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Evaluation of Risk to the Lumbar Spine and Shoulders During Simulated Wheelchair Pushing

Weston, Eric Brian
http://orcid.org/0000-0002-6476-6342
http://rave.ohiolink.edu/etdc/view?acc_num=osu1480535340490527

Abstract Details

2016, Master of Science, Ohio State University, Industrial and Systems Engineering.
Health care workers and at-home caregivers have a high prevalence of occupational back and shoulder injuries related to attendant-propelled, or manual, wheelchair pushing. Wheelchair design affects posture, comfort, and biomechanical load for attendants. Thus, the objective of this study was to determine how simulated manual wheelchair pushing influences biomechanical loading to the lumbar spine and shoulders. 62 subjects performed simulated wheelchair pushing and turning in a laboratory. An overhead rig allowed for the setup of a simulated standard manual wheelchair. Linear or rotational resistance provided by an overhead braking system increased incrementally during each pushing or turning trial such that subjects ended each trial with a maximum voluntary exertion (MVE). A dynamic, electromyography-assisted biomechanical model was used to estimate spinal loads; moments at the shoulder joint, measures of external hand force, and net torque were also assessed. Finally, multiple linear regression techniques were employed to develop biomechanically-based wheelchair pushing guidelines relating resultant hand force or net torque to spinal load. The highest compressive spinal loads were found at the L3/L4 Inferior endplate, while peak lateral and anterior/posterior (A/P) shear loads were found at the L5/S1 Superior and L5/S1 Inferior endplates, respectively. Compressive and A/P shear spinal loads were significantly higher for male subjects (p<0.01) and were increased for wheelchair turning compared to straight wheelchair pushing (p<0.001). Peak shoulder moments were 62.7±18.0 Nm for males and 35.2±8.7 Nm for females. Maximum applied handle force during straight wheelchair pushing was 295±72 N for males and 206±53 N for females, while maximum torque applied for turns was 70±20 Nm and 51±19 Nm. For straight wheelchair push exertions, subjects applied hand force at a mean angle of 39.8±15.6 degrees relative to horizontal. Results from multiple linear regression calculated biomechanically-determined maximum acceptable resultant hand forces during wheelchair pushing. Biomechanically-determined values were 17-18% lower than the closest psychophysically determined comparisons. Attendant-propelled wheelchair pushing poses biomechanical risk to the lumbar spine in compression and A/P shear and the shoulders, particularly for males. Current psychophysically-determined maximum acceptable push forces are not protective enough of this biomechanical risk; rather, the biomechanically-based wheelchair pushing guidelines presented in this study should instead be implemented. Additionally, there is opportunity for improved manual wheelchair design, particularly in regard to wheelchair handle height; higher handle heights might result in a more horizontally applied hand force, which would decrease rolling resistance in manual wheelchair pushing. Finally, the results of the study should be considered with its limitations. The study population was young and inexperienced in patient handling, and subjects were not guaranteed to give a true MVE. Spinal loads were also interpreted relative to compression and shear thresholds that are neither sex nor age dependent, and shoulder moments were compared to maximum strength capabilities generated under controlled experimental conditions.
William Marras, PhD (Advisor)
Safdar Khan, MD (Committee Member)
44 p.
Engineering; Health Care Management; Industrial Engineering; Occupational Safety
wheelchairs; attendant propelled; caregiver; nursing; pushing; turning; patient handling; spinal loading; push guidelines

Recommended Citations

Citations

  • Weston, E. B. (2016). Evaluation of Risk to the Lumbar Spine and Shoulders During Simulated Wheelchair Pushing [Master's thesis, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1480535340490527

    APA Style (7th edition)

  • Weston, Eric. Evaluation of Risk to the Lumbar Spine and Shoulders During Simulated Wheelchair Pushing. 2016. Ohio State University, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1480535340490527.

    MLA Style (8th edition)

  • Weston, Eric. "Evaluation of Risk to the Lumbar Spine and Shoulders During Simulated Wheelchair Pushing." Master's thesis, Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1480535340490527

    Chicago Manual of Style (17th edition)

osu1480535340490527
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This open access ETD is published by The Ohio State University and OhioLINK.