Physiological evaluation of a newly designed lever mechanism for wheelchairs.

Lever-propelled wheelchairs have been described as more efficient and less physically demanding than hand-rim-propelled wheelchairs. To evaluate a newly designed lever mechanism (MARC) in both one- and two-arm use, a series of wheelchair exercise tests were performed on a motor-driven treadmill. Eight able-bodied male subjects performed a standard exercise test in the prototype MARC, both in an asynchronic and a synchronic bimanual propelling mode and in an unilateral (left-sided) mode. Subsequently the subjects performed additional exercise tests in a conventional crank-to-rod lever mechanism with unilateral and bimanual propulsion and in a conventional hand rim wheelchair. Analysis of variance was used to study the effect of the different work modes upon power output and cardiorespiratory parameters statistically (p < 0.05). The MARC stood out well in comparison with the conventional lever design. The additional design features which are to be implemented (variable gearing, reverse gear) will make the MARC a useful wheelchair. One-arm wheelchair propulsion is a very strenuous form of locomotion, requiring careful consideration in terms of provision. Mechanical and ergonomic improvements are quite feasible in lever propulsion and may to a certain extent reduce this problem. To improve overall mobility of wheelchair-dependent subjects further, ergonomic and mechanical design improvements are very necessary in lever as well as hand-rim wheelchairs. A combined biomechanical and physiological research approach will help in the definition of design criteria and fitting guidelines.