 van der Woude, Cowan, Goosey-Tolfrey, Chénier, Arnet and Vegter and BJMB. This is an open-
access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives 4.0
International License which permits unrestricted use, distribution, and reproduction in any medium, provided the
original author and source are credited.
Funding: There was no funding for this study.
Competing interests: The authors have declared that no competing interests exist.
DOI: https://doi.org/10.20338/bjmb.v16i2.261