Due to lower limb paralysis people with SCI rely heavily on their upper extremities (UEs) for performing activities of daily living (ADL) of which wheelchair transfers lists as one of the ADL’s that are particularly taxing on the UEs. Preservation of UE function is extremely important to maintain independence and quality of life amongst people with Spinal Cord Injury. Although the Paralyzed Veterans of America developed Clinical Practice Guidelines to preserve UE function, limited research/recommendations are available for optimal transfer strategies that reduce loading on UE joints. Specific aims of this dissertation were to 1) Describe biomechanical strategies for preferred methods of transferring amongst persons with paraplegia and tetraplegia (Chapter 2), 2) Determine how taught transfer techniques and self-selected transferring reduce mechanical loading at the UE (Chapter 3), 3) Investigate how upper limb strength and balance impact loading at the UE joints during transfers (Chapter 4). 20 participants took part in the study, only 18 (17 male and 1 female) could execute the taught techniques. The group consisted of 12 persons with paraplegia (6 with complete & 6 with incomplete injury) and 6 with tetraplegia (all with incomplete injury). A custom transfer measurement system was used to capture kinetic and kinematic measures of the UEs and feet while participants performed wheelchair transfers. Participants performed self-selected transfers & three transfer techniques that varied on leading hand placement and trunk flexion. Functional measures recorded included: Strength, balance, anthropometrics and pain scores. Comparison of mechanical loading between the group with paraplegia and tetraplegia shed light on potential risk of injuries that may occur for each individual group. Taught technique comparison pointed towards a tradeoff, among force and moment components, at the leading and trailing arms, influenced by leading hand placement compared to amount of trunk flexion. Primarily a modified trunk upright technique was employed, trunk remained upright and hand placed close to the body, as preferred method of transferring. Impact of functional measures on transfer kinetics showed that transfer strategy may override functional capacity. Findings of this study will assist in refining clinical practice guidelines on safe level sitting pivot transfer strategies
