Spectrum and patterns of shoulder pathology on MRI in symptomatic elite wheelchair basketball athletes.

BACKGROUND: Wheelchair basketball (WCB) is a popular para-sport adapted for athletes with physical disabilities. Shoulder injuries are commonly reported among WCB athletes. However, the understanding of the specific patterns and characteristics of shoulder injuries in WCB players is currently limited, and there is a lack of comprehensive literature available on this subject. OBJECTIVES: To investigate the spectrum of pathologies observed in elite wheelchair basketball (WCB) athletes referred for MRI evaluation of symptomatic injuries of the shoulder. METHODS: Retrospective review of consecutive elite WCB athletes referred for MRI evaluation of symptomatic shoulder injury. Demographic, clinical, and functional data including international wheelchair basketball federation (IWBF) classification of each athlete were collected. A total of 28 MRI studies were reviewed. Excluding MRI examinations of the same shoulder, 18 study cases were assessed for pathology of the rotator cuff (RC), labrum, long-head of biceps tendon, glenohumeral and acromioclavicular joints, and osseous lesions of the humerus or glenoid. Correlations between clinical-demographic features and MRI findings were statistically evaluated. RESULTS: Supraspinatus tears were observed in 72.2%, infraspinatus tears in 50%, and subscapularis tears in 38.9% shoulders. Articular-sided partial tears frequently involved posterior supraspinatus (88.9%) and anterior infraspinatus (100%). Labral tears were seen in 38.9%, with involvement of the posterosuperior labrum in all tears. Hill-Sachs and osseous Bankart lesions (5.6%), and anterior-inferior labral tears (11.1%), were uncommon findings. Statistically significant correlations were observed of low IWBF point class and non-ambulatory athletes with subscapularis tendinosis (p = 0.015, p = 0.001) and tearing (p = 0.050, p = 0.013), and athletes with limited trunk control with subscapularis tendinosis (p = 0.013). CONCLUSIONS: RC tears are common in elite WCB athletes with pattern of RC and labral tearing suggesting internal (superior-posterior) impingement as a contributory pathoetiologic mechanism. Non-ambulatory, low IWBF point class athletes, as well as those with limited trunk control have a statistically significant increase in subscapularis tendon pathology on MRI.

Intelligent systems for sitting posture monitoring and anomaly detection: an overview.

The number of people who need to use wheelchair for proper mobility is increasing. The integration of technology into these devices enables the simultaneous and objective assessment of posture, while also facilitating the concurrent monitoring of the functional status of wheelchair users. In this way, both the health personnel and the user can be provided with relevant information for the recovery process. This information can be used to carry out an early adaptation of the rehabilitation of patients, thus allowing to prevent further musculoskeletal problems, as well as risk situations such as ulcers or falls. Thus, a higher quality of life is promoted in affected individuals. As a result, this paper presents an orderly and organized analysis of the existing postural diagnosis systems for detecting sitting anomalies in the literature. This analysis can be divided into two parts that compose such postural diagnosis: on the one hand, the monitoring devices necessary for the collection of postural data and, on the other hand, the techniques used for anomaly detection. These anomaly detection techniques will be explained under two different approaches: the traditional generalized approach followed to date by most works, where anomalies are treated as incorrect postures, and a new individualized approach treating anomalies as changes with respect to the normal sitting pattern. In this way, the advantages, limitations and opportunities of the different techniques are analyzed. The main contribution of this overview paper is to synthesize and organize information, identify trends, and provide a comprehensive understanding of sitting posture diagnosis systems, offering researchers an accessible resource for navigating the current state of knowledge of this particular field.

Evaluation of power wheelchair driving performance in simulator compared to driving in real-life situations: the SIMADAPT (simulator ADAPT) project-a pilot study.

OBJECTIVE: The objective of this study was to evaluate users' driving performances with a Power Wheelchair (PWC) driving simulator in comparison to the same driving task in real conditions with a standard power wheelchair. METHODS: Three driving circuits of progressive difficulty levels (C1, C2, C3) that were elaborated to assess the driving performances with PWC in indoor situations, were used in this study. These circuits have been modeled in a 3D Virtual Environment to replicate the three driving task scenarios in Virtual Reality (VR). Users were asked to complete the three circuits with respect to two testing conditions during three successive sessions, i.e. in VR and on a real circuit (R). During each session, users completed the two conditions. Driving performances were evaluated using the number of collisions and time to complete the circuit. In addition, driving ability by Wheelchair Skill Test (WST) and mental load were assessed in both conditions. Cybersickness, user satisfaction and sense of presence were measured in VR. The conditions R and VR were randomized. RESULTS: Thirty-one participants with neurological disorders and expert wheelchair drivers were included in the study. The driving performances between VR and R conditions were statistically different for the C3 circuit but were not statistically different for the two easiest circuits C1 and C2. The results of the WST was not statistically different in C1, C2 and C3. The mental load was higher in VR than in R condition. The general sense of presence was reported as acceptable (mean value of 4.6 out of 6) for all the participants, and the cybersickness was reported as acceptable (SSQ mean value of 4.25 on the three circuits in VR condition). CONCLUSION: Driving performances were statistically different in the most complicated circuit C3 with an increased number of collisions in VR, but were not statistically different for the two easiest circuits C1 and C2 in R and VR conditions. In addition, there were no significant adverse effects such as cybersickness. The results show the value of the simulator for driving training applications. Still, the mental load was higher in VR than in R condition, thus mitigating the potential for use with people with cognitive disorders. Further studies should be conducted to assess the quality of skill transfer for novice drivers from the simulator to the real world. Trial registration Ethical approval n ∘ 2019-A001306-51 from Comité de Protection des Personnes Sud Mediterranée IV. Trial registered the 19/11/2019 on ClinicalTrials.gov in ID: NCT04171973.

Towards an accurate rolling resistance: Estimating intra-cycle load distribution between front and rear wheels during wheelchair propulsion from inertial sensors.

Accurate assessment of rolling resistance is important for wheelchair propulsion analyses. However, the commonly used drag and deceleration tests are reported to underestimate rolling resistance up to 6% due to the (neglected) influence of trunk motion. The first aim of this study was to investigate the accuracy of using trunk and wheelchair kinematics to predict the intra-cyclical load distribution, more particularly front wheel loading, during hand-rim wheelchair propulsion. Secondly, the study compared the accuracy of rolling resistance determined from the predicted load distribution with the accuracy of drag test-based rolling resistance. Twenty-five able-bodied participants performed hand-rim wheelchair propulsion on a large motor-driven treadmill. During the treadmill sessions, front wheel load was assessed with load pins to determine the load distribution between the front and rear wheels. Accordingly, a machine learning model was trained to predict front wheel load from kinematic data. Based on two inertial sensors (attached to the trunk and wheelchair) and the machine learning model, front wheel load was predicted with a mean absolute error (MAE) of 3.8% (or 1.8 kg). Rolling resistance determined from the predicted load distribution (MAE: 0.9%, mean error (ME): 0.1%) was more accurate than drag test-based rolling resistance (MAE: 2.5%, ME: -1.3%).

The Push Forward in Rehabilitation: Validation of a Machine Learning Method for Detection of Wheelchair Propulsion Type.

Within rehabilitation, there is a great need for a simple method to monitor wheelchair use, especially whether it is active or passive. For this purpose, an existing measurement technique was extended with a method for detecting self- or attendant-pushed wheelchair propulsion. The aim of this study was to validate this new detection method by comparison with manual annotation of wheelchair use. Twenty-four amputation and stroke patients completed a semi-structured course of active and passive wheelchair use. Based on a machine learning approach, a method was developed that detected the type of movement. The machine learning method was trained based on the data of a single-wheel sensor as well as a setup using an additional sensor on the frame. The method showed high accuracy (F1 = 0.886, frame and wheel sensor) even if only a single wheel sensor was used (F1 = 0.827). The developed and validated measurement method is ideally suited to easily determine wheelchair use and the corresponding activity level of patients in rehabilitation.

Transformable Quadruped Wheelchairs Capable of Autonomous Stair Ascent and Descent.

Despite advancements in creating barrier-free environments, many buildings still have stairs, making accessibility a significant concern for wheelchair users, the majority of whom check for accessibility information before venturing out. This paper focuses on developing a transformable quadruped wheelchair to address the mobility challenges posed by stairs and steps for wheelchair users. The wheelchair, inspired by the Unitree B2 quadruped robot, combines wheels for flat surfaces and robotic legs for navigating stairs and is equipped with advanced sensors and force detectors to interact with its surroundings effectively. This research utilized reinforcement learning, specifically curriculum learning, to teach the wheelchair stair-climbing skills, with progressively increasing complexity in a simulated environment crafted in the Unity game engine. The experiments demonstrated high success rates in both stair ascent and descent, showcasing the wheelchair's potential in overcoming mobility barriers. However, the current model faces limitations in tackling various stair types, like spiral staircases, and requires further enhancements in safety and stability, particularly in the descending phase. The project illustrates a significant step towards enhancing mobility for wheelchair users, aiming to broaden their access to diverse environments. Continued improvements and testing are essential to ensure the wheelchair's adaptability and safety across different terrains and situations, underlining the ongoing commitment to technological innovation in aiding individuals with mobility impairments.

Design and Characterization of a Powered Wheelchair Autonomous Guidance System.

The current technological revolution driven by advances in machine learning has motivated a wide range of applications aiming to improve our quality of life. Representative of such applications are autonomous and semiautonomous Powered Wheelchairs (PWs), where the focus is on providing a degree of autonomy to the wheelchair user as a matter of guidance and interaction with the environment. Based on these perspectives, the focus of the current research has been on the design of lightweight systems that provide the necessary accuracy in the navigation system while enabling an embedded implementation. This motivated us to develop a real-time measurement methodology that relies on a monocular RGB camera to detect the caregiver's feet based on a deep learning method, followed by the distance measurement of the caregiver from the PW. An important contribution of this article is the metrological characterization of the proposed methodology in comparison with measurements made with dedicated depth cameras. Our results show that despite shifting from 3D imaging to 2D imaging, we can still obtain comparable metrological performances in distance estimation as compared with Light Detection and Ranging (LiDAR) or even improved compared with stereo cameras. In particular, we obtained comparable instrument classes with LiDAR and stereo cameras, with measurement uncertainties within a magnitude of 10 cm. This is further complemented by the significant reduction in data volume and object detection complexity, thus facilitating its deployment, primarily due to the reduced complexity of initial calibration, positioning, and deployment compared with three-dimensional segmentation algorithms.

Sitting Pressure Measurements in Wheelchair Users-Can the Effects of Daily Relief Activities Be Depicted?

Seat pressure measurements in wheelchair users have been available for some time; however, repeated measurements from a commercially available pressure mat over 90 min did not differ in the pressure-loaded measurement area or the coordinates of the center of pressure, even in participants who were able to reposition themselves in the wheelchair. The question therefore arises: to what extent are there other parameters that reflect the activity of wheelchair users with the pressure mat? To investigate this, a commercial pressure mat (BodiTrak®) was used to perform the measurements of pressure of 33 adult wheelchair-dependent people with spinal cord injury after 30 and 90 min sitting on the cushion. In addition to the standard output of the pressure mat, graph-based surface analyses (calculation of the area of maximum pressure, calculation of the pressure-loaded measurement area, and pressure-area ratio) was performed retrospectively using Python 3.7. The analysis of the measurements after 30 and 90 min was performed by distinguishing the participants between those who could actively change their position (N = 24) and those who could not (N = 9). The parameters of the pressure mat and the graph-based analyses remained unchanged for active participants. In participants who were unable to actively change their position, the area of maximum pressure and the pressure-area ratio (ratio of maximum pressure area and total pressure-loaded area) increased. Significant differences between minutes 30 and 90 are only found for the pressure-area ratio. Thus, when measuring the seat pressure of wheelchair users, the pressure-area ratio should be taken into account as it reflects the daily relief activities of wheelchair users.

Urban Pedestrian Routes' Accessibility Assessment Using Geographic Information System Processing and Deep Learning-Based Object Detection.

The need to establish safe, accessible, and inclusive pedestrian routes is considered one of the European Union's main priorities. We have developed a method of assessing pedestrian mobility in the surroundings of urban public buildings to evaluate the level of accessibility and inclusion, especially for people with reduced mobility. In the first stage of assessment, artificial intelligence algorithms were used to identify pedestrian crossings and the precise geographical location was determined by deep learning-based object detection with satellite or aerial orthoimagery. In the second stage, Geographic Information System techniques were used to create network models. This approach enabled the verification of the level of accessibility for wheelchair users in the selected study area and the identification of the most suitable route for wheelchair transit between two points of interest. The data obtained were verified using inertial sensors to corroborate the horizontal continuity of the routes. The study findings are of direct benefit to the users of these routes and are also valuable for the entities responsible for ensuring and maintaining the accessibility of pedestrian routes.

Driving Assistance System with Obstacle Avoidance for Electric Wheelchairs.

A system has been developed to convert manual wheelchairs into electric wheelchairs, providing assistance to users through the implemented algorithm, which ensures safe driving and obstacle avoidance. While manual wheelchairs are typically controlled indoors based on user preferences, they do not guarantee safe driving in areas outside the user's field of vision. The proposed model utilizes the dynamic window approach specifically designed for wheelchair use, allowing for obstacle avoidance. This method evaluates potential movements within a defined velocity space to calculate the optimal path, providing seamless and safe driving assistance in real time. This innovative approach enhances user assistance and safety by integrating state-of-the-art algorithms developed using the dynamic window approach alongside advanced sensor technology. With the assistance of LiDAR sensors, the system perceives the wheelchair's surroundings, generating real-time speed values within the algorithm framework to ensure secure driving. The model's ability to adapt to indoor environments and its robust performance in real-world scenarios underscore its potential for widespread application. This study has undergone various tests, conclusively proving that the system aids users in avoidance obstacles and ensures safe driving. These tests demonstrate significant improvements in maneuverability and user safety, highlighting a noteworthy advancement in assistive technology for individuals with limited mobility.

A Brain-Controlled and User-Centered Intelligent Wheelchair: A Feasibility Study.

Recently, due to physical aging, diseases, accidents, and other factors, the population with lower limb disabilities has been increasing, and there is consequently a growing demand for wheelchair products. Modern product design tends to be more intelligent and multi-functional than in the past, with the popularization of intelligent concepts. This supports the design of a new, fully functional, intelligent wheelchair that can assist people with lower limb disabilities in their day-to-day life. Based on the UCD (user-centered design) concept, this study focused on the needs of people with lower limb disabilities. Accordingly, the demand for different functions of intelligent wheelchair products was studied through a questionnaire survey, interview survey, literature review, expert consultation, etc., and the function and appearance of the intelligent wheelchair were then defined. A brain-machine interface system was developed for controlling the motion of the intelligent wheelchair, catering to the needs of disabled individuals. Furthermore, ergonomics theory was used as a guide to determine the size of the intelligent wheelchair seat, and eventually, a new intelligent wheelchair with the features of climbing stairs, posture adjustment, seat elevation, easy interaction, etc., was developed. This paper provides a reference for the design upgrade of the subsequently developed intelligent wheelchair products.

Inertial Measurement Unit and Heart Rate Monitoring to Assess Cardiovascular Fitness of Manual Wheelchair Users during the Six-Minute Push Test.

Manual wheelchair users (MWUs) are prone to a sedentary life that can negatively affect their physical and cardiovascular health, making regular assessment important to identify appropriate interventions and lifestyle modifications. One mean of assessing MWUs' physical health is the 6 min push test (6MPT), where the user propels themselves as far as they can in six minutes. However, reliance on observer input introduces subjectivity, while limited quantitative data inhibit comprehensive assessment. Incorporating sensors into the 6MPT can address these limitations. Here, ten MWUs performed the 6MPT with additional sensors: two inertial measurement units (IMUs)-one on the wheelchair and one on the wrist together with a heart rate wristwatch. The conventional measurements of distance and laps were recorded by the observer, and the IMU data were used to calculate laps, distance, speed, and cadence. The results demonstrated that the IMU can provide the metrics of the traditional 6MPT with strong significant correlations between calculated laps and observer lap counts (r = 0.947, p < 0.001) and distances (r = 0.970, p < 0.001). Moreover, heart rate during the final minute was significantly correlated with calculated distance (r = 0.762, p = 0.017). Enhanced 6MPT assessment can provide objective, quantitative, and comprehensive data for clinicians to effectively inform interventions in rehabilitation.

Using high-resolution imaging to study the impact of the Kalogon wheelchair cushion on blood flow in the gluteal area.

AIM OF THE STUDY: This study investigated how the air-bladder offloading mode of the Orbiter by Kalogon wheelchair cushion (Orbiter) affected blood flow in the gluteal region of non-disabled subjects. The hypothesis was that the cushion's offloading mode would improve blood flow, resulting in reduced reactive hyperemia when compared to the static setting, or Loaded Control (LC). Furthermore, the study proposed a technique using a high-resolution image laser speckle contrast system to measure blood flow in the gluteal area. METHODS: Two procedures were carried out, one with the participant sitting on a cushion in LC, and the second, the cushion was set to offloading mode. Blood flow was measured through data imaging after each procedure. Three trials were performed, starting and ending in different cushion bladders. Customized algorithms were used to select regions of interest on the images for calculations. The Wilcoxon Signed-Rank Test was conducted to compare the offloads and loaded control values of each region of interest. Results were considered significant at α = 0.05. RESULTS: Ten healthy, non-disabled adults participated in the study, seven females and three males. There were no significant differences among the participants. However, results showed that seven subjects tended to decrease reactive hyperemia in the offload sequence of trial when the last two bladders offloaded were the sacrum followed by the right ischial tuberosity. CONCLUSIONS: The high-resolution imager showed that the Orbiter Offloads helped reduce reactive hyperemia in seven subjects, potentially improving blood flow. More research is necessary to comprehend the mechanisms of these effects fully.

"Now We Can Speak": Wheelchair Sport Participation in Areas of Armed Conflict.

This study sought to understand the lived experiences of wheelchair basketball athletes from low- and middle-income countries of recent or current armed conflict and the meaning that they ascribed to their participation. Wheelchair basketball athletes (N = 108) from eight national teams participated in semistructured focus-group interviews. Study data were analyzed thematically using an interpretive descriptive approach. Three themes were developed: "I can do anything I want; not only basketball," self-concept changes through sport participation; "Now they see me as a respectable person," societal belonging through sport; and "I have motivated other disabled people," influence on nonparticipating disabled persons. The findings indicated that participation in wheelchair sports may help disabled persons see themselves as capable individuals on the court and in aspects of daily living, perhaps even peer role models for other disabled persons in their communities and countries.

Respiratory Muscle Training in Para-Athletes: A Systematic Review on the Training Protocols and Effects on Reported Outcomes.

CONTEXT AND OBJECTIVES: Respiratory muscle training (RMT) is considered an effective tool to improve cardiorespiratory limitations in athletes. The goals of this systematic review were to explore the role of RMT and its implementation within sport rehabilitation programs in para-athletes. EVIDENCE ACQUISITION: Several databases were searched until January 2024. Eligible studies were independently reviewed by 2 reviewers. Quality assessment was made using the PEDro scale and version 2 of the Cochrane Risk-of-Bias Tool for Randomized Trials. Eight studies (a total of 108 participants) were selected for the analysis. EVIDENCE SYNTHESIS: Five studies preferred using resistive loading, while 2 studies used normocapnic hyperpnea, and 1 study used threshold inspiratory muscle training. Respiratory functions (respiratory muscle strength and endurance, spirometry measures) and exercise performance were assessed as the main outcomes. Significant increases in respiratory muscle strength were reported in 5 studies. Two studies observed improvement in respiratory muscle endurance and 3 studies reported increased exercise capacity. CONCLUSIONS: This review suggests that although RMT can enhance respiratory muscle strength and endurance, it should not be considered the primary method for boosting the exercise performance of para-athletes. Additional research is necessary to explore the impact of various RMT techniques on different outcomes from the perspective of sport rehabilitation in para-athletes.

The effect of wheelchair cushion properties on the microclimate at the cushion-user interface: A systematic review and meta-analysis.

INTRODUCTION: Pressure injuries are a preventable yet highly prevalent health concern. Wheelchair cushion prescription can have significant implications for wheelchair users' risk of pressure injury development, which can impact functional abilities and quality of life. The efficacy of a wheelchair cushion to redistribute pressure has been well-researched, but the efficacy to manage the microclimate is less clear, particularly in warm-hot environments. The aim of this study was to systematically review studies examining the effect of wheelchair cushions on temperature, moisture and thermal perception to determine which cushions are superior to improve these responses. METHOD: A systematic review with meta-analyses of randomised cross-over and randomised control trials of wheelchair cushion interventions on measures of temperature, moisture, and thermal perception was conducted. RESULTS: Eight studies were identified that met the eligibility criteria and six meta-analyses were conducted. Pooled analyses identified a significantly lower temperature on foam-gel cushions compared to air cushions (MD = 0.80, 95% CI: 0.31, 1.29; p = 0.002) and a significantly lower temperature on foam-gel cushions compared to foam cushions (SMD = 0.76, 95%CI; 0.45, 1.06; p < 0.00001). Pooled analyses also demonstrated significantly lower relative humidity (i.e., moisture) on foam cushions compared to foam-gel cushions (p = 0.02). Differences in thermal perception were inconclusive due to limited data found. CONCLUSION: It is clear that not one cushion is ideal in managing all aspects of microclimate, as foam-gel cushions were the superior cushion to manage temperature and foam cushions were the superior cushion to manage moisture. This article provides occupational therapists and other health professionals with evidence-based information to assist with wheelchair cushion prescription that minimises the temperature and moisture accumulation, and associated risk of pressure injury for wheelchair users.

[Structural Design and Analysis of Portable Intelligent Wheelchair for Knee Rehabilitation].

Objective: In order to address the issues of inconvenience, high medical costs, and lack of universality associated with traditional knee rehabilitation equipment, a portable intelligent wheelchair for knee rehabilitation was designed in this study. Methods: Based on the analysis of the knee joint's structure and rehabilitation mechanisms, an electric pushrod-driven rehabilitation institution was developed. A multi-functional module was designed with a modular approach, and the control of the wheelchair body and each functional module was implemented using an STM32 single-chip microcomputer. A three-dimensional model was established using SolidWorks software. In conjunction with Adams and Ansys simulation software, kinematic and static analyses were conducted on the knee joint rehabilitation institution and its core components. A prototype was constructed to verify the equipment's actual performance. Results: According to the prototype testing, the actual range of motion for the knee joint swing rod is 15.1°~88.9°, the angular speed of the swing rod ranges from -7.9 to 8.1°/s, the angular acceleration of the swing rod varies from -4.2 to 1.6°/s², the thrust range of the electric pushrod is -82.6 to 153.1 N, and the maximum displacement of the load pedal is approximately 1.7 mm, with the leg support exhibiting a maximum deformation of about 1.5 mm. Conclusion: The intelligent knee joint rehabilitation wheelchair meets the designed functions and its actual performance aligns with the design criteria, thus validating the rationality and feasibility of the structural design.

Kinematic analysis of preparation for transferring from wheelchair to bed.

This study aimed to clarify the kinematics, particularly of the shoulder and hip joints, during preparation for manual wheelchair-to-bed transfer (i.e. when flipping up the arm and foot supports). This cross-sectional study included 32 able-bodied individuals. The kinematics of the shoulder and hip joints when the arm and foot supports were flipped up of manual wheelchair, were evaluated using a markerless inertial sensor-based motion capture system. We found that flipping the arm support upwards involved a large amount of abduction, internal and external rotation, flexion, and extension at the shoulder joint, whereas flipping the foot support upwards involved a large amount of flexion at the hip joint. The findings suggest that it is necessary to consider the range of motion required to flip up the arm and foot supports of manual wheelchairs, particularly in those with limited shoulder and hip range of motion such as older people, neuromuscular disorders, and orthopedic disorders.

Trunk and glenohumeral joint adaptations to manual wheelchair propulsion over a cross-slope: An exploratory study.

BACKGROUND: Cross-slopes are often encountered by manual wheelchair users propelling within an urban setting. While propulsion over cross-slopes is more difficult than on level surfaces, little is known about how the users counter the downhill turning tendency of the wheelchair over cross-slopes. This study aimed to identify the adaptations of the manual wheelchair users to the presence of cross-slopes and examine how these might impact shoulder injury. METHODS: Nine manual wheelchair users propelled themselves across a cross-slope and over a level surface. The trunk and glenohumeral joint kinematics, as well as the handrim contact tangential force were compared between both conditions for the uphill and downhill limbs. FINDINGS: The uphill arm technique used to counter the downhill turning tendency varied greatly in terms of potential injury risk and efficiency between participants. Trunk flexion increased the turning tendency of the manual wheelchair, yet only one participant decreased his flexion when rolling over the cross-slope. Various potential pathomecanisms related to the trunk lateral flexion and the glenohumeral kinematics over a cross-slope were identified. INTERPRETATION: Both the uphill arm technique and trunk kinematics are important to propel over a cross-slope both efficiently and safely. Accordingly, tips about posture and kinematics are needed to teach this skill to manual wheelchair users. Additionally, as wheelchair positioning seems to influence the cross-slope skill, more research is needed to explore the impact of positioning devices (e.g., lateral supports) and wheelchair modifications (e.g., power assist wheels, handrim projections) on this skill.