Marieke G.M. Kloosterman, Jaap H. Buurke, Wiebe de Vries, Lucas H.V. Van der Woude, Johan S. Rietman, Medical Engineering & Physics, Available online 22 August 2015, ISSN 1350-4533, http://dx.doi.org/10.1016/j.medengphy.2015.07.004.
According to the guidelines, in order to create a better balance between mechanical loading and the work-capacity of the shoulder complex during propulsion, power-assisted propulsion on a treadmill is effective in reducing the majority of the potential risk factors of shoulder injury. Therefore, the use of power-assisted wheelchairs might be indicated for subjects prone to developing overuse injuries due to hand-rim propulsion or subjects with difficulties driving a hand-rim wheelchair primarily due to lack of upper-extremity power.
Source: Effect of power-assisted hand-rim wheelchair propulsion on shoulder load in experienced wheelchair users: A pilot study with an instrumented wheelchair