Dataset Information

Shoulder pain and cycle to cycle kinematic spatial variability during recovery phase in manual wheelchair users: a pilot investigation.

ABSTRACT:

Unlabelled

Wheelchair propulsion plays a significant role in the development of shoulder pain in manual wheelchair users (MWU). However wheelchair propulsion metrics related to shoulder pain are not clearly understood. This investigation examined intra-individual kinematic spatial variability during semi-circular wheelchair propulsion as a function of shoulder pain in MWU. Data from 10 experienced adult MWU with spinal cord injury (5 with shoulder pain; 5 without shoulder pain) were analyzed in this study. Participants propelled their own wheelchairs on a dynamometer at 3 distinct speeds (self-selected, 0.7 m/s, 1.1 m/s) for 3 minutes at each speed. Motion capture data of the upper limbs were recorded. Intra-individual kinematic spatial variability of the steady state wrist motion during the recovery phase was determined using principal component analysis (PCA). The kinematic spatial variability was calculated at every 10% intervals (i.e at 11 interval points, from 0% to 100%) along the wrist recovery path.

Results

Overall, spatial variability was found to be highest at the start and end of the recovery phase and lowest during the middle of the recovery path. Individuals with shoulder pain displayed significantly higher kinematic spatial variability than individuals without shoulder pain at the start (at 10% interval) of the recovery phase (p<.004).

Conclusions

Analysis of intra-individual kinematic spatial variability during the recovery phase of manual wheelchair propulsion distinguished between those with and without shoulder pain. Variability analysis of wheelchair propulsion may offer a new approach to monitor the development and rehabilitation of shoulder pain.

SUBMITTER: Jayaraman C

PROVIDER: S-EPMC3948626 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Publications

Shoulder pain and cycle to cycle kinematic spatial variability during recovery phase in manual wheelchair users: a pilot investigation.

Jayaraman Chandrasekaran C Moon Yaejin Y Rice Ian M IM Hsiao Wecksler Elizabeth T ET Beck Carolyn L CL Sosnoff Jacob J JJ

PloS one 20140310 3

<h4>Unlabelled</h4>Wheelchair propulsion plays a significant role in the development of shoulder pain in manual wheelchair users (MWU). However wheelchair propulsion metrics related to shoulder pain are not clearly understood. This investigation examined intra-individual kinematic spatial variability during semi-circular wheelchair propulsion as a function of shoulder pain in MWU. Data from 10 experienced adult MWU with spinal cord injury (5 with shoulder pain; 5 without shoulder pain) were anal ...[more]

PMID: 24614232

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Project description:To test the effectiveness of a high-dose home exercise/telerehabilitation program for manual wheelchair users who have a spinal cord injury (SCI) by determining whether the intervention would reduce pain and increase function, as we hypothesized.A pre-post trial with outcomes measured at 3 time points: baseline, postintervention (12wk), and follow-up (>24 wk).Subjects performed an exercise program at their homes using telerehabilitation for therapist monitoring of technique and exercise advancement. Baseline and postintervention data were collected at a motion analysis laboratory in a tertiary medical center.A convenience sample of manual wheelchair users (N=16, 3 women; average age, 41y; average time in a wheelchair, 16y) with shoulder pain (average pain duration, 9y) and mechanical impingement signs on physical examination.A 12-week home exercise program of rotator cuff and scapular stabilization exercises was given to each participant. The program included a high dose of 3 sets of 30 repetitions, 3 times weekly, and regular physical therapist supervision via videoconferencing.Primary outcomes of pain and function were measured with the Wheelchair User's Shoulder Pain Index (WUSPI), Disabilities of Arm, Shoulder, and Hand (DASH) Index, and Shoulder Rating Questionnaire (SRQ). Secondary outcomes of strength were measured with isometric strength tests of scapulothoracic and glenohumeral muscles, and a static fatigue test of the lower trapezius.Pain was reduced and function improved after the intervention. There was a significant main effect for pain and function between the 3 time points based on the Friedman signed-ranked test, WUSPI (?(2)2=5.10, P=.014), DASH Index (?(2)2=5.41, P=.012), and SRQ (?(2)2=23.71, P?.001). Wilcoxon signed-rank tests demonstrated that isometric strength measurements of the serratus anterior and scapular retractors increased after the exercise intervention ([t=2.42, P=.04] and [t=4.67, P=.003], respectively). Muscle impulse produced by the lower trapezius during a fatigue task also improved (t=2.2, P=.02). No differences were measured in isometric strength for the lower trapezius, glenohumeral rotators, and abductors between the baseline and 12-week time points.A high-dose scapular stabilizer and rotator cuff strengthening program using telerehabilitation for supervision holds promise for shoulder pain treatment in manual wheelchair users with SCI. Additional work is needed to determine the effectiveness compared with other interventions, as well as the potential for earlier intervention to prevent development of shoulder pain.

Project description:BackgroundMost individuals with spinal cord injury who use manual wheelchairs experience shoulder pain related to wheelchair use, potentially in part from mechanical impingement of soft tissue structures within the subacromial space. There is evidence suggesting that scapula and humerus motion during certain wheelchair tasks occurs in directions that may reduce the subacromial space, but it hasn't been thoroughly characterized in this context.MethodsShoulder motion was imaged and quantified during scapular plane elevation with/without handheld load, propulsion with/without added resistance, sideways lean, and weight-relief raise in ten manual wheelchair users with spinal cord injury using biplane fluoroscopy and computed tomography. For each position, minimum distance between rotator cuff tendon insertions (infraspinatus, subscapularis, supraspinatus) and the coracoacromial arch was determined. Tendon thickness was measured with ultrasound, and impingement risk scores were defined for each task based on frequency and amount of tendon compression.FindingsPeriods of impingement were identified during scapular plane elevation and propulsion but not during pressure reliefs in most participants. There was a significant effect of activity on impingement risk scores (P < 0.0001), with greatest impingement risk during scapular plane elevation followed by propulsion. Impingement risk scores were not significantly different between scapular plane elevation loading conditions (P = 0.202) or propulsion resistances (P = 0.223). The infraspinatus and supraspinatus tendons were both susceptible to impingement during scapular plane elevation (by acromion), whereas the supraspinatus was most susceptible during propulsion (by acromion and coracoacromial ligament).InterpretationThe occurrence of mechanical impingement during certain manual wheelchair tasks, even without increased load/resistance, demonstrates the importance of kinematics inherent to a task as a determinant of impingement. Frequency of and technique used to complete daily tasks should be carefully considered to reduce impingement risk, which may help preserve shoulder health long-term.

Dataset Information

Shoulder pain and cycle to cycle kinematic spatial variability during recovery phase in manual wheelchair users: a pilot investigation.

Unlabelled

Results

Conclusions

Publications

Shoulder pain and cycle to cycle kinematic spatial variability during recovery phase in manual wheelchair users: a pilot investigation.

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