Biomechanicall Analysis of Class II Cerebra! Palsied Wheelchair Athletes

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1 ADAPTED PHYSICAL ACTIVITY QUARTERLY, 1990,7,52-61 Biomechanicall Analysis of Class II Cerebra! Palsied Wheelchair Athletes Ron Davis, Gale Gehlsen Ball State University Jerry D. Wilkerson Texas Woman's University This study quantitatively analyzed the backward propulsion technique used by elite Class 11 CP wheelchair athletes. Six subjects, 3 males and 3 females, were selected from the 1984 International Games for the Disabled. The subjects were filmed in a staged setting during a sprint start for the first three complete cycles. A digitizer interfaced to an Apple 11+ computer was employed to digitize the film data. A computer program sewed to reduce the data into linear and angular kinematic components. For the purposes of analysis, the foot propulsive movement cycles or thrust cycles were divided into the two movement phases of and. The results of the study indicated that the initial three movement cycles appeared to be characterized by longer than time, and wheelchair velocity appeared to be associated with phase displacement. The United States Cerebral Palsy Athletic Association (USCPAA) classifies athletes according to functional level. The classification system encompasses Classes I through Vm. A Class II athlete is characterized by severe to moderate quadriplegia, normally able to propel a wheelchair with the legs or propel a wheelchair very slowly with the arms if able. The Class II athlete is also characterized by poor functional strength and severe control problems in the upper extremities (Sherrill, Mushett, & Jones, 1988). Class 11 athletes propel their wheelchairs using their feet in either a forward pulling technique or a backward ing technique. Athletes who race using a pull technique are seated in the wheelchair facing the direction of motion. Athletes who race using a technique are seated in the wheelchair with their back to the direction of motion. Only athletes using a technique were employed in this study. The Class II athlete also utilizes one of two distinct racing wheelchair designs. As identified in this study, the Type I wheelchair has the main wheels in the lead direction of motion. The Type II wheelchair has the smaller wheels or casters in the lead direction of motion. Over the past decade, researchers (Hamilton, Ridgway, Morse, Hedrick, & Adrian, 1987; Higgs, 1984; Kling, 1981; Perry, 1980) in the area of disabled Request reprints from Ron Davis, Department of Physical Education, Ball State University, Rm 150 University Gym, Muncie, IN

2 Class II Cerebral Palsied Athletes 53 sports activity have helped to determine the biomechanical factors affecting wheelchair propulsion. However, the research has been limited to hand propulsion techniques and spinal cord injured athletes. There is no available literature focused on determining the biomechanical factors affecting the backward (foot) wheelchair propulsion technique (the technique). Therefore the purpose of this study was to describe the selected kinematic characteristics of the backward (foot) propulsion technique during a sprint start. The four selected kinematic dependent variables were (a) wheelchair velocity, (b) linear displacement characteristics of each movement phase, (c) temporal characteristics of each movement phase, and (d) range of movement characteristics of the trunk and thigh. The research questions addressed in this study were the following: 1. What was the average wheelchair velocity during the first three thrust cycles of the sprint start? 2. What percentage of the distance covered during the first three thrust cycles was covered during the and phases? 3. What percentage of the time taken for the first three cycles was spent during the and phases? 4. What was the range of movement of the trunk and thigh during the sprint start? Subjects Methods Approximately 41 countries participated in the 1984 International Games for the Disabled. There were 14 competitors in the Class II track competition. The winners of the male and female competition utilizing the backward technique in the 60-m and 200-m races, respectively, were selected as subjects. Six Class 11 elite athletes using the backward technique served as subjects (3 males and 3 females). The male subjects were the first, third, and fourth place finishers in the 60-m final event. The female subjects were the first, second, and fourth place finishers in the 200-m final event. All other winners used the pull technique, therefore these athletes did not qualify for this study. The subjects were given a full explanation of the research procedures and each signed a consent form in accordance with the policy of the American College of Sports Medicine. To further describe the subjects and assist in future study replication, the anthropometric characteristics such as sitting height, body mass, and upper and lower leg length were determined for each subject. Source of Data The sagittal plane of movement was filmed during three staged wheelchair sprint starts for each subject. Two bilaterally positioned Bell & Howell 16-mm cameras (50 and 54 fps) were placed m (45 ft) from the plane of motion. Bilateral camera placement was used in an attempt to avoid any obstructed camera view. The camera view proximal to the side used for the propulsive movement was selected for digitizing (i.e., left leg movement, left camera film digitized). Only one subject (Subject 1) propelled the wheelchair backward using an alternating pattern with both legs. Symmetry of movement was assumed for Subject 1

3 54 Davis, Gehlsen, and Wilkerson and should be identified as a limitation of the study. No procedures were used to determine whether one side of the athlete was affected more than the other by the cerebral palsy condition. Therefore the results for Subject 1 are reported as an average of the two sides. Both cameras began operating simultaneously at the starting signal. Each subject was verbally cued to perform a sprint start immediately after the cameras began filming. Data Reduction The film data were projected onto the digitizing table via a Lafayette motion analyzer. A Numonics 1224 digitizer interfaced to an Apple II-t computer was employed to digitize the film coordinate data. The film sampling rate for each subject for three thrust cycles was 18 Hz. A complete thrust cycle was defined as including a and, or glide, until the start of next phase. Cubic spline technique was used to smooth the digitized data. The computer program BIOMEK (Richards & Wilkerson, 1984) was used to reduce the data into linear and angular kinematic components. The average velocity (m-s-') for the first three cycles was calculated by dividing the center of mass displacement by the time to complete the three cycles. The body segments studied were the trunk, measured from the sternal notch to the greater trochanter; the thigh, measured from the greater trochanter to the lateral condyle of the knee; and the lower leg or shank, measured from the lateral condyle of the knee to the lateral malleolus at the ankle. The body segments studied were the trunk and the thigh. The trunk was measured from the sternal notch to the greater trochanter with the right horizontal in a counterclockwise direction (Figure 1). Positive values of the trunk angle Rgure 1 - Body segments and angles studied during the sprint start.

4 Class II Cerebral Palsied Athletes 55 indicate an increasing of the angle (extension) which occurred with backward trunk movement at the hip, whereas negative values are interpreted as decreasing of the angle or forward trunk movement at the hip. The thigh was measured from the greater trochanter to the lateral condyle of the knee with the right horizontal through the greater trochanter in a clockwise direction. This permitted the same negative and positive angle interpretation as those of the trunk. A positive value indicated extension and a negative value indicated flexion of the thigh at the hip. Results The anthropometric characteristics of the six subjects are described in Table 1. Two distinctly different wheelchair designs were used by the Class I1 athletes participating in this study (see Figure 2). Phase Analysis For the purposes of analysis, the foot propulsive movement cycles or thrust cycles were divided into the two movement phases of and. Figure 3 illustrates a general description of the thrust cycle and is not depictive of any one athlete. The phase began with the first foot-to-ground contact and was characterized by the knee moving from flexion to extension. The phase began with the foot-to-ground release and ended with the next foot-to-ground contact. The phase was characterized by the knee moving from extension to flexion. Table 1 Description of Elite Male and Female Class II Cerebral Palsied Athletes Subject Gender Age SHb Massc TLd LLe CPf Yrs exp. Ath 2 Ath Ath 1 AthISp 1 Ath Note. amean calculated with left & right of Subject 1; bitting height in cm; Cmass in kg; dthigh length in cm; elower leg length in cm; ftype of cerebral palsy: Sp = spastic, Ath = athetoid.

5 Davis, Gehlsen, and Wilkerson - TYPE I ) TYPE I1 Figure 2 - Wheelchair designs for elite Class H CP athletes. Push Phase Recovery Phases gure 3 - Push and phases of Class I1 ep wheelchair athletes.

6 Class ll Cerebral Palsied Athletes 57 Velocity The average linear velocity values ranged from 1.53 to 1.00 mes-'. The fastest average velocity value for the initial three cycles of movement was obtained by Subject 1 using a two-footed technique. Subjects 4 and 5, using a single-footed technique, had the next highest average velocity values (see Table 2). Table 2 Wheelchair Velocity (m-s-') During Push and Recovery Variable Subjects Cycle I & rec. Cycle II & rec. Cycle Ill & rec. Velocity (tot. dis.ltot. time) Linear Displacement Table 3 illustrates the variables under consideration: and phases of wheelchair displacement and percent of linear displacement during the and phases. The Pearson product moment correlation between the phase displacement ( of three phases) and velocity was r=0.50, px.05. The corresponding phase and velocity correlation was r=0.92, p<0.01. The subjects tended to increase the phase linear displacement with each successive cycle of movement. Temporal Variables The time per cycle and percent of time the subjects devoted to the and phases for three thrust cycles is described in Table 4. The relationship between velocity and time devoted to the phases was r= -0.07, px.05, and the relationship between velocity and the time devoted to the phase was r=0.52, px.05.

7 Davis, Gehlsen, and Wilkerson Table 3 Displacement (m) Variables During Push and Recovery Variable Subjects Cycle I Cycle II Cycle Ill Ave. displace.lcycle Displacementnotal Push phase displacement1 dis. (%) Recovery phase displacementl dis. (%) Range of Motion Table 5 presents the trunk and thigh range of motion values during the first three and phases. Subject 1 was the only subject to use both legs for propulsion and Table 5 contains Subject 1's average for the right and left leg values. Although there was a great deal of variability of the trunk and thigh range of motion values both inter- and intrasubjects, the subjects tended to increase the hip angle (thigh and trunk movements at the hip joint) during the phase and decrease the hip angle during the phase. The two subjects with the highest average wheelchair velocity values also had the greater trunk range of motion values during the phase of the first cycle. The two subjects with the lowest average wheelchair velocity had the lower trunk range of motion values. Discussion This study was limited to the first three movement cycles and therefore can only generalize as to these initial sprinting movements. It may not be surprising that the results of this study indicated that the average wheelchair velocity (over the first three movement cycles) was related to the amount of linear displacement. r, what is surprising is that there appears to be a significant correlation wheelchair velocity and phase displacement, and no signifi-

8 Class II Cerebral Palsied Athletes 59 Table 4 Temporal Variables (in seconds) During Push and Recovery Phases Variable Subjects Cycle I Cycle II Cycle Ill Ave. timelcycle Time Push phase timel time (%) Recovery phase timel time (oh) Table 5 Trunk and Thigh ROM During Push and Recovery Subjects Variable Cycle Trunk Push ROM Thigh Push ROM Trunk Recovery ROM Thigh Recovery ROM

9 60 Davis, Gehlsen, and Wilkerson cant correlation between velocity and phase displacement. It is possible that the inertia characteristics related to initiating movement were responsible for the significant correlation value between wheelchair velocity and displacement values. Without exception, the subjects in this study spent more time in the phase during the three initial thrust cycles than in the phase (see Table 4). Higgs (1984) reported that hand propulsive wheelchair athletes (sprinters and distance) spent more time in the phase than in the propulsive () phase. Likewise, Ridgway, Pope, and Wilkerson (1988) reported that hand propulsive wheelchair athletes spent 33 % of time in propulsion and 67 % in, while Sanderson and Sommer (1985) reported 35 to 44% in. This apparent difference between the present study and those cited here was probably due to the stage of the race studied. Higgs' data were based on the middle to final stages of a race, as were the data of Ridgway et al. and Sanderson and Sommer. Kling (1981) studied the initial stages of a sprint start using hand propulsion and reported a range of 59 to 78 % of time in propulsion and 22 to 41 % of time in. In contrast, Perry (1980) found initial propulsion and phases of a sprint start using hand propulsion to be 41 and 59%, respectively. The results of the present study tend to support those reported by Kling (1981) and do not support the results reported by Perry (1980). A similar analogy to the present study's results can be found in the 100-m sprint. Atwater (1980), in an analysis of ablebodied Olympic sprinters, discovered that the athletes spent more time in the support phase than in the nonsupport phase during the first four strides from the starting line. The phenomenon found here, longer initial phase movements, is that of impulse. One way to increase velocity is to apply a force over a longer period of time (impulse). Two different wheelchair designs were used in this study. The relationship between velocity and the type of chair used was not investigated. However, further investigation as to the attributes of each chair may prove useful. Summary Although this study was primarily designed as a descriptive, case, or pilot study, the results tended to describe some possible relationships for further study. Analogous to running, the velocity of the backward (foot) propulsive wheelchair technique during the initial three movement cycles appears to be dependent on a longer time than time. References Atwater, A. (1980, October). Kinematic analysis of sprinting. In J. Cooper & B. Haven (Eds.), Biomechanics Symposium Proceedings (pp ). Indianapolis: Indiana State Board of Health. Hamilton, N., Ridgway, M., Morse, M., Hedrick, B., & Adrian, M. (1987, October). Comparison of sprint and distance wheelchair racing stroke kinematics. Paper presented at the 16th National Conference of Physical Activity for the Exceptional Individual, Fresno, CA. Higgs, C. (1984). Propulsion of racing wheelchairs. In C. Sherrill (Ed.), Sport and disabled athletes. The 1984 Olympic Scienti3c Congress proceedings (Vol. 9) (pp ). Champaign, IL: Human Kinetics.

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