Research Relating to the Ergonomics of Wheelchair Propulsion and the Natural-Fit Handrim

For a set of tables and references that form the basis for the Letter of Medical Necessity for using the Natural-Fit Handrim in the treatment of Carpal Tunnel Syndrome, please click here.

The research references listed below are grouped into five categories. Within each category, references are listed in alphabetical order by first author's last name. References that are relevant to two different areas are listed in both.

I. Wheelchair Propulsion and the Prevalence of Pain and Injury

These references provide evidence in support of the link between wheelchair propulsion biomechanics, or how someone propels his or her wheelchair, and the onset and prevalence of pain and injury among manual wheelchair users.

Baldwin MA, Boninger ML, Shimada SD, Cooper RA, O'Connor TJ, A Relationship Between Pushrim Kinetics and Median Nerve Dysfunction, Proceedings 21st Annual RESNA Conference, Minneapolis, Minnesota, pp. 378-380, 1998
Boninger ML, Cooper RA, Baldwin MA, Shimada SD, Koontz AM: Wheelchair Pushrim Kinetics, Weight and Median Nerve Function. Archives of Physical Medicine and Rehabilitation, 1999; 80:910-915.
Boninger ML, Souza A, Cooper RA, Fitzgerald SG, Koontz A, Fay B. Propulsion Patterns and Pushrim Biomechanics in Manual Wheelchair Propulsion. Archives of Physical Medicine & Rehabilitation, 2002, 83(5): 718-723.
Boninger ML, Dicianno BE, Cooper RA, Towers JD, Koontz AM, Souza AL, Shoulder Magnetic Resonance Imaging Abnormalities, Wheelchair Propulsion, and Gender, Archives of Physical Medicine and Rehabilitation, Vol. 84, No. 11, pp. 1615-1620, November 2003.
Boninger ML, Impink B, Cooper RA, Koontz AM, Relation Between Median and Ulnar Nerve Function and Wrist Kinematics During Wheelchair Propulsion, Archives of Physical Medicine and Rehabilitation, Vol. 85, No. 7, pp. 1141-1145, July 2004.
Fronczak KJ, Boninger ML, Souza AL, Cooper, RA. Wheelchair propulsion biomechanics, weight, and median nerve damage: A longitudinal study, Proceedings of the RESNA 2003 Annual Conference, Atlanta, GA, June 19-23, 2003.
Rice I, Impink B, Niyonkuru C, Boninger ML, Manual Wheelchair Stroke Characteristics During an Extended Period of Propulsion, Spinal Cord, pp. 413-417, Vol. 47, No. 5, May 2009.
Shimada SD, Boninger ML, Cooper RA, Baldwin MA, Relationship Between Wrist Biomechanics during Wheelchair Propulsion and Median Nerve Dysfunction, Proceedings 21st Annual RESNA conference, Minneapolis, Minnesota, pp. 128-130, 1998.

II. Handrim Design and Wheelchair Propulsion Style and Biomechanics

These references include surveys of propulsion style, direct comparisons of alternative handrim designs or coating alternatives, an examination of end-user preferences, and the impact of design changes on wheelchair propulsion biomechanics.

Baldwin MA, Boninger ML, Koontz AM, Fay BT, Cooper RA. Comparison of propulsion kinetics and forearm EMG between two wheelchair pushrim designs, Proceedings of the 1st Joint Meeting of BMES & EMBS, Atlanta, GA 1999; Abstract, 105.
Boninger ML, Souza A, Cooper RA, Fitzgerald SG, Koontz A, Fay B. Propulsion Patterns and Pushrim Biomechanics in Manual Wheelchair Propulsion. Archives of Physical Medicine & Rehabilitation, 2002, 83(5): 718-723.
Gaines RF, La WT. Users' responses to contoured wheelchair handrims. J Rehabil Res Dev 1986; 23(3):57-62.
Koontz AM, Boninger ML, Baldwin MA, Cooper RA, O'Connor TJ, Effect of Vinyl Coated Pushrims on Wheelchair Propulsion Kinetics, Proceedings 21st Annual RESNA Conference, Minneapolis, Minnesota, pp. 131-133, 1998.
Kwarciak AM, Sisto SA, Yarossi M, Price R, Komaroff E, Boninger ML, Redefining the Manual Wheelchair Stroke Cycle: Identification and Impact of Nonpropulsive Pushrim Contact, Archives of Physical Medicine and Rehabilitation, pp. 66-73, Vol. 90, No. 1, January 2009.
Perks BA, Mackintosh R, Stewart CP, Bardsley GI, A survey of marginal wheelchair users, J ehabil Res Dev 1994; 31(4):297-302.
Rice I, Impink B, Niyonkuru C, Boninger ML, Manual Wheelchair Stroke Characteristics During an Extended Period of Propulsion, Spinal Cord, pp. 413-417, Vol. 47, No. 5, May 2009.
Traut L, Schmauder M. Ergonomic design of the hand-machine-interface for wheelchairs. Proceedings from the Ergonomics of Manual Wheelchair Conference 1993;335-48.
van der Linden ML, Valent L, Veeger HE, van der Woude LH. The effect of wheelchair handrim tube diameter on propulsion efficiency and force application (tube diameter and efficiency in wheelchairs), IEEE Trans Rehab Engr 1996; 4(3):123-32.

III. Direct Comparisons between the Natural-Fit Handrim and Standard Handrims

These references include research that directly compares the Natural-Fit Handrim (or earlier prototypes) to a standard "round-tube" wheelchair handrim.

Dieruf, K., Ewer, L., Boninger, D.S. (2008). Factors related to improved symptoms and function with use of the Natural-Fit contoured wheelchair handrims, Journal of Spinal Cord Medicine, 31, 62-69.
Koontz, A.M., Yang, Y., Boninger, D.S., Kanaly, J., Cooper, R.A., Boninger, M.L., Dieruf, K., Ewer, L. (2006). Investigation of the Performance of an Ergonomic Handrim as a Pain-Relieving Intervention for Manual Wheelchair Users, Assistive Technology, 18, 123-143.
Boninger, DS., Dixon, M. Examination of the Effect of an Ergonomic Wheelchair Handrim on Upper Extremity Pain in Manual Wheelchair Users, Proceedings 28th Annual RESNA Conference, Atanta, GA, 2005.
Yang, Y, Koontz AM, Kanaly J., Boninger M., & Cooper R. Start-Up Propulsion Biomechanics Using a Prototype Ergonomic Pushrim, Proceedings 28th Annual RESNA Conference, Atanta, GA, 2005.

IV. General Prevalence of Upper Extremity Pain and Injury among Manual Wheelchair Users

These references provide general evidence of prevalence of pain and injury among manual wheelchair users, particularly with respect to hand, wrist, and shoulder injuries.

Aljure J, Eltorai I, Bradley WE, Lin JE, Johnson B: Carpal tunnel syndrome in paraplegic patients. PARAPLEGIA 1985;23:182-186.
Boninger ML, Towers JD, Cooper RA, Dicianno BE, Munin MC: Shoulder Imaging Abnormalities in Individuals with Paraplegia. J of Rehab R & D 2001; 38(4) 401-408.
Davidoff G, Werner R, Waring W: Compressive mononeuropathies of the upper extremity in chronic paraplegia. PARAPLEGIA 1991;29:17-24.
Escobedo EM, Hunter JC, Hollister MC, Patten RM, Goldstein B: MR imaging of rotator cuff tears in individuals with paraplegia. AJR 1997;168:919-923.
Gellman H, Chandler DR, Petrasek J, Sie I, Adkins R, Waters RL: Carpal tunnel syndrome in paraplegic patients. J Bone Joint Surg [Am] 1988;70:517-519.
Gellman H, Sie I, Waters RL: Late complications of the weight-bearing upper extremity in the paraplegic patient. Clinical Orthopaedics & Related Research 1988;233:132-135.
Pentland WE, Twomey LT: The weight-bearing upper extremity in women with long term paraplegia. PARAPLEGIA 1991;29:521-530.
Sie IH, Waters RL, Adkins RH, Gellman H: Upper extremity pain in the postrehabilitation spinal cord injured patient. Arch Phys Med Rehabil 1992;73:44-48.
Subbarao JV, Klopfstein J, Turpin R: Prevalence and impact of wrist and shoulder pain in patients with spinal cord injury. J Spinal Cord Med 1994;18:9-13.
Tun CG, Upton J: The paraplegic hand: Electrodiagnostic studies and clinical findings. J Hand Surg [Am] 1988;13:716-719.
Wylie EJ, Chakera TM: Degenerative joint abnormalities in patients with paraplegia of duration greater than 20 years. PARAPLEGIA 1988; 26:101-106.

V. The Consequences of Upper Extremity Pain and Injury among Manual Wheelchair Users

These references provide evidence of the "quality of life" consequences of secondary pain and injury among manual wheelchair users.

Curtis KA, Roach KE, Applegate EB, et al: Development of the Wheelchair User's Shoulder Pain Index (WUSPI). PARAPLEGIA 1995; 33:290-293.
Lundqvist C, Siosteen A, Blomstrand C, Lind B, Sullivan M: Spinal cord injuries. Clinical, functional, and emotional status. Spine 1991; 16:78-83.
Subbarao JV, Klopfstein J, Turpin R: Prevalence and impact of wrist and shoulder pain in patients with spinal cord injury. J Spinal Cord Med 1994; 18:9-13.