APPLIED SCIENCES

Biodynamics

Biomechanical comparison of two racing

wheelchair propulsion techniques
JOHN W. CHOW, TIM A. MILLIKAN, LES G. CARLTON, MARTY I. MORSE, and WOEN-SIK CHAE
Department of Kinesiology and Division of Rehabilitation Education Services, University of Illinois at Urbana-
Champaign, Urbana, IL 61801
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ABSTRACT
CHOW, J. W., T. A. MILLIKAN, L. G. CARLTON, M. I. MORSE, and W-S. CHAE. Biomechanical comparison of two racing
wheelchair propulsion techniques. Med. Sci. Sports Exerc., Vol. 33, No. 3, 2001, pp. 476 – 484. Purpose: The purpose was to compare
the conventional (CVT) and para-backhand (PBT) techniques used for racing wheelchair propulsion. Selected 3-D kinematic
characteristics of the upper body and the electromyographic (EMG) signals of selected muscles during racing wheelchair propulsion
over a roller system were examined. Methods: Eight CVT and seven PBT elite performers served as the subjects. Each subject
performed maximum effort pushing for 30 s at a load that simulated overground pushing. Two S-VHS camcorders (60 Hz) were used
to obtain 3-D kinematic parameters and muscle activity was monitored using surface electrodes. Results: The CVT was found to have
significant shorter push time, smaller relative push time, and greater relative recovery time than the PBT. The CVT is a more compact
stroke (smaller joint range of motion) and the PBT has a faster overall movement speed. Significant differences in arm positions were
found between the two techniques at the instants of hand contact and hand release, and the upper arm was more internally rotated at
these two instants in the CVT when compared with the PBT. The EMG data showed that large variations in muscle activation patterns
existed in each technique group. In general, the flexor carpi radialis and triceps brachii were most active in the push phase. The upper
trapezius and postero-middle deltoids were most active in the ascending recovery phase, whereas the extensor carpi radialis, biceps
brachii, antero-middle deltoids, and pectoralis major were most active during the descending recovery phase. Conclusions: The greater
push time and push angle associated with the PBT suggest that the PBT may be more suitable for endurance athletes who are less
explosive in their pushing strokes. The greater time and angle allow PBT users the opportunity to transmit more force to the wheel.
Key Words: KINEMATICS, ELECTROMYOGRAPHY, WHEELCHAIR SPORTS, DISABILITY

W
heelchair track events and road races are popular
among athletes with locomotive disabilities.
Over the years, most wheelchair racers with un-
impaired upper extremity function used the so-called con-
ventional technique (CVT, also called the thumb technique)
to propel their wheelchairs (Fig. 1). With the CVT, the
hands are fully flexed in a tight fist with the thumb in a slight
extended position (a hitchhiker’s pose). With the forearm
pronated and the shoulder internally rotated, the initial con-
tact with the pushrim occurs between the first joint and
knuckle of the thumb. After the initial contact, forearm
supination is initiated and the back (dorsal surface) of the
index and middle fingers between the middle joint and
knuckle begin to make contact with the lateral surface of the
pushrim (8). A flick of the wrist is commonly observed at
the bottom of the stroke. Tape preparations with heavy
padding over the contact areas of the hand are required.
0195-9131/01/3303-0476/$3.00/0
MEDICINE & SCIENCE IN SPORTS & EXERCISE®
Copyright © 2001 by the American College of Sports Medicine
Submitted for publication January 2000.
Accepted for publication June 2000.
476
With an aim of reducing upper extremity injuries among
wheelchair racing athletes, a different racing wheelchair
propulsion technique—the para-backhand technique
(PBT)—was developed in the early 1990s (9). Unlike the
CVT, the PBT begins with the thumb pressing against the
index finger of a closed fist to insure stability of the fingers
during the contact with the pushrim (Fig. 1). Using a spe-
cialized glove designed for the PBT, the hand makes initial
contact with the pushrim with the back of the index and
middle fingers between the first and second joints rather
than the thumb. After the initial contact, the hand rides
around the lateral surface of the pushrim, and the contact
point is switched to the base of the thumb, and the index,
middle, and ring finger cuticles. The forearm pronation/
supination and shoulder internal/external rotation during
pushing are limited in the PBT when compared with the
CVT. This may help to decrease the stress placed on dif-
ferent joints of the upper extremity.
The choice between the CVT and PBT is usually a per-
sonal preference of the athlete or instructor. The differences
in biomechanical characteristics between these two racing
wheelchair propulsion techniques have not been explored.

FIGURE 1—Front view of the arms (top), oblique front view of the
right hand (middle), and rear view of the right hand (bottom) at an
instant during the early push phase for the conventional (left) and
para-backhand (right) techniques. Gloves and tape preparations on
hands were not included for clear illustration.
To expand our understanding on the differences in move-
ment characteristics and muscle functions during the exe-
cution of these two techniques, it was the purpose of this
study to compare the kinematic and muscle activation char-
acteristics during maximum effort racing wheelchair push-
ing over a roller system using the PBT and CVT techniques.
It was anticipated that the findings would provide new
information which would be useful for teaching and instruc-
tion purposes.
METHODS
All subjects were highly-trained experienced racers. The
CVT group consisted of eight men, and the PBT group
consisted of six men and one woman (Table 1). A woman
was included because she was a world class athlete and her
performance level was comparable to the male subjects.
They signed informed consent documents that had been
approved by the Institutional Review Board before their
participation.
Experimental Setup
All pushing trials were performed on a computerized
drum roller system with a maximum braking resistance of
15 N·m (Eagle Sports Chair, Snellville, GA, U.S.). The
system consisted of a metal roller (diameter ⫽ 17.8 cm)
mounted on the rear end of a metal base. The front wheel of
RACING WHEELCHAIR PROPULSION
the wheelchair was fixed to the front end of the base, and the
rear wheels were supported by the roller. The axle of the rear
wheels was aligned vertically with the axis of rotation of the
roller. Two S-VHS camcorders (Panasonic AG-455, 60 Hz)
were located in front and behind, and to the left of the
subject (camera-subject distance ⫽ 3 m). A calibration
frame (17 control points, 1.3 ⫻ 1.1 ⫻ 0.9 m3), a plumbline,
and two markers were used for spatial reference and defin-
ing a global reference frame, respectively.
Electromyographic (EMG) Recordings
Eight pairs of surface electrodes with on-site preamplifi-
cation circuitry (Liberty Technology, Hopkinton, MA, U.S.)
(MYO115 electrodes, gain ⫽ 1000, input impedance ⬎ 1014
⍀, CMRR ⬎ 90 dB, frequency response ⫽ bandpass 3 dB
at 90 and 500 Hz, center to center distance ⫽ 1.5 cm) were
attached to the right-hand side of the body to monitor the
flexor carpi radialis (FCR), approximately 1/3 of the fore-
arm length from the elbow on the medial side of the fore-
arm; extensor carpi radialis (ECR), approximately 1/4 of the
forearm length from the elbow on the lateral side of the
forearm; biceps brachii (BBR), approximately midway be-
tween shoulder and elbow on the anterior side of the upper
arm; triceps brachii (TBR), approximately midway between
shoulder and elbow on the posterior side of the upper arm;
antero-middle deltoid (AMD), midway between the anterior
and middle deltoids; postero-middle deltoid (PMD), mid-
way between the middle and posterior deltoids; pectoralis
major (PCM), midway between the armpit and suprasternal
notch; and upper trapezius (UTR), approximately midway
between the acromion of scapula and C7/T1 vertebrae. To
obtain maximum EMG levels of the selected muscles, max-
imum effort isometric contractions were performed before
the experimental trials when the subject was in his/her chair
with the trunk in an upright position (Appendix). One trial
was performed for each isometric exercise and each con-
traction lasted for about 5 s. The EMG signals were further
magnified using a general purpose amplifier (Biocommuni-
cation Electronics, Model 215, Madison, WI, U.S.) input
impedance ⫽ 109 ⍀, CMRR ⬎ 100 dB) before A/D con-
version (12-bit) at a sampling rate of 1000 Hz.
Experimental Trials
All subjects used their own racing wheelchairs during the
data collection. Using a stationary start, each subject was
asked to perform a maximum effort trial for 30 s similar to
a Wingate test (6) on the roller system. According to athletes
who used the roller system for training purposes, the resis-
tance load used in this study—30% of the maximum resis-
tance offered by the roller system—provided a resistance
that was comparable to the resistance encountered during
pushing over a flat surface. The EMG signals were collected
for 5 s starting at the 20-s mark of a trial. The speedometer
reading (stroke speed) when the EMG data were collected
was recorded. To synchronize the video and EMG data, a
synchronization unit was manually activated during the time
the EMG signals were sampled. The unit activated a large
Medicine & Science in Sports & Exercise姞 477
TABLE 1. Subject information.
Pushrim
Propulsion Age Injury Track Years of Diameter
Subject Technique Sex (yr) Level Classification Best Events Training (cm) Major Achievements
1 Conventional M 38 T10 T4 100–400 m 15 38.1
2 Conventional M 27 T10–11 T3 200–800 m 5 36.8 US paralympian ’96
3 Conventional M 39 T12 T4 5K-marathon 7 38.1 US paralympian ’92
4 Conventional M 38 T12–L1 T4 800–10K 4 36.8 Multiple 10K victories
5 Conventional M 35 T5–6 T4 100–200 m 13 38.1
6 Conventional M 17 T12 T4 200–800 m 5 38.1
7 Conventional M 17 T12 T4 200–1500m 5 36.8 US paralympian ’96
8 Conventional M 16 L1 T4 400–1500m 4 35.7 US junior national record holder
9 Para-backhand M 22 T12 T4 100–800 m 12 38.1
10 Para-backhand M 23 T10 T4 5K-marathon 4 38.1
11 Para-backhand M 20 T8 T3 400–1500m 3 38.1
12 Para-backhand M 18 T10 T4 100–800 m 6 38.1
13 Para-backhand M 21 L3 T4 800m–10K 6 38.1 US 10K national champion
14 Para-backhand M 26 T10–12 T4 400–1500m 9 38.1 US paralympian ’92 & ’96
15 Para-backhand F 29 L1 T4 800m-marathon 9 38.1 US paralympian ’92 & ’96

light emitted diode (LED), which was visible in both camera phases. In addition, contact, release, and push angles (Fig. 2)
views, and forwarded a 3-V signal to the A/D converter of were determined for each stroke. The average angular speed
the EMG data acquisition system. of the wheel during the push phase was determined using the
push angle and the corresponding push time.
Data Reduction The raw EMG signals were filtered using a recursive
digital filter (Matlab Elliptic filter, 10 –500 Hz band pass,
The average calibration error (i.e., the root-mean-square
The Mathworks, Inc., Natick, MA, U.S.) and full-wave
error between the computed locations of the control points
rectified. The maximum isometric trial data were smoothed
and their known locations) for different data collection
using a moving average of 2 s and the largest EMG value
sessions was 2.6 mm. For the purpose of this study, a stroke
recorded for each muscle was considered the maximum
cycle starts at the instant of initial hand contact with the
EMG level. The experimental trial data were smoothed
pushrim and ends at the instant of the next initial hand
using a moving average of 30 ms before normalizing to the
contact (5,11). For each subject, three stroke cycles of EMG
respective maximum EMG levels (Fig. 3).
and the corresponding video recordings were analyzed. A
For each stroke cycle being analyzed, average EMG val-
manual digitizing Peak Motion Measurement System
ues were determined for the different stroke phases and the
(Englewood, CO) was used to extract 2-dimensional coor-
whole cycle. For each kinematic and EMG parameter in
dinates of the supra-sternal notch, midpoint between two
each trial, the average value over the three stroke cycles was
hips, left shoulder, elbow, and wrist from the video record-
used for subsequent analysis.
ings. The direct linear transformation (DLT) procedure (1)
was used to obtain 3-dimensional coordinates. Coordinate
transformation was performed so that the principal axes of
the global reference frame were aligned with the antero-
posterior, vertical, and medio-lateral directions (positive for
forward, upward, and medial directions).
For each stroke cycle, selected kinematic parameters of
the body landmarks (relative location, range of motion
(ROM), and velocity) and body segments (inclination and
angular speed) and the orientation of a plane formed by the
upper arm and forearm (arm plane) at the instants of initial
hand contact (HC), hand release (HR; the instant the hand
breaks contact with the pushrim), and maximum elbow
height (MEH) were determined. The inclination of a seg-
ment is the smallest angle between a segment and the
horizontal plane; the angle is positive if the distal endpoint
is higher than the proximal endpoint. The orientation of an
arm plane, represented by a unit vector perpendicular to the
plane and pointing forward, was obtained by the cross
FIGURE 2—Angular parameters used to indicate the locations of the
product of two vectors defining the upper arm and forearm, hand relative to the wheel center at the instants of initial hand contact
respectively. Time durations, both in seconds and as a (the contact angle) and release (the release angle). Both angles are
fraction of the stroke time, were determined for the push measured clockwise from a line joining the wheel center and top dead
center. Mathematically, the push angle is obtained by subtracting the
(from HC to HR), ascending recovery (HR to MEH), de- contact angle from the release angle. Adapted from Chow et al. (2) with
scending recovery (MEH to HR), and recovery (HR to HC) permission.

478 Official Journal of the American College of Sports Medicine http://www.acsm-msse.org

 TABLE 2. Means (standard deviations) of different temporal characteristics.
Propulsion Technique
Conventional Para-backhand
Speed (m䡠s⫺1) 9.2 (0.9) 9.6 (1.2)
Stroke time (s) 0.54 (0.06) 0.53 (0.03)
Stroke frequency (push䡠min⫺1) 112.8 (13.2) 112.8 (6.6)
Push time (s) 0.09 (0.01)* 0.11 (0.02)*
Relative push time (%) 16.6 (4.0) 19.9 (3.0)
Recovery time (s) 0.45 (0.07) 0.43 (0.03)
Relative recovery time (%) 83.4 (4.0) 80.1 (3.0)
Ascending recovery time (s) 0.35 (0.05) 0.30 (0.06)
Relative ascending recovery time (%) 64.1 (3.5)* 55.5 (10.4)*
Descending recovery time (s) 0.11 (0.03) 0.13 (0.04)
Relative descending recovery time (%) 19.3 (4.1) 24.5 (9.0)
* Significant difference between techniques (P ⬍ 0.05).

recovery phases. The two phases are defined based on the

instant of maximum elbow height. This is justified because
distinct kinematic and functional characteristics can be
found in the ascending and descending portions of the
recovery phase.

FIGURE 3—Raw and normalized EMG of different muscles for a
conventional technique subject. The vertical lines indicate instants of
hand contact and release (solid lines) and maximum elbow height
(dashed lines).
Statistical Analysis
For each kinematic and EMG parameter, mean and stan-
dard deviation (SD) were computed for each technique. A
one-way ANOVA was used to test for significant differ-
ences between the two techniques (P ⬍ 0.05).
RESULTS
Comparable to the work of O’Connor et al. (10), the
recovery phase is divided into ascending and descending
Kinematic Characteristics
No significant differences were found between the two
techniques in the stroke speed, stroke time and stroke fre-
quency (Table 2). However, the CVT had significantly
shorter push time (P ⫽ 0.03) and greater relative recovery
time (P ⫽ 0.04) than the PBT. Although there were apparent
differences in mean values of the relative push time, as-
cending and descending recovery times, and relative de-
scending recovery time between the two techniques, the
differences were not statistically significant because of large
between subject differences within each technique.
Significant differences were found in the antero-posterior
(A/P) location of the elbow relative to the wrist (P ⫽ 0.02)
and the A/P and medio-lateral (M/L) location of the elbow
relative to the shoulder (P ⫽ 0.01 and P ⫽ 0.01, respec-
tively) at HC (Table 3). The PBT has significantly smaller
upper arm inclination at HC than the CVT (P ⫽ 0.05) (Table
4). Significant differences were found in the A/P (P ⫽ 0.05),
vertical (P ⬍ 0.01), and M/L (P ⬍ 0.01) locations of the
elbow relative to the wrist and the vertical location of the
elbow relative to the shoulder (P ⬍ 0.01) at HR (Table 3).
The PBT has significantly greater forearm inclination (less
negative) at HR than the CVT (P ⫽ 0.04) (Table 4). In

TABLE 3. Relative locations (m) of adjacent upper extremity joints at different critical instants.
Propulsion Technique
Conventional Para-backhand
Antero/Posterior Vertical Medio/Lateral Antero/Posterior Vertical Medio/Lateral
Hand contact (HC)
Elbow/wrist 0.05* (0.02) 0.28 (0.02) ⫺0.05 (0.03) ⫺0.01* (0.06) 0.30 (0.03) ⫺0.08 (0.03)
Elbow/shoulder ⫺0.21* (0.03) 0.05 (0.05) ⫺0.21* (0.01) ⫺0.25* (0.02) 0.00 (0.05) ⫺0.26* (0.04)
Hand release (HR)
Elbow/wrist 0.07* (0.04) 0.28* (0.02) 0.01** (0.02) 0.10* (0.02) 0.30* (0.02) 0.06** (0.02)
Elbow/shoulder ⫺0.21 (0.03) ⫺0.17* (0.03) ⫺0.14 (0.022) ⫺0.23 (0.04) ⫺0.23* (0.01) ⫺0.14 (0.03)
Maximum elbow height (MEH)
Elbow/wrist 0.23 (0.04) 0.13 (0.07) 0.05 (0.06) 0.24 (0.04) 0.16 (0.08) 0.07 (0.07)
Elbow/shoulder ⫺0.15 (0.06) 0.19 (0.04) ⫺0.19 (0.03) ⫺0.19 (0.05) 0.16 (0.08) ⫺0.21 (0.05)
Standard deviations in parentheses.
A positive value indicates that the first joint is located in front of, above, or medial to the second joint.
Significant difference between techniques (* P ⬍ 0.05 or ** P ⬍ 0.01).

RACING WHEELCHAIR PROPULSION Medicine & Science in Sports & Exercise姞 479
FIGURE 4 —The orientations of the planes formed by the left forearm and upper arm, represented as unit vectors perpendicular to the planes and
pointing forward, at the instants of (a) hand contact, (b) hand release, and (c) maximum elbow height. Viewing from the back of a unit circle, each
symbol indicates a location on the front surface of a unit circle. Therefore, a vector directed from the center of the circle to a symbol represents the
orientation of a left arm plane. For example, the symbol indicated by an arrow denotes a left arm plane that is facing downward (unit vector
approximately 22.5° below the horizontal plane) and outward (unit vector approximately 40° from the sagittal plane). The grid lines illustrate the
deviations from the sagittal or horizontal plane at 22.5° intervals.

general, the wrist was located behind, below, and lateral to
the shoulder at HR for both techniques.
For both techniques, the unit vector representing the arm
plane at HC was directed approximately half way between
forward and sideward (approximately 35–55° from the sag-
ittal plane), and slightly downward (Fig. 4a). The arm plane
faced forward, downward, and sideward at MEH for both
techniques (Fig. 4c). Significant differences in the magni-
tudes of the A/P and vertical components of the unit vector
at HR (P ⫽ 0.04 for both) were found between the two
techniques. The arm plane at HR for the CVT faced more
forward and downward when compared with the PBT.
The PBT had significantly greater M/L ROMs in the
elbow (P ⫽ 0.02) and wrist (P ⫽ 0.02) joints than the CVT
(Table 5). Although not statistically significant (P ⫽ 0.07),
the PBT has notably greater vertical ROM in the elbow than
the CVT. The PBT also had significantly greater release
angle (P ⫽ 0.01) and push angle (P ⫽ 0.04) than the CVT
(Table 6).
Instead of reporting the segment angular parameters in
the sagittal, frontal, and transverse planes (13), a combina-
tion of segment angular speeds (Table 4) and joint velocities
(Table 7) are used to describe the 3-dimensional segment
motion at different critical instants. No significant differ-
ence between the two techniques was found in any segment
angular speed and joint velocity at HC and MEH. However,
significant differences were found in the angular speeds of
the trunk (P ⫽ 0.03), upper arm (P ⫽ 0.01), and forearm (P
⫽ 0.01) at HR between the two techniques (Table 4). The
CVT had greater speeds than the PBT in all cases except the
angular speed of the forearm at HR. Significant differences
were also found in the vertical velocities of the shoulder (P
⫽ 0.01), elbow (P ⫽ 0.02), and wrist (P ⫽ 0.04) and the
M/L velocities of the elbow (P ⫽ 0.01) and wrist (P ⫽ 0.04)
(Table 7). The CVT had greater speeds than the PBT in all
cases except the M/L speed of the wrist at HR. It is worth
nothing that the wrist was moving downward for the CVT
and upward for the PBT at HR.

TABLE 4. Segment inclinations and angular speeds at different critical instants.

Inclination (°) Angular Speed (°s䡠ⴚ1)
Conventional Para-backhand Conventional Para-backhand
Hand contact (HC)
Trunk 14.6 (8.6) 14.2 (8.4) 101.9 (40.1) 125.8 (39.4)
Upper Arm 9.0 (8.3)* 0.2 (7.3)* 516.9 (159.3) 551.9 (178.9)
Forearm ⫺74.5 (5.2) ⫺72.2 (6.2) 520.0 (88.2) 511.2 (137.9)
Hand release (HR)
Trunk 7.3 (8.5) 7.1 (10.2) 71.4 (28.9)* 37.8 (26.3)*
Upper Arm ⫺34.0 (6.6) ⫺40.4 (6.9) 348.8 (111.7)* 196.3 (94.0)*
Forearm ⫺74.9 (6.7)* ⫺68.2 (4.1)* 460.5 (59.4)* 552.2 (68.4)*
Maximum elbow height (MEH)
Trunk 24.5 (9.0) 24.4 (6.0) 34.8 (17.4) 31.1 (23.2)
Upper Arm 38.7 (9.5) 29.0 (16.2) 142.0 (43.8) 166.3 (72.3)
Forearm ⫺27.0 (14.3) ⫺29.9 (15.8) 276.9 (99.2) 299.1 (93.7)
Standard deviations in parentheses.
* Significant difference between techniques (P ⬍ 0.05).

480 Official Journal of the American College of Sports Medicine http://www.acsm-msse.org

TABLE 5. Ranges of motion (m) of different upper extremity joints.
Conventional
Antero/Posterior Vertical
Shoulder 0.07 (0.03) 0.18 (0.05)
Elbow 0.17 (0.04) 0.55 (0.06)
Wrist 0.35 (0.06) 0.72 (0.11)
Standard deviations in parentheses.
* Significant difference between techniques (P ⬍ 0.05).
Muscle Activation
Although greater wrist motion and forearm rotation are
associated with the CVT, no significant difference was
found in any EMG parameters for the FCR and ECR be-
tween the two techniques (Fig. 5). For both techniques, the
FCR and ECR were most active during the push and de-
scending recovery phases, respectively, and a certain degree
of FCR and ECR co-contraction was presented throughout
the stroke. It is not clear why the subjects did not relax their
wrist muscles during the recovery phase.
For both techniques, the BBR and TBR were most active
during the descending recovery and push phases, respec-
tively (Fig. 5). Although not statistically significant (P ⫽
0.07), the average TBR activity during the push phase for
the CVT was much higher than the corresponding activity
for the PBT. For both techniques, the AMD and PMD were
most active during the descending and ascending recovery
phases, respectively.
The PCM and UTR were most active during the descend-
ing and ascending recovery phases, respectively, for both
techniques (Fig. 5). The UTR was generally more active in
the CVT than in the PBT throughout the stroke. The CVT
had significantly higher UTR activity during the ascending
recovery phase than the PBT (P ⫽ 0.04).
DISCUSSION
Because the primary focus of this study was to compare
the kinematic and EMG characteristics exhibited by the
CVT and PBT, we only compared our findings with previ-
ous studies that had testing protocols comparable to this
study (i.e., maximal effort pushing overground or over roller
systems using modern racing wheelchairs) in the discussion.
The racing wheelchairs used in the 1980s were quite differ-
ent from those used in the 1990s. Using a modern wheel-
chair, an athlete performs strokes from a kneeling position
instead of a sitting position for old style racing wheelchairs.
It is conceivable that the stroke mechanics is quite different
TABLE 6. Contact, release, and push angles.
Propulsion Technique
Conventional Para-backhand
Contact Angle (°) 30.3 (11.5) 38.6
Release Angle (°) 170.9 (24.3)** 200.5
Push Angle (°) 140.6 (21.1)* 161.9
Angular Speed (°䡠s⫺1)a 1,610 (163) 1,549
Standard deviations in parentheses.
a
Average angular speed of the wheel during the push phase (push angle/push time).
Significant difference between techniques (* P ⬍ 0.05 or ** P ⬍ 0.01).
RACING WHEELCHAIR PROPULSION
Propulsion Technique
Para-backhand
Medio/Lateral Antero/Posterior Vertical Medio/Lateral
0.06 (0.02) 0.06 (0.02) 0.19 (0.03) 0.05 (0.02)
0.09* (0.03) 0.18 (0.06) 0.61 (0.05) 0.13* (0.03)
0.11* (0.03) 0.42 (0.08) 0.78 (0.11) 0.19* (0.08)
between modern and old wheelchairs because of the differ-
ences in trunk position.
Kinematic Characteristics
Temporal characteristics. Comparing to previous
studies using roller systems, the average stroke speed of 9.4
m·s-1 recorded in this study is comparable to the highest
speed recorded in Wang et al. (13) and greater than the
speeds recorded in the other studies (3,4,7). Although the
stroke times recorded in this study are generally comparable
to those reported in previous studies, the relative push times
(Table 2) are much smaller than the corresponding values
reported in these studies (3,4,11,13), probably because of
the higher speeds attained by our subjects.
Relative locations and segment inclinations. Be-
cause the wrist is located slightly behind the elbow for the
CVT (Table 3), the upper arm was more internally rotated at
HC in the CVT when compared with the PBT. Contrary to
the original belief, the elbow was actually farther away from
the body for the PBT at HC. It is possible that the outward
elbow position allows a PBT user to “punch” (press inward)
the pushrim more effectively at HC. The arm inclinations at
HR indicate that the arm was not fully extended at HR
(Table 4). Despite the differences in relative joint locations,
the inclinations of the upper arm and forearm indicate that
the elbow angles at HR were about the same (approximately
109°) for both techniques.
Arm planes. For instructional purposes, the orientations
of the arm planes at different critical instants (Fig. 4) can be
very useful for evaluating arm position during a stroke
cycle. For example, instead of describing an arm position at
a given instant using locations of the elbow relative to the
shoulder and wrist utilizing terminologies such as above/
below, in front of/behind, and lateral/medial (Table 3), an
arm plane facing toward a specific direction with approxi-
mate angles from the sagittal and horizontal planes can be
very easy to explain and visualize by instructors and stu-
dents. For most subjects, the arm plane at HR was at a
vertical orientation (a horizontal unit vector) and faced more
sideward than at HC (Fig. 4b). For the CVT subjects who
had downward arm planes at HR (indicated by an arrow in
Fig. 4b), their upper arms were more internally rotated than
(11.5)
(8.7)** the other subjects. This may place more stress on the struc-
(13.6)* tures around the shoulder joint.
(192)
Ranges of motion. In general, the joint ROM values
suggest that, when compared with the PBT, the CVT is a
more compact stroke (smaller joint ROMs). Although the
Medicine & Science in Sports & Exercise姞 481
TABLE 7. Joint velocities (m䡠s⫺1) at different critical instants.
Propulsion Technique
Conventional Para-backhand
Antero/Posterior Vertical Medio/Lateral Antero/Posterior Vertical Medio/Lateral
Hand contact (HC)
Shoulder 0.04 (0.28) ⫺1.04 (0.42) ⫺0.38 (0.19) ⫺0.19 (0.30) ⫺1.20 (0.27) ⫺0.39 (0.09)
Elbow ⫺0.71 (0.57) ⫺4.13 (0.70) ⫺0.03 (0.37) ⫺0.73 (0.90) ⫺4.55 (0.73) 0.17 (0.43)
Wrist 1.34 (0.74) ⫺4.72 (0.69) 0.34 (0.21) 1.36 (0.77) ⫺4.72 (0.97) 0.09 (0.40)
Hand release (HR)
Shoulder ⫺0.13 (0.19) ⫺0.51# (0.35) 0.00 (0.11) ⫺0.14 (0.16) ⫺0.03# (0.24) 0.02 (0.06)
Elbow 0.04 (0.34) ⫺1.26* (1.02) 0.72# (0.20) ⫺0.18 (0.41) ⫺0.13* (0.63) 0.25# (0.41)
Wrist ⫺2.05 (0.48) ⫺0.61* (1.25) ⫺0.43* (0.38) ⫺2.52 (0.74) 0.53* (0.45) ⫺0.79* (0.20)
Maximum elbow height (MEH)
Shoulder 0.39 (0.17) ⫺0.11 (0.18) 0.01 (0.16) 0.22 (0.20) 0.04 (0.29) 0.09 (0.14)
Elbow 0.73 (0.26) ⫺0.04 (0.06) ⫺0.09 (0.18) 0.47 (0.63) 0.03 (0.06) ⫺0.10 (0.28)
Wrist 1.56 (0.62) ⫺1.32 (0.65) 0.29 (0.27) 1.20 (0.99) ⫺1.01 (1.37) 0.43 (0.84)
Standard deviations in parentheses.
Positive value indicates anterior, upward, or medial direction.
Significant difference between techniques (* P ⬍ 0.05 or # P ⬍ 0.01).

differences in arm positions at HC and HR and joint ROM
between the two techniques may have implications for the
stress placed on upper extremity joints, the results do not
provide sufficient information for determining the advan-
tages of one technique over another in terms of injury
prevention.
FIGURE 5—Average normalized EMG levels during different phases
of a stroke cycle for different muscles. Significant differences were
found between the conventional and para-backhand techniques (*).
The error bars indicate standard deviations.
482 Official Journal of the American College of Sports Medicine
Locations of the hand relative to the wheel cen-
ter. The significantly smaller release angle found in the
CVT (Table 6) indicates that the CVT subjects broke contact
with the pushrim earlier than the PBT subjects. Because the
push angle is determined by both the contact and release
angles, the significant difference in release angle between
the two techniques explains the significant difference in the
push angle. It is worth nothing that, despite the significantly
greater push angle found in the PBT, no significant differ-
ence in the angular speed of the wheel during the push phase
was observed between the two techniques (Table 6).
The contact angles exhibited by our subjects (Table 6)
indicate that the pull-push driving motion (7) was not ob-
served in this study. In a pull-push motion, the initial contact
is made behind the top dead center (TDC; Fig. 2) (i.e., a
negative contact angle) of the pushrim and the pulling
(elbow flexion) occurs in the early push phase when the
hand passes over the TDC in the forward direction. Because
the contact angle tends to increase with increasing speed
(13), the relatively large contact angles obtained in this
study are probably related to the high speeds attained by our
subjects. The large contact angles may also be due to the
exaggerated forward lean trunk position adopted by our
subjects (Table 4).
Segment angular speeds and joint velocities. In
addition to the other kinematic parameters, the segment
angular speed and joint velocity data further illustrate the
differences in movement characteristics at HR between the
two techniques. It is apparent that most of the differences
are related to the early hand release (i.e., shorter push time
and smaller release angle) in the CVT (Table 5). For the
CVT, the trunk and arms were still moving downward at
relatively high speeds at HR as compared with the PBT. On
the other hand, the relatively high forearm angular speed at
HR suggests that the PBT emphasizes elbow extension
when the wrist passes the bottom dead center of the wheel
at the end of the push phase. The PBT allows the athlete to
apply force to the pushrim for a greater distance when
compared with the CVT. The disadvantage is the shorter
recovery time for muscles that are active during the push
phase.
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APPENDIX. Maximum effort isometric contraction trials.
Joint Motion
Wrist flexion Upper arm next to the trunk, forearm horizontal and supinated, and wrist neutral. Resistance applied downward against the hand.
Wrist extension Same as wrist flexion except pronated forearm.
Elbow flexion Same as wrist flexion. Resistance applied downward against the wrist.
Elbow extension Same as wrist extension. Resistance applied upward against the wrist.
Shoulder flexion and abduction Arm straight and pointing forward and sideward; 45° from the horizontal. Resistance applied downward against the elbow.
Shoulder extension and abduction Straight arm pointing backward and sideward; 45° from the horizontal. Resistance applied downward against the elbow.
Shoulder extension Arm straight hyperextended approximately 45° to the vertical. Resistance applied downward against the elbow.
Shoulder horizontal adduction Upper arm horizontal and midway between anterior and lateral directions, and forearm vertical upward. Resistance applied
outward against the elbow.
Muscle Activation
Judging from the SD values of different EMG parameters
(Fig. 5), it is evident that large variations in muscle activa-
tion patterns existed in each technique group. In other
words, the same pushing movement can be achieved by
different combinations of muscle activation. The large SD
values probably contribute to the fact that there was only
one significant difference between the two techniques found
among all EMG parameters.
Previous studies reported that the BBR was most active
toward the end of the recovery phase and at the beginning of
the push phase (7,12). Mâsse et al. (7) suggested that the
elbow flexion was responsible for pulling the pushrim for-
ward during the early push phase. However, such pulling
action was not observed in the kinematic analysis (positive
contact angles, Table 5). Consequently, low BBR activity
was recorded at HC in this study. The differences may due
to the difference in testing protocol—submaximal effort
pushing was used in previous studies (7,12).
The activation patterns of the AMD and PMD observed in
this study are different from the deltoid activity reported in
the literature (7,13). For example, the relatively low AMD
and high PMD activity during the push phase were not
observed in previous studies. The differences may be related
to the exaggerated forward lean trunk position adopted by
our subjects (Table 4).
The high EMG activity of PCM and UTR during the
recovery phase (Fig. 5) demonstrates the important roles of
these two muscles in moving the upper arm up and down
during the recovery phase. The significantly higher UTR
activity during the ascending recovery phase found in the
CVT is likely related to the “flicking” motion at HR often
found in the CVT.
Limitations. There are several possible sources of error
in the kinematic measurements obtained in this study. In
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