A hypothesis: Self-propulsion in a wheelchair early after stroke might not be harmful

Abstract

Background: There is often strong clinical resistance to patients self-propelling a wheelchair post stroke as this is believed to produce immediate increases in abnormal posture and movement. Research to support this viewpoint is limited. Objective: To begin investigation of the immediate effects of self-propulsion on symmetrical sitting. Design: Replicated single-case studies ABABA. Setting: Movement analysis laboratory. Subjects: Four patients, a maximum of eight weeks post stroke and six age-matched healthy volunteers. Interventions: Subjects sat in the wheelchair during the A phases and self-propelled forwards during the B phases. The Manchester Active Position Seat (consists of 68 force transducers which transmit data at 10 Hz) measured the magnitude of peak force and the position of peak force on both sides of the seat. The mean symmetry index and standard deviation for each study phase were calculated and graphed for each subject. Interpretation was by visual inspection. Results: Only one stroke patient and one volunteer increased asymmetry of magnitude of peak force following the two periods of self-propulsion. Only one of the stroke patients increased asymmetry of position of peak force following self-propulsion compared with three of the healthy volunteers. Conclusions: These results raise the hypothesis that self-propulsion early post stroke might not produce immediate detrimental effects on seated symmetry. © 2003, Sage Publications. All rights reserved.