A comparison of methods to compute the point of force application in handrim wheelchair propulsion: a technical note.

Several methods are available for computing the location of the point of force application (PFA) in manual wheelchair propulsion using kinetic data. We compared five different techniques for computing the PFA location in analysis of data from five wheelchair users propelling their own wheelchairs using their normal propulsion style. The effects of the assumptions used in the calculations on the resulting location of the PFA, handrim force and moment components, and mechanical efficiency (e) were quantified. When kinetic data were used to locate the PFA, the most consistent and stable results were obtained using the assumptions that components of the handrim moment about the anteriorly directed and vertically directed axes were negligible. Some assumptions led to unsolvable equations at points during the propulsion cycle, demonstrating that they were inappropriate. All PFA values calculated with kinetic data were unstable at the beginning and end of the propulsion phase. While differences exist due to individual technique, assuming handrim moment components about the anterior-posterior, vertical, and/or both axes resulted in the most representative results.

Active responses decrease impact forces at the hip and shoulder in falls to the side.

Active responses, such as using the arm to break the fall, may be an effective means of decreasing likelihood of injury in a fall and may help explain why only a small percentage of falls result in a fracture. We quantified the impact force at the hip and shoulder in falls to the side from a kneeling position under three conditions: (1) attempting to break the fall by using an arm; (2) falling with the body relaxed; and (3) falling with the body tensed. Subjects fell from a kneeling position onto a force platform array covered with foam padding and impact force data were recorded. The ground reaction force-time curve was generally bimodal due to sequential impacts of the hip and shoulder. Impact forces at the hip and shoulder were 12 and 16% less for the slap condition (p < 0.05) than for the tensed condition. The impact forces for the relaxed and tensed conditions were not significantly different, although impact forces tended to be less in the relaxed condition. We concluded that active responses reduce the impact forces experienced at the hip and shoulder in falls to the side. Decreased effectiveness of protective responses, due to increases in reaction time and decreases in strength with age, may help explain why so many hip fractures occur in the elderly but so few occur in younger people.