Biomechanics of manual wheeled propulsion in children and adolescents with neuromuscular disorders: A scoping review.

Abstract

Manual wheelchair use supports independence and participation for children with neuromuscular disorders; however, pediatric propulsion biomechanics remain poorly defined. Clinical practice often relies on adult data despite developmental differences in growth, motor control, and endurance. A pediatric-specific synthesis is needed to inform wheelchair prescription, training, and shoulder preservation strategies. This scoping review aimed to map biomechanical outcomes, methods, and propulsion protocols in pediatric manual wheelchair users with neuromuscular disorders, while identifying clinical implications and research gaps. A scoping review following PRISMA-ScR guidelines was conducted using PubMed and Embase through August 2025. Eligible studies included individuals ≤18 years with neuromuscular conditions using manual or power-assist wheelchairs and reporting at least one biomechanical outcome. Data were extracted on study design, populations, measurement tools, propulsion tasks, and key findings. Methodological quality was also assessed. Seventeen studies met inclusion criteria, most involving pediatric-onset spinal cord injury, with fewer including spina bifida, cerebral palsy, muscular dystrophy, or Charcot-Marie-Tooth disease. Three domains emerged: (1) upper extremity mechanics: children experienced substantial shoulder loading (6-10% body weight), distinct kinematics, and high interindividual variability; (2) propulsion efficiency: smaller contact angles, higher cadences, and less mature stroke patterns were common, though brief training improved efficiency; and (3) physiologic cost: limited evidence indicated high metabolic demand, with VO₂ during the 6-Minute Push Test reaching 85-89% of VO₂peak in myelomeningocele. Pediatric propulsion is biomechanically demanding and developmentally distinct, emphasizing the need for pediatric-specific training and early shoulder-preservation strategies. Key research gaps include broader diagnostic representation, standardized protocols, seating-interface biomechanics, and longitudinal outcomes.