The Paralympic Games are the pinnacle of sport for many athletes with a disability. A potential issue for many\r\nwheelchair athletes is how to train hard to maximise performance while also reducing the risk of injuries,\r\nparticularly to the shoulder due to the accumulation of stress placed on this joint during activities of daily living,\r\ntraining and competition. The overall purpose of this narrative review was to use the constraints-led approach of\r\ndynamical systems theory to examine how various constraints acting upon the wheelchair-user interface may alter\r\nhand rim wheelchair performance during sporting activities, and to a lesser extent, their injury risk. As we found no\r\nstudies involving Paralympic athletes that have directly utilised the dynamical systems approach to interpret their\r\ndata, we have used this approach to select some potential constraints and discussed how they may alter\r\nwheelchair performance and/or injury risk. Organism constraints examined included player classifications,\r\nwheelchair setup, training and intrinsic injury risk factors. Task constraints examined the influence of velocity and\r\ntypes of locomotion (court sports vs racing) in wheelchair propulsion, while environmental constraints focused on\r\nforces that tend to oppose motion such as friction and surface inclination. Finally, the ecological validity of the\r\nresearch studies assessing wheelchair propulsion was critiqued prior to recommendations for practice and future\r\nresearch being given.
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