Le fauteuil roulant chez le blessé médullaire, facteur déterminant de l'insertion sociale. État des lieux et effets de la locomotion en dévers sur les astreintes physiologiques

Abstract : Introduction. Displacement capacities and possibilities in manual wheelchair (MWC) are strong determinants of social and occupational integration of MWC users. Objectives. Improve the knowledge of the strains involved by displacement in MWC through 2 studies; the first one to identify habits and difficulties of MWC users. The second one, induced by the results of the first one, has assessed the poorly known cardiac, energetic, muscular and subjective strains of the displacement of MWC users on a cross slope. Methods. The first study was a survey answered by 118 paraplegics habitual MWC users. The second one, a laboratory study conducted with 25 paraplegic men, includes 2 tests: a sub maximal arm-cranking test and a 300 m propulsion test with 8 conditions combining 4 cross slopes (0, 2, 8 et 12%) and 2 velocities (0,97 m.s-1 and a "comfortable" chosen one). Results. The first study shows an adverse environment, with many places unreachable without help and disturbances, like cross slope, which hinders users' displacements. The second study demonstrates the increases of cardiac, energetic, muscular and subjective strains with cross slope. Differencies between 0 and 2% cross slopes are low but quantified. Displacement on a 12% cross slope is very difficult. The balance of muscles activities is changing at 2% cross slope. The injury level makes deep changes in the displacements strategies and in as well perceived as measured strain levels. Discussion-Conclusion. Effects of cross slope are perceived for as low as 2% and onwards values. They are high and deleterious at 8%. This work allows to construct a model of cross slope strains which confirms that the regulatory 2% cross slope limit is well chosen because it allows most MWC users to move without help and remain active
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Benoît Pierret. Le fauteuil roulant chez le blessé médullaire, facteur déterminant de l'insertion sociale. État des lieux et effets de la locomotion en dévers sur les astreintes physiologiques. Médecine humaine et pathologie. Université de Lorraine, 2012. Français. ⟨NNT : 2012LORR0216⟩. ⟨tel-01749619⟩

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