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Walking and Wheelchair Energetics in Persons with Paraplegia

Ms. Cerny was a master's degree candidate at the University of Southern California, University Park, Los Angeles, CA, when this study was conducted. She is currently Assistant Professor, Physical Therapy Option, Health Science Department, California State University, Northridge, Northridge, CA 91330 (USA).
Dr. Waters is Chief of Medicine, Rehabilitation Engineering, and Chief of Surgery, Rancho Los Amigos Hospital, 7601 E Imperial Hwy, Downey, CA 90242.
Dr. Hislop is Professor and Chairman, Department of Physical Therapy, Rancho Los Amigos Center, University of Southern California, Los Angeles, CA 90007.
Dr. Perry is Director of Pathokinesiology Service, Rancho Los Amigos Hospital.

The energetics of walking with orthoses and wheelchair propulsion at free velocity were tested in 10 adults with low-level spinal cord injuries. Eight were subjects who customarily used wheelchairs as their primary mode of locomotion; the other two used orthoses and had discontinued use of their wheelchairs. All required bilateral knee-ankle-foot orthoses to walk. A third habitual walker also was tested during walking only. Patients walked or propelled their wheelchairs around a 60.5-meter outdoor cement track. Heart rate, respiratory rate, and step frequency were recorded and transmitted by radiotelemetry. Expired air was collected for gas analysis in a polyethylene bag during the activity after a three-minute warm-up. During wheelchair propulsion all subjects demonstrated physiological responses within normal limits. Walking was significantly more difficult to perform than wheelchair propulsion (p < .005). Subjects who customarily used orthoses walked at a mean velocity of 59 ± 5 m/min; those who primarily used wheelchairs had a mean walking velocity of 22 ± 13 m/min. Oxygen uptake per minute was similar for both groups. These data suggest that the wheelchair will be the primary mode of locomotion for persons with spinal cord injury who need two knee-ankle-foot orthoses to walk, unless they are willing to work under anaerobic conditions and can walk at a velocity of 54 m/min or better.

Key Words: Energy metabolism • Gait • Paraplegia • Wheelchairs

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				C. E Beekman, L. Miller-Porter, and M. Schoneberger Energy Cost of Propulsion in Standard and Ultralight Wheelchairs in People With Spinal Cord Injuries Physical Therapy, February 1, 1999; 79(2): 146 - 158. [Abstract] [Full Text] [PDF]