Abstract

Manual wheelchair (WC) users with spinal cord injury (SCI) experience shoulder pain and fatigue associated with their increased reliance on the upper extremity during activities of daily living (Bayley et al. 1987, “The Weight-Bearing Shoulder. The Impingement Syndrome in Paraplegics,” J. Bone Jt. Surg. Am., 69(5), pp. 676–678). We hypothesized that the mechanical demand imposed on the shoulder, represented as resultant shoulder net joint moment (NJM) impulse, would be greater when initiating manual WC propulsion from a stationary position without momentum than when manually propelling at speed on a level sidewalk. Thirty manual WC users with paraplegia participated. Each individual initiated manual WC propulsion from a stationary position and propelled on a level sidewalk at their self-selected fast speed. Upper extremity kinematics and pushrim reaction forces (RFs) were measured and upper extremity joint kinetics were calculated and compared (α = 0.05) between cycle 1, initiated without momentum, and cycle 3 with momentum. Results indicate that multiple factors contributing to the mechanical demand imposed on the shoulder were significantly greater when manual WC propulsion was initiated without momentum than with momentum. Significant differences in resultant shoulder NJM impulse, push duration, orientation of RF relative to forearm, and resultant average shoulder NJMs during push were observed between momentum conditions. No significant differences in average resultant RF during push were found. These results indicate that mechanical loading of the shoulder during manual WC propulsion differs between momentum conditions; these differences in resultant shoulder NJM impulse during push need to be considered when assessing shoulder load exposure in stop-and-start activities.

References

References
1.
Bayley
,
J. C.
,
Cochran
,
T. P.
, and
Sledge
,
C. B.
,
1987
, “
The Weight-Bearing Shoulder. The Impingement Syndrome in Paraplegics
,”
J. Bone Jt. Surg. Am.
,
69
(
5
), pp.
676
678
.10.2106/00004623-198769050-00006
2.
Dalyan
,
M.
,
Cardenas
,
D. D.
, and
Gerard
,
B.
,
1999
, “
Upper Extremity Pain After Spinal Cord Injury
,”
Spinal Cord.
,
37
(
3
), pp.
191
195
.10.1038/sj.sc.3100802
3.
Curtis
,
K. A.
,
Drysdale
,
G. A.
,
Lanza
,
R. D.
,
Kolber
,
M.
,
Vitolo
,
R. S.
, and
West
,
R.
,
1999
, “
Shoulder Pain in Wheelchair Users With Tetraplegia and Paraplegia
,”
Arch. Phys. Med. Rehabil.
,
80
(
4
), pp.
453
457
.10.1016/S0003-9993(99)90285-X
4.
Gutierrez
,
D. D.
,
Thompson
,
L.
,
Kemp
,
B.
, and
Mulroy
,
S. J.
,
2007
, “
The Relationship of Shoulder Pain Intensity to Quality of Life, Physical Activity, and Community Participation in Persons With Paraplegia
,”
J. Spinal Cord. Med.
,
30
(
3
), pp.
251
255
.10.1080/10790268.2007.11753933
5.
Silfverskiold
,
J.
, and
Waters
,
R. L.
,
1991
, “
Shoulder Pain and Functional Disability in Spinal Cord Injury Patients
,”
Clin. Orthop. Relat. Res.
, pp.
141
145
.10.1097/00003086-199111000-00021
6.
Pentland
,
W. E.
, and
Twomey
,
L. T.
,
1994
, “
Upper Limb Function in Persons With Long Term Paraplegia and Implications for Independence: Part II
,”
Paraplegia
,
32
(
4
), pp.
219
224
.10.1038/sc.1994.41
7.
Jain
,
N. B.
,
Higgins
,
L. D.
,
Katz
,
J. N.
, and
Garshick
,
E.
,
2010
, “
Association of Shoulder Pain With the Use of Mobility Devices in Persons With Chronic Spinal Cord Injury
,”
Platinum Met. Rev.
,
2
(
10
), pp.
896
900
. 10.1016/j.pmrj.2010.05.004
8.
Munaretto
,
J. M.
,
McNitt-Gray
,
J. L.
,
Flashner
,
H.
, and
Requejo
,
P. S.
,
2013
, “
Reconfiguration of the Upper Extremity Relative to the Pushrim Affects Load Distribution during Wheelchair Propulsion
,”
Med. Eng. Phys.
,
35
(
8
), pp.
1141
1149
.10.1016/j.medengphy.2012.12.002
9.
National Spinal Cord Injury Statistical Center,
2019
, Facts and Figures at a Glance,
University of Alabama at Birmingham
,
Birmingham, AL
, accessed Nov. 23, 2019, https://www.nscisc.uab.edu/Public/Facts%20and%20Figures%202019%20-%20Final.pdf
10.
Sie
,
I. H.
,
Waters
,
R. L.
,
Adkins
,
R. H.
, and
Gellman
,
H.
,
1992
, “
Upper Extremity Pain in the Postrehabilitation Spinal Cord Injured Patient
,”
Arch. Phys. Med. Rehabil.
,
73
(
1
), pp.
44
48
.https://www.ncbi.nlm.nih.gov/pubmed/1729973
11.
Munaretto
,
J. M.
,
McNitt-Gray
,
J. L.
,
Flashner
,
H.
, and
Requejo
,
P. S.
,
2012
, “
Simulated Effect of Reaction Force Redirection on the Upper Extremity Mechanical Demand Imposed During Manual Wheelchair Propulsion
,”
Clin. Biomech. (Bristol, Avon)
,
27
(
3
), pp.
255
262
.10.1016/j.clinbiomech.2011.10.001
12.
Raina
,
S.
,
McNitt-Gray
,
J.
,
Mulroy
,
S.
, and
Requejo
,
P.
,
2012
, “
Effect of Choice of Recovery Patterns on Handrim Kinetics in Manual Wheelchair Users With Paraplegia and Tetraplegia
,”
J. Spinal Cord Med.
,
35
(
3
), pp.
148
155
.10.1179/2045772312Y.0000000013
13.
Koontz
,
A. M.
,
Cooper
,
R. A.
,
Boninger
,
M. L.
,
Yang
,
Y.
,
Impink
,
B. G.
, and
van der Woude
,
L. H. V.
,
2005
, “
A Kinetic Analysis of Manual Wheelchair Propulsion During Start-Up on Select Indoor and Outdoor Surfaces
,”
J. Rehabil. Res. Dev.
,
42
(
4
), p.
447
.10.1682/JRRD.2004.08.0106
14.
Russell
,
I. M.
,
Raina
,
S.
,
Requejo
,
P. S.
,
Wilcox
,
R. R.
,
Mulroy
,
S.
, and
McNitt-Gray
,
J. L.
,
2015
, “
Modifications in Wheelchair Propulsion Technique With Speed
,”
Front. Bioeng. Biotechnol.
,
3
, pp.
1
11
.10.3389/fbioe.2015.00171
15.
Papp
,
M.
,
Russell
,
I. M.
,
Requejo
,
P. S.
,
Furumasu
,
J.
, and
McNitt-Gray
,
J. L.
,
2018
, “Comparison of Reaction Force Generation Between Initiating Manual Wheelchair Propulsion at Self-Selected Fast Speeds,” World Congress of Biomechanics, Dublin, Ireland, July
8
12
.
16.
Rozendaal
,
L. A.
,
Veeger
,
H. E.
, and
van der Woude
,
L. H.
,
2003
, “
The Push Force Pattern in Manual Wheelchair Propulsion as a Balance Between Cost and Effect
,”
J Biomech.
,
36
(
2
), pp.
239
247
.10.1016/S0021-9290(02)00320-2
17.
Rozendaal
,
L. A.
, and
Veeger
,
D. E.
,
2000
, “
Force Direction in Manual Wheel Chair Propulsion: Balance Between Effect and Cost
,”
Clin. Biomech.
,
15
(
Suppl. 1
), pp.
S39
S41
.10.1016/S0268-0033(00)00059-0
18.
Rankin
,
J. W.
,
Kwarciak
,
A. M.
,
Mark Richter
,
W.
, and
Neptune
,
R. R.
,
2010
, “
The Influence of Altering Push Force Effectiveness on Upper Extremity Demand During Wheelchair Propulsion
,”
J. Biomech.
,
43
(
14
), pp.
2771
2779
.10.1016/j.jbiomech.2010.06.020
19.
Anon
,
2005
, “
Preservation of Upper Limb Function Following Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals
,”
J. Spinal Cord Med.
,
28
(
5
), pp.
434
470
.10.1080/10790268.2005.11753844
20.
van der Woude
,
L. H. V.
,
Bouw
,
A.
,
van Wegen
,
J.
,
van As
,
H.
,
Veeger
,
D.
, and
de Groot
,
S.
,
2009
, “
Seat Height: Effects on Submaximal Hand Rim Wheelchair Performance During Spinal Cord Injury Rehabilitation
,”
J. Rehabil. Med.
,
41
(
3
), pp.
143
149
.10.2340/16501977-0296
21.
De Leva
,
P.
,
1996
, “
Adjustments to Zatsiorsky-Seluyanov's Segment Inertia Parameters
,”
J. Biomech.
,
29
(
9
), pp.
1223
1230
.10.1016/0021-9290(95)00178-6
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