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Cordes CMA, Leonardis JM, Samet J, Schnorenberg AJ, England M, Mukherjee S, Vogel LC, Seitz AL, Slavens BA. Handrim kinetics and quantitative ultrasound parameters for assessment of subacromial impingement in wheelchair users with pediatric-onset spinal cord injury. Gait Posture 2024; 113:561-569. [PMID: 39182433 PMCID: PMC11388546 DOI: 10.1016/j.gaitpost.2024.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Most manual wheelchair users with pediatric-onset spinal cord injury (SCI) will experience shoulder pain or pathology at some point in their life. However, guidelines for preservation of the upper limb in children with SCI are limited. RESEARCH QUESTION What are the relationships between manual wheelchair handrim kinetics and quantitative ultrasound parameters related to subacromial impingement in individuals with pediatric-onset SCI? METHODS Subacromial impingement risk factors including supraspinatus tendon thickness (SST), acromiohumeral distance (AHD), and occupation ratio (OR; SST/AHD) were measured with ultrasound in 11 manual wheelchair users with pediatric-onset SCI. Handrim kinetics were acquired during the stroke cycle, including peak resultant force (FR), peak rate of rise of resultant force (ROR) and fractional effective force (FEF). Variability of handrim kinetics was computed using the coefficient of variation and linear regression was performed to assess correlations between handrim metrics and quantitative ultrasound parameters. RESULTS Peak resultant force significantly increased 1.4 % and variability of FEF significantly decreased 8.0 % for every 0.1 cm increase in AHD. FEF decreased 3.5 % for every 0.1 cm increase in SST. Variability of peak resultant force significantly increased 3.6 % and variability of peak ROR of resultant force significantly increased 7.3 % for every 0.1 cm increase in SST. FEF variability significantly decreased 11.6 % for every 0.1 cm increase in SST. Peak ROR significantly decreased 1.54 % with every 10 % increase in OR. FEF variability significantly decreased 1.5 % with every 10 % increase in OR. SIGNIFICANCE This is the first study to investigate relationships among handrim kinetics and shoulder structure in manual wheelchair users with pediatric-onset SCI. Associations were identified between subacromial impingement risk factors and magnitude and variability of wheelchair handrim kinetics. These results indicate the critical need to further explore the relationships among wheelchair handrim kinetics, shoulder joint dynamics, and shoulder pathology in manual wheelchair users with pediatric-onset SCI.
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Affiliation(s)
- Caleb M A Cordes
- University of Wisconsin-Milwaukee, Department of Rehabilitation Sciences and Technology, Milwaukee, WI 53211, USA; University of Wisconsin-Milwaukee, Department of Mechanical Engineering, Milwaukee, WI 53211, USA.
| | - Joshua M Leonardis
- University of Wisconsin-Milwaukee, Department of Rehabilitation Sciences and Technology, Milwaukee, WI 53211, USA; University of Illinois Urbana-Champaign, College of Applied Health Sciences, Urbana, IL 61801, USA; University of Illinois Urbana-Champaign, Beckman Institute for Advanced Science and Technology, Urbana, IL 61801, USA
| | - Jonathan Samet
- Ann and Robert H. Lurie Children's Hospital, Department of Medical Imaging, Chicago, IL 60611, USA; Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Alyssa J Schnorenberg
- University of Wisconsin-Milwaukee, Department of Mechanical Engineering, Milwaukee, WI 53211, USA
| | - Mark England
- Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Shubhra Mukherjee
- Shriners Children's Chicago, Chicago, IL 60707, USA; Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | | | - Amee L Seitz
- Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Brooke A Slavens
- University of Wisconsin-Milwaukee, Department of Rehabilitation Sciences and Technology, Milwaukee, WI 53211, USA; University of Wisconsin-Milwaukee, Department of Mechanical Engineering, Milwaukee, WI 53211, USA
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Leonardis JM, Schnorenberg AJ, Vogel LC, Harris GF, Slavens BA. Sex-Related Differences in Shoulder Complex Joint Dynamics Variability During Pediatric Manual Wheelchair Propulsion. J Appl Biomech 2024; 40:112-121. [PMID: 37984356 DOI: 10.1123/jab.2022-0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 09/08/2023] [Accepted: 10/13/2023] [Indexed: 11/22/2023]
Abstract
More than 80% of adult manual wheelchair users with spinal cord injuries will experience shoulder pain. Females and those with decreased shoulder dynamics variability are more likely to experience pain in adulthood. Sex-related differences in shoulder dynamics variability during pediatric manual wheelchair propulsion may influence the lifetime risk of pain. We evaluated the influence of sex on 3-dimensional shoulder complex joint dynamics variability in 25 (12 females and 13 males) pediatric manual wheelchair users with spinal cord injury. Within-subject variability was quantified using the coefficient of variation. Permutation tests evaluated sex-related differences in variability using an adjusted critical alpha of P = .001. No sex-related differences in sternoclavicular or acromioclavicular joint kinematics or glenohumeral joint dynamics variability were observed (all P ≥ .042). Variability in motion, forces, and moments are considered important components of healthy joint function, as reduced variability may increase the likelihood of repetitive strain injury and pain. While further work is needed to generalize our results to other manual wheelchair user populations across the life span, our findings suggest that sex does not influence joint dynamics variability in pediatric manual wheelchair users with spinal cord injury.
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Affiliation(s)
- Joshua M Leonardis
- Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Alyssa J Schnorenberg
- Department of Mechanical Engineering, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | - Gerald F Harris
- Shriners Children's, Chicago, IL, USA
- Department of Biomedical Engineering, Orthopaedic & Rehabilitation Center, Marquette University, Milwaukee, WI, USA
| | - Brooke A Slavens
- Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
- Department of Mechanical Engineering, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
- Shriners Children's, Chicago, IL, USA
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Braaksma J, Vegter RJK, Leving MT, van der Scheer JW, Tepper M, Woldring FAB, van der Woude LHV, Houdijk H, de Groot S. Handrim Wheelchair Propulsion Technique in Individuals With Spinal Cord Injury With and Without Shoulder Pain: A Cross-sectional Comparison. Am J Phys Med Rehabil 2023; 102:886-895. [PMID: 36917041 DOI: 10.1097/phm.0000000000002240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
OBJECTIVE The aim of this study was to compare handrim wheelchair propulsion technique between individuals with spinal cord injury with and without shoulder pain. DESIGN A cross-sectional study including 38 experienced handrim wheelchair users with spinal cord injury was conducted. Participants were divided into the "shoulder pain" ( n = 15) and "no-shoulder pain" ( n = 23) groups using the Local Musculoskeletal Discomfort scale. Kinetic and spatiotemporal aspects of handrim wheelchair propulsion during submaximal exercise on a motor-driven treadmill were analyzed. Data were collected using a measurement wheel instrumented with three-dimensional force sensors. RESULTS After correction for confounders (time since injury and body height), linear regression analyses showed that the pain group had a 0.30-sec (95% confidence interval, -0.5 to -0.1) shorter cycle time, 0.22-sec (95% confidence interval, -0.4 to -0.1) shorter recovery time, 15.6 degrees (95% confidence interval, -27.4 to -3.8) smaller contact angle, and 8% (95% confidence interval, -15 to 0) lower variability in work per push compared with the no-pain group. Other parameters did not differ between groups. CONCLUSIONS This study indicates that individuals with spinal cord injury who experience shoulder pain propel their handrim wheelchair kinematically differently from individuals with spinal cord injury without shoulder pain. This difference in propulsion technique might be a pain-avoiding mechanism aimed at decreasing shoulder range of motion.
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Affiliation(s)
- Jelmer Braaksma
- From the Centre for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (JB, RJKV, MTL, HH); The Healthcare Improvement Studies (THIS) Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (JWvdS); Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (MT, FABW, LHVvdW); Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom (LHVvdW); Amsterdam Rehabilitation Research Centre | Reade, Amsterdam, the Netherlands (SdG); and Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands (SdG)
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Wieczorek B, Kukla M, Warguła Ł, Giedrowicz M, Rybarczyk D. Evaluation of anti-rollback systems in manual wheelchairs: muscular activity and upper limb kinematics during propulsion. Sci Rep 2022; 12:19061. [PMID: 36351954 PMCID: PMC9646883 DOI: 10.1038/s41598-022-21806-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 10/04/2022] [Indexed: 11/11/2022] Open
Abstract
Self-propelling a wheelchair up a hill requires intense muscular effort and introduces the risk of the wheelchair rolling down. The purpose of this paper was to assess the user's muscular activity during ramp climbing. Tests were carried out on a group of 10 subjects who had to propel a wheelchair up a standardized wheelchair ramp. Basic parameters of upper limb kinematics were measured to determine the total push-rim rotation angle. This was 105.91° for a wheelchair with a stiff anti-rollback system, 99.39° for a wheelchair without an anti-rollback system and 98.18° for a wheelchair with a flexible anti-rollback system. The upper limb muscle effort was measured at 55 ± 19% for the wheelchair without an anti-rollback system, 59 ± 19% for the wheelchair with a stiff anti-rollback system and 70 ± 46% for the wheelchair with a flexible anti-rollback system. The conducted research showed an increase in muscle effort while using anti-rollback systems. In the case of push-rim rotation angle, no significant differences in the value of the rotation angle were found.
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Affiliation(s)
- Bartosz Wieczorek
- grid.6963.a0000 0001 0729 6922Faculty of Mechanical Engineering, Poznan University of Technology, Piotrowo 3 St., 424 BM, 61-139 Poznań, Poland
| | - Mateusz Kukla
- grid.6963.a0000 0001 0729 6922Faculty of Mechanical Engineering, Poznan University of Technology, Piotrowo 3 St., 424 BM, 61-139 Poznań, Poland
| | - Łukasz Warguła
- grid.6963.a0000 0001 0729 6922Faculty of Mechanical Engineering, Poznan University of Technology, Piotrowo 3 St., 424 BM, 61-139 Poznań, Poland
| | - Marcin Giedrowicz
- grid.6963.a0000 0001 0729 6922Faculty of Architecture, Poznan University of Technology, Poznań, Poland
| | - Dominik Rybarczyk
- grid.6963.a0000 0001 0729 6922Faculty of Mechanical Engineering, Poznan University of Technology, Piotrowo 3 St., 424 BM, 61-139 Poznań, Poland
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Skedros JG, Cronin JT, Finlinson ED, Langston TD, Adondakis MG. Manual wheelchair use leads to a series of failed shoulder replacements: A case report and literature review. Clin Case Rep 2022; 10:e06374. [PMID: 36188047 PMCID: PMC9508804 DOI: 10.1002/ccr3.6374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022] Open
Abstract
Manual wheelchair users place high stress on their shoulders. We describe a 69-year-old male who developed end-stage shoulder osteoarthritis from chronic manual wheelchair (MW) use. Three prosthetic total shoulder replacements failed, reflecting his refusal to transition to an electric wheelchair. MW use must be avoided in some of these patients.
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Affiliation(s)
- John G. Skedros
- Department of Orthopaedic SurgeryThe University of UtahSalt Lake CityUtahUSA
- Utah Orthopaedic SpecialistsSalt Lake CityUtahUSA
- Intermountain Medical CenterSalt Lake CityUtahUSA
| | | | | | - Tanner D. Langston
- Department of RadiologyWest Virginia UniversityMorgantownWest VirginiaUSA
| | - Micheal G. Adondakis
- Department of RadiologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
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Relationship Between Shoulder Pain and Joint Reaction Forces and Muscle Moments During 2 Speeds of Wheelchair Propulsion. J Appl Biomech 2022; 38:404-411. [DOI: 10.1123/jab.2022-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/31/2022] [Accepted: 08/29/2022] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to determine shoulder joint reaction forces and muscle moments during 2 speeds (1.3 and 2.2 m/s) of wheelchair propulsion and to investigate the relationship between joints reaction forces, muscle moments, and shoulder pain. The measurements were obtained from 20 manual wheelchair users. A JR3 6-channel load sensor (±1% error) and a Qualisys system were used to record 3-dimensional pushrim kinetics and kinematics. A 3-dimensional inverse dynamic model was generated to compute joint kinetics. The results demonstrated significant differences in shoulder joint forces and moments (P < .01) between the 2 speeds of wheelchair propulsion. The greatest peak shoulder joint forces during the drive phase were anterior directed (Fy, 184.69 N), and the greatest joint moment was the shoulder flexion direction (flexion moment, 35.79 N·m) at 2.2 m/s. All the shoulder joint reaction forces and flexion moment were significantly (P < .05) related to shoulder pain index. The forces combined in superior and anterior direction found at the shoulder joint may contribute to the compression of subacromial structure and predispose manual wheelchair users to potential rotator cuff impingement syndrome.
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Leonardis JM, Schnorenberg AJ, Vogel LC, Harris GF, Slavens BA. Biological Sex-Related Differences in Glenohumeral Dynamics Variability during Pediatric Manual Wheelchair Propulsion. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4619-4622. [PMID: 34892243 DOI: 10.1109/embc46164.2021.9630865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Shoulder pain and pathology are extremely common in adult manual wheelchair users with spinal cord injury (SCI). Within this population, biological sex and variability in shoulder joint dynamics have been shown to be important contributors to both shoulder pain and pathology. Sex-related differences in shoulder dynamics variability during pediatric manual wheelchair propulsion may influence a user's lifetime risk of shoulder pain and pathology. The purpose of this study was to assess the influence of biological sex on variability in three-dimensional (3-D) glenohumeral joint dynamics in pediatric manual wheelchair users with SCI. An inverse dynamics model computed 3-D glenohumeral joint angles, forces, and moments of 20 pediatric manual wheelchair users. Levene's tests assessed biological sex-related differences in variability. Females exhibited less variability in glenohumeral joint kinematics and forces, but greater variability in joint moments than males. Evaluation of glenohumeral joint dynamics with consideration for biological sex and variability strengthens our interpretation of the relationships among shoulder function, pain, and pathology in pediatric manual wheelchair users.Clinical Relevance- Female pediatric manual wheelchair users may be at an increased risk of shoulder repetitive strain injuries due to decreased glenohumeral joint motion and force variability during propulsion. This work establishes quantitative methods for determining the effects of biological sex on the variability of shoulder joint dynamics.
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Mashola MK, Korkie E, Mothabeng DJ. Pain and its impact on functioning and disability in manual wheelchair users with spinal cord injury: a protocol for a mixed-methods study. BMJ Open 2021; 11:e044152. [PMID: 33408217 PMCID: PMC7789463 DOI: 10.1136/bmjopen-2020-044152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/05/2020] [Accepted: 11/30/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Approximately 80% of people with spinal cord injury experience clinically significant chronic pain. Pain (whether musculoskeletal or neuropathic) is consistently rated as one of the most difficult problems to manage and negatively affects the individual's physical, psychological and social functioning and increases the risk of pain medication misuse and poor mental health. The aim of this study is to therefore determine the presence of pain and its impact on functioning and disability as well as to develop a framework for self-management of pain for South African manual wheelchair users with spinal cord injury. METHODS AND ANALYSIS Community-dwelling participants with spinal cord injury will be invited to participate in this three-phase study. Phase 1 will use a quantitative, correlational design to determine factors related to pain such as pectoralis minor length, scapular dyskinesis, wheelchair functioning, physical quality of life, community reintegration and pain medication misuse. Demographic determinants of pain such as age, gender, type of occupation, completeness of injury and neurological level of injury will also be investigated. Participants with pain identified in phase 1 will be invited to partake in a qualitative descriptive and contextually designed phase 2 to explore their lived experience of pain through in-depth interviews. The results of phases 1 and 2 will then be used with the assistance from experts to develop a framework for self-management of pain using a modified Delphi study. Data analysis will include descriptive and inferential statistics (quantitative data) and thematic content analysis (qualitative data). ETHICS AND DISSEMINATION Approval for this study is granted by the Faculty of Health Sciences Research Ethics Committee of the University of the Pretoria (approval number 125/2018). This study is registered with the South African National Health Research Database (reference GP201806005). This study's findings will be shared in academic conferences and published in scientific peer-reviewed journals.
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Affiliation(s)
- Mokgadi Kholofelo Mashola
- Department of Physiotherapy, School of Healthcare Sciences, University of Pretoria, Pretoria, South Africa
- Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elzette Korkie
- Department of Physiotherapy, School of Healthcare Sciences, University of Pretoria, Pretoria, South Africa
| | - Diphale Joyce Mothabeng
- Department of Physiotherapy, School of Healthcare Sciences, University of Pretoria, Pretoria, South Africa
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Briley SJ, Vegter RJ, Goosey-Tolfrey VL, Mason BS. Scapular kinematic variability during wheelchair propulsion is associated with shoulder pain in wheelchair users. J Biomech 2020; 113:110099. [DOI: 10.1016/j.jbiomech.2020.110099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/07/2020] [Accepted: 10/17/2020] [Indexed: 10/23/2022]
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Briley SJ, Vegter RJ, Tolfrey VL, Mason BS. Propulsion biomechanics do not differ between athletic and nonathletic manual wheelchair users in their daily wheelchairs. J Biomech 2020; 104:109725. [DOI: 10.1016/j.jbiomech.2020.109725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 11/25/2022]
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Predictors of shoulder pain in manual wheelchair users. Clin Biomech (Bristol, Avon) 2019; 65:1-12. [PMID: 30927682 PMCID: PMC6520124 DOI: 10.1016/j.clinbiomech.2019.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Manual wheelchair users rely on their upper limbs to provide independent mobility, which leads to high muscular demand on their upper extremities and often results in shoulder pain and injury. However, the specific causes of shoulder pain are unknown. Previous work has shown that decreased shoulder muscle strength is predictive of shoulder pain onset, and others have analyzed joint kinematics and kinetics, propulsion technique and intra-individual variability for their relation to shoulder pathology. The purpose of this study was to determine in a longitudinal setting whether there are specific biomechanical measures that predict shoulder pain development in manual wheelchair users. METHODS All participants were asymptomatic for shoulder pain and categorized into pain and no pain groups based on assessments at 18 and 36 months later. Shoulder strength, handrim and joint kinetics, kinematics, spatiotemporal measures, intra-individual standard deviations and coefficients of variation were evaluated as predictors of shoulder pain. FINDINGS Individuals who developed shoulder pain had weaker shoulder adductor muscles, higher positive shoulder joint work during recovery, and less trunk flexion than those who did not develop pain. In addition, relative intra-individual variability was a better predictor of shoulder pain than absolute variability, however future work is needed to determine when increased versus decreased variability is more favorable for preventing shoulder pain. INTERPRETATION These predictors may provide insight into how to improve rehabilitation training and outcomes for manual wheelchair users and ultimately decrease their likelihood of developing shoulder pain and injuries.
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Scarborough DM, Bassett AJ, Mayer LW, Berkson EM. Kinematic sequence patterns in the overhead baseball pitch. Sports Biomech 2018; 19:569-586. [DOI: 10.1080/14763141.2018.1503321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Donna Moxley Scarborough
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
- School of Rehabilitation Sciences, MGH Institute of Health Professions, Charlestown, MA, USA
| | - Ashley J. Bassett
- Harvard Combined Orthopaedic Residency, Harvard University, Boston, MA, USA
| | - Lucas W. Mayer
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Eric M. Berkson
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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Risikofaktoren für Rotatorenmanschettenrupturen bei Paraplegikern. DER ORTHOPADE 2018; 47:561-566. [DOI: 10.1007/s00132-018-3546-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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López-Pascual J, Page Á, Serra-Añó P. Movement Variability Increases With Shoulder Pain When Compensatory Strategies of the Upper Body Are Constrained. J Mot Behav 2017; 50:510-516. [PMID: 29028425 DOI: 10.1080/00222895.2017.1371109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This cross-sectional study analyzed the influence of chronic shoulder pain (CSP) on movement variability/kinematics during humeral elevation, with the trunk and elbow motions constrained to avoid compensatory strategies. For this purpose, 37 volunteers with CSP as the injured group (IG) and 58 participants with asymptomatic shoulders as the control group (CG) participated in the study. Maximum humeral elevation (Emax), maximum angular velocity (Velmax), variability of the maximum angle (CVEmax), functional variability (Func_var), and approximate entropy (ApEn) were calculated from the kinematic data. Patients' pain was measured on the visual analogue scale (VAS). Compared with the CG, the IG presented lower Emax and Velmax and higher variability (i.e., CVEmax, Func_var, and ApEn). Moderate correlations were achieved for the VAS score and the kinematic variables Emax, Velmax and variability of curve analysis, Func_varm, and ApEn. No significant correlation was found for CVEmax. In conclusion, CSP results in a decrease of angle and velocity and an increased shoulder movement variability when the neuromuscular system cannot use compensatory strategies to avoid painful positions.
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Affiliation(s)
- Juan López-Pascual
- a Instituto de Biomecánica de Valencia, Universitat Politècnica de València , Spain
| | - Álvaro Page
- b Departament Física Aplicada , Universitat Politècnica de València , Spain.,c Grupo de Tecnología Sanitaria del IBV, CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN) , Spain
| | - Pilar Serra-Añó
- d Departament de Fisioteràpia , Universitat de València , Spain
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Effects of Daily Physical Activity Level on Manual Wheelchair Propulsion Technique in Full-Time Manual Wheelchair Users During Steady-State Treadmill Propulsion. Arch Phys Med Rehabil 2017; 98:1374-1381. [DOI: 10.1016/j.apmr.2017.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/05/2017] [Accepted: 01/08/2017] [Indexed: 11/20/2022]
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MacGillivray MK, Lam T, Klimstra M, Zehr EP, Sawatzky BJ. Exploring the ecological validity and variability of a 10-min bout of wheeling. Disabil Rehabil Assist Technol 2017; 13:287-292. [PMID: 28485185 DOI: 10.1080/17483107.2017.1323965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the ecological validity of using able-bodied participants to perform a 10-min wheeling trial by (1) evaluating changes in biomechanics over the trial in manual wheelchair users and able-bodied participants naïve to wheeling and (2) describing differences in changes and variability between groups. MATERIALS AND METHODS Manual wheelchair users (n = 7, 2-27 years' experience) and able-bodied participants (n = 11) wheeled for 10 min. Kinetic and temporal variables were collected and averaged over each minute, while wheeling strategy (movement pattern) was categorized at minutes 1 and 10. RESULTS There was a main effect of time for push angle, and a main effect of group for average push angle, tangential force and total force. Manual wheelchair users used larger push angles and forces compared to able-bodied participants. Surprisingly, intercycle variability did not differ between groups. CONCLUSION Using able-bodied participants to represent manual wheelchair users performing a 10-min wheeling trial is not ecologically valid and caution should be used when interpreting push angle and forces applied to the pushrim. Considering that push angle was the only variable that demonstrated a main effect of time, long durations (e.g., 10 min) of wheeling may be appropriate for use in study designs acknowledging potential changes in wheeling strategy and push angle. Implications for Rehabilitation Some experienced wheelchair users and non-wheelchair users modify their movement pattern from an arc to a circular pattern within a 10-min wheeling trial. There are clear biomechanical differences in push angle and forces applied to the pushrim between wheelchair users with experience and able-bodied non-wheelchair users. Able-bodied participants who have no prior manual wheeling experience are no more variable than long-term wheelchair users. Variability may play an important role in wheelchair propulsion.
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Affiliation(s)
- Megan K MacGillivray
- a International Collaboration on Repair Discoveries , Vancouver , Canada.,b Rehabilitation Sciences, University of British Columbia , Vancouver , Canada
| | - Tania Lam
- a International Collaboration on Repair Discoveries , Vancouver , Canada.,c School of Kinesiology , University of British Columbia , Vancouver , Canada
| | - Marc Klimstra
- d School of Exercise Science, Physical and Health Education , University of Victoria , Victoria , Canada
| | - E Paul Zehr
- a International Collaboration on Repair Discoveries , Vancouver , Canada.,d School of Exercise Science, Physical and Health Education , University of Victoria , Victoria , Canada
| | - Bonita J Sawatzky
- a International Collaboration on Repair Discoveries , Vancouver , Canada.,e Department of Orthopedics , University of British Columbia , Vancouver , Canada
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Gauthier C, Grangeon M, Ananos L, Brosseau R, Gagnon DH. Quantifying cardiorespiratory responses resulting from speed and slope increments during motorized treadmill propulsion among manual wheelchair users. Ann Phys Rehabil Med 2017; 60:281-288. [PMID: 28410868 DOI: 10.1016/j.rehab.2017.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/15/2017] [Accepted: 02/21/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiorespiratory fitness assessment and training among manual wheelchair (MW) users are predominantly done with an arm-crank ergometer. However, arm-crank ergometer biomechanics differ substantially from MW propulsion biomechanics. This study aimed to quantify cardiorespiratory responses resulting from speed and slope increments during MW propulsion on a motorized treadmill and to calculate a predictive equation based on speed and slope for estimating peak oxygen uptake (VO2peak) in MW users. METHODS In total, 17 long-term MW users completed 12 MW propulsion periods (PP), each lasting 2min, on a motorized treadmill, in a random order. Each PP was separated by a 2-min rest. PPs were characterized by a combination of 3 speeds (0.6, 0.8 and 1.0m/s) and 4 slopes (0°, 2.7°, 3.6° and 4.8°). Six key cardiorespiratory outcome measures (VO2, heart rate, respiratory rate, minute ventilation and tidal volume) were recorded by using a gas-exchange analysis system. Rate of perceived exertion (RPE) was measured by using the modified 10-point Borg scale after each PP. RESULTS For the 14 participants who completed the test, cardiorespiratory responses increased in response to speed and/or slope increments, except those recorded between the 3.6o and 4.8o slope, for which most outcome measures were comparable. The RPE was positively associated with cardiorespiratory response (rs≥0.85). A VO2 predictive equation (R2=99.7%) based on speed and slope for each PP was computed. This equation informed the development of a future testing protocol to linearly increase VO2 via 1-min stages during treadmill MW propulsion. CONCLUSIONS Increasing speed and slope while propelling a MW on a motorized treadmill increases cardiorespiratory response along with RPE. RPE can be used to easily and accurately monitor cardiorespiratory responses during MW exercise. The VO2 can be predicted to some extent by speed and slope during MW propulsion. A testing protocol is proposed to assess cardiorespiratory fitness during motorized MW propulsion.
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Affiliation(s)
- Cindy Gauthier
- School of Rehabilitation, Université de Montréal, Montréal, QC, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Pathokinesiology Laboratory, Institut de réadaptation Gingras-Lindsay-de-Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Murielle Grangeon
- School of Rehabilitation, Université de Montréal, Montréal, QC, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Pathokinesiology Laboratory, Institut de réadaptation Gingras-Lindsay-de-Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Ludivine Ananos
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Pathokinesiology Laboratory, Institut de réadaptation Gingras-Lindsay-de-Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada; UFR-STAPS, University of Paris Ouest Nanterre Defense, Nanterre, France
| | - Rachel Brosseau
- School of Rehabilitation, Université de Montréal, Montréal, QC, Canada; Institut de cardiologie de Montréal, Montreal, QC, Canada
| | - Dany H Gagnon
- School of Rehabilitation, Université de Montréal, Montréal, QC, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Pathokinesiology Laboratory, Institut de réadaptation Gingras-Lindsay-de-Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada.
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Leving MT, Vegter RJK, de Groot S, van der Woude LHV. Effects of variable practice on the motor learning outcomes in manual wheelchair propulsion. J Neuroeng Rehabil 2016; 13:100. [PMID: 27881124 PMCID: PMC5120477 DOI: 10.1186/s12984-016-0209-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 11/11/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Handrim wheelchair propulsion is a cyclic skill that needs to be learned during rehabilitation. It has been suggested that more variability in propulsion technique benefits the motor learning process of wheelchair propulsion. The purpose of this study was to determine the influence of variable practice on the motor learning outcomes of wheelchair propulsion in able-bodied participants. Variable practice was introduced in the form of wheelchair basketball practice and wheelchair-skill practice. Motor learning was operationalized as improvements in mechanical efficiency and propulsion technique. METHODS Eleven Participants in the variable practice group and 12 participants in the control group performed an identical pre-test and a post-test. Pre- and post-test were performed in a wheelchair on a motor-driven treadmill (1.11 m/s) at a relative power output of 0.23 W/kg. Energy consumption and the propulsion technique variables with their respective coefficient of variation were calculated. Between the pre- and the post-test the variable practice group received 7 practice sessions. During the practice sessions participants performed one-hour of variable practice, consisting of five wheelchair-skill tasks and a 30 min wheelchair basketball game. The control group did not receive any practice between the pre- and the post-test. RESULTS Comparison of the pre- and the post-test showed that the variable practice group significantly improved the mechanical efficiency (4.5 ± 0.6% → 5.7 ± 0.7%) in contrast to the control group (4.5 ± 0.6% → 4.4 ± 0.5%) (group x time interaction effect p < 0.001).With regard to propulsion technique, both groups significantly reduced the push frequency and increased the contact angle of the hand with the handrim (within group, time effect). No significant group × time interaction effects were found for propulsion technique. With regard to propulsion variability, the variable practice group increased variability when compared to the control group (interaction effect p < 0.001). CONCLUSIONS Compared to a control, variable practice, resulted in an increase in mechanical efficiency and increased variability. Interestingly, the large relative improvement in mechanical efficiency was concomitant with only moderate improvements in the propulsion technique, which were similar in the control group, suggesting that other factors besides propulsion technique contributed to the lower energy expenditure.
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Affiliation(s)
- Marika T. Leving
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Riemer J. K. Vegter
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Sonja de Groot
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands
| | - Lucas H. V. van der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
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19
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Zukowski LA, Christou EA, Shechtman O, Hass CJ, Tillman MD. The Effect of Propulsion Style on Wrist Movement Variability During the Push Phase After a Bout of Fatiguing Propulsion. PM R 2016; 9:265-274. [PMID: 27390056 DOI: 10.1016/j.pmrj.2016.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/18/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Wheelchair propulsion has been linked to overuse injuries regardless of propulsion style. Many aspects of the arcing (ARC) and semicircular (SEMI) propulsion styles have been compared, but differences in intracycle movement variability, which have been linked to overuse injuries, have not been examined. OBJECTIVE To explore how ARC and SEMI affect changes in intracycle wrist movement variability after a fatiguing bout of propulsion. DESIGN Repeated measures crossover design. SETTING Wheelchair rollers and wheelchair fatigue course in a research laboratory. PARTICIPANTS Twenty healthy, nondisabled adult men without previous wheelchair experience. INTERVENTIONS Participants learned ARC and SEMI and used each to perform a wheelchair fatigue protocol. MAIN OUTCOME MEASUREMENTS Thirty seconds of propulsion on rollers were recorded by motion-capture cameras before and after a fatigue protocol for each propulsion style on 2 testing days. Angular wrist orientations (flexion/extension and radial/ulnar deviation) and linear wrist trajectories (mediolateral direction) were computed, and intracycle movement variability was calculated as standard deviations of the detrended and filtered values during the push phase beginning and end. Paired samples t tests were used to compare ARC and SEMI based on the percent changes from pre- to postfatigue protocol. RESULTS Both propulsion styles resulted in increased intracycle wrist movement variability postfatigue, but observed increases did not significantly differ between ARC and SEMI. CONCLUSIONS This study evinces that intersubject variability exceeded average changes in intracycle wrist movement variability for both propulsion styles. Neither propulsion style resulting in a greater change in intracycle movement variability may suggest that no single propulsion style is ideal for everyone. The large intersubject variability may indicate that the propulsion style resulting in the smallest increase in intracycle movement variability after a fatiguing bout of propulsion may differ for each person and may help explain why wheelchair users self-select to use different propulsion styles.
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Affiliation(s)
- Lisa A Zukowski
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Bondurant 3007, CB# 7135, Chapel Hill, NC 27599; and Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL(∗).
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL(†)
| | - Orit Shechtman
- Department of Occupational Therapy, University of Florida, Gainesville, FL(‡)
| | - Christopher J Hass
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL(§)
| | - Mark D Tillman
- WellStar College of Health and Human Services, Kennesaw State University, Kennesaw, GA; and Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL(¶)
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Jayaraman C, Beck CL, Sosnoff JJ. Shoulder pain and jerk during recovery phase of manual wheelchair propulsion. J Biomech 2015; 48:3937-44. [PMID: 26472307 PMCID: PMC4655152 DOI: 10.1016/j.jbiomech.2015.09.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 09/21/2015] [Accepted: 09/24/2015] [Indexed: 11/24/2022]
Abstract
UNLABELLED Repetitive loading of the upper limb due to wheelchair propulsion plays a leading role in the development of shoulder pain in manual wheelchair users (mWCUs). There has been minimal inquiry on understanding wheelchair propulsion kinematics from a human movement ergonomics perspective. This investigation employs an ergonomic metric, jerk, to characterize the recovery phase kinematics of two recommended manual wheelchair propulsion patterns: semi-circular and the double loop. Further it examines if jerk is related to shoulder pain in mWCUs. Data from 22 experienced adult mWCUs was analyzed for this study (semi-circular: n=12 (pain/without-pain:6/6); double-loop: n=10 (pain/without-pain:4/6)). Participants propelled their own wheelchair fitted with SMARTWheels on a roller dynamometer at 1.1 m/s for 3 min. Kinematic and kinetic data of the upper limbs were recorded. Three dimensional absolute jerk experienced at the shoulder, elbow and wrist joint during the recovery phase of wheelchair propulsion were computed. Two-way ANOVAs were conducted with the recovery pattern type and shoulder pain as between group factors. FINDINGS (1) Individuals using a semi-circular pattern experienced lower jerk at their arm joints than those using a double loop pattern (P<0.05, η(2)=0.32)wrist;(P=0.05, η(2)=0.19)elbow;(P<0.05, η(2)=0.34)shoulder and (2) individuals with shoulder pain had lower peak jerk magnitude during the recovery phase (P≤0.05, η(2)=0.36)wrist;(P≤0.05, η(2)=0.30)elbow;(P≤0.05, η(2)=0.31)shoulder. CONCLUSIONS Jerk during wheelchair propulsion was able to distinguish between pattern types (semi-circular and double loop) and the presence of shoulder pain. Jerk provides novel insights into wheelchair propulsion kinematics and in the future it may be beneficial to incorporate jerk based metric into rehabilitation practice.
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Affiliation(s)
- Chandrasekaran Jayaraman
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Carolyn L Beck
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Jacob J Sosnoff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
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Sosnoff JJ, Rice IM, Hsiao-Wecksler ET, Hsu IMK, Jayaraman C, Moon Y. Variability in Wheelchair Propulsion: A New Window into an Old Problem. Front Bioeng Biotechnol 2015; 3:105. [PMID: 26284239 PMCID: PMC4515595 DOI: 10.3389/fbioe.2015.00105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/10/2015] [Indexed: 11/13/2022] Open
Abstract
Manual wheelchair users are at great risk for the development of upper extremity injury and pain. Any loss of upper limb function due to pain adversely impacts the independence and mobility of manual wheelchair users. There is growing theoretical and empirical evidence that fluctuations in movement (i.e., motor variability) are related to musculoskeletal pain. This perspectives paper discusses a local review on several investigations examining the association between variability in wheelchair propulsion and shoulder pain in manual wheelchair users. The experimental data reviewed highlights that the variability of wheelchair propulsion is impacted by shoulder pain in manual wheelchair users. We maintain that inclusion of these metrics in future research on wheelchair propulsion and upper limb pain may yield novel data. Several promising avenues for future research based on this collective work are discussed.
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Affiliation(s)
- Jacob J. Sosnoff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ian M. Rice
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Elizabeth T. Hsiao-Wecksler
- Department of Mechanical Engineering and Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Iris M. K. Hsu
- Department of Mechanical Engineering and Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Chandrasekaran Jayaraman
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Yaejin Moon
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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22
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Dysterheft JL, Rice IM, Rice LA. Influence of handrim wheelchair propulsion training in adolescent wheelchair users, a pilot study. Front Bioeng Biotechnol 2015; 3:68. [PMID: 26042217 PMCID: PMC4435070 DOI: 10.3389/fbioe.2015.00068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/30/2015] [Indexed: 11/13/2022] Open
Abstract
Ten full-time adolescent wheelchair users (ages 13–18) completed a total of three propulsion trials on carpet and tile surfaces, at a self-selected velocity, and on a concrete surface, at a controlled velocity. All trials were performed in their personal wheelchair with force and moment sensing wheels attached bilaterally. The first two trials on each surface were used as pre-intervention control trials. The third trial was performed after receiving training on proper propulsion technique. Peak resultant force, contact angle, stroke frequency, and velocity were recorded during all trials for primary analysis. Carpet and tile trials resulted in significant increases in contact angle and peak total force with decreased stroke frequency after training. During the velocity controlled trials on concrete, significant increases in contact angle occurred, as well as decreases in stroke frequency after training. Overall, the use of a training video and verbal feedback may help to improve short-term propulsion technique in adolescent wheelchair users and decrease the risk of developing upper limb pain and injury.
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Affiliation(s)
- Jennifer L Dysterheft
- Wheelchair Biomechanics Performance Laboratory, Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign , Urbana, IL , USA
| | - Ian M Rice
- Wheelchair Biomechanics Performance Laboratory, Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign , Urbana, IL , USA
| | - Laura A Rice
- Wheelchair Biomechanics Performance Laboratory, Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign , Urbana, IL , USA
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23
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Leving MT, Vegter RJK, Hartog J, Lamoth CJC, de Groot S, van der Woude LHV. Effects of visual feedback-induced variability on motor learning of handrim wheelchair propulsion. PLoS One 2015; 10:e0127311. [PMID: 25992626 PMCID: PMC4439159 DOI: 10.1371/journal.pone.0127311] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/14/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND It has been suggested that a higher intra-individual variability benefits the motor learning of wheelchair propulsion. The present study evaluated whether feedback-induced variability on wheelchair propulsion technique variables would also enhance the motor learning process. Learning was operationalized as an improvement in mechanical efficiency and propulsion technique, which are thought to be closely related during the learning process. METHODS 17 Participants received visual feedback-based practice (feedback group) and 15 participants received regular practice (natural learning group). Both groups received equal practice dose of 80 min, over 3 weeks, at 0.24 W/kg at a treadmill speed of 1.11 m/s. To compare both groups the pre- and post-test were performed without feedback. The feedback group received real-time visual feedback on seven propulsion variables with instruction to manipulate the presented variable to achieve the highest possible variability (1st 4-min block) and optimize it in the prescribed direction (2nd 4-min block). To increase motor exploration the participants were unaware of the exact variable they received feedback on. Energy consumption and the propulsion technique variables with their respective coefficient of variation were calculated to evaluate the amount of intra-individual variability. RESULTS The feedback group, which practiced with higher intra-individual variability, improved the propulsion technique between pre- and post-test to the same extent as the natural learning group. Mechanical efficiency improved between pre- and post-test in the natural learning group but remained unchanged in the feedback group. CONCLUSION These results suggest that feedback-induced variability inhibited the improvement in mechanical efficiency. Moreover, since both groups improved propulsion technique but only the natural learning group improved mechanical efficiency, it can be concluded that the improvement in mechanical efficiency and propulsion technique do not always appear simultaneously during the motor learning process. Their relationship is most likely modified by other factors such as the amount of the intra-individual variability.
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Affiliation(s)
- Marika T. Leving
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Riemer J. K. Vegter
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- * E-mail:
| | - Johanneke Hartog
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Claudine J. C. Lamoth
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Sonja de Groot
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, the Netherlands
| | - Lucas H. V. van der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
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24
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Gil-Agudo Á, Solís-Mozos M, Crespo-Ruiz B, Del-Ama Eng AJ, Pérez-Rizo E, Segura-Fragoso A, Jiménez-Díaz F. Echographic and kinetic changes in the shoulder joint after manual wheelchair propulsion under two different workload settings. Front Bioeng Biotechnol 2014; 2:77. [PMID: 25566539 PMCID: PMC4275037 DOI: 10.3389/fbioe.2014.00077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/07/2014] [Indexed: 11/13/2022] Open
Abstract
Manual wheelchair users with spinal cord injury (SCI) have a high prevalence of shoulder pain due to the use of the upper extremity for independent mobility, transfers, and other activities of daily living. Indeed, shoulder pain dramatically affects quality of life of these individuals. There is limited evidence obtained through radiographic techniques of a relationship between the forces acting on the shoulder during different propulsion conditions and shoulder pathologies. Today, ultrasound is widely accepted as a precise tool in diagnosis, displaying particularly effectiveness in screening the shoulder rotator cuff. Thus, we set out to perform an ultrasound-based study of the acute changes to the shoulder soft tissues after propelling a manual wheelchair in two workload settings. Shoulder joint kinetics was recorded from 14 manual wheelchair users with SCI while they performed high- and low-intensity wheelchair propulsion tests (constant and incremental). Shoulder joint forces and moments were obtained from inverse dynamic methods, and ultrasound screening of the shoulder was performed before and immediately after the test. Kinetic changes were more relevant after the most intensive task, showing the significance of high-intensity activity, yet no differences were found in ultrasound-related parameters before and after each propulsion task. It therefore appears that further studies will be needed to collect clinical data and correlate data regarding shoulder pain with both ultrasound images and data from shoulder kinetics.
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Affiliation(s)
- Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Marta Solís-Mozos
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Beatriz Crespo-Ruiz
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Antonio J Del-Ama Eng
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Enrique Pérez-Rizo
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | | | - Fernando Jiménez-Díaz
- Laboratory of Performance and Sports Rehabilitation, Faculty of Sport Science, University of Castilla-La Mancha , Toledo , Spain
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25
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Jayaraman C, Moon Y, Rice IM, Hsiao Wecksler ET, Beck CL, Sosnoff JJ. Shoulder pain and cycle to cycle kinematic spatial variability during recovery phase in manual wheelchair users: a pilot investigation. PLoS One 2014; 9:e89794. [PMID: 24614232 PMCID: PMC3948626 DOI: 10.1371/journal.pone.0089794] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 01/24/2014] [Indexed: 11/19/2022] Open
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.
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Affiliation(s)
- Chandrasekaran Jayaraman
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Yaejin Moon
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Ian M. Rice
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Elizabeth T. Hsiao Wecksler
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Carolyn L. Beck
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Jacob J. Sosnoff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
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Vegter RJK, Lamoth CJ, de Groot S, Veeger DHEJ, van der Woude LHV. Inter-individual differences in the initial 80 minutes of motor learning of handrim wheelchair propulsion. PLoS One 2014; 9:e89729. [PMID: 24586992 PMCID: PMC3931829 DOI: 10.1371/journal.pone.0089729] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 01/22/2014] [Indexed: 11/19/2022] Open
Abstract
Handrim wheelchair propulsion is a cyclic skill that needs to be learned during rehabilitation. Yet it is unclear how inter-individual differences in motor learning impact wheelchair propulsion practice. Therefore we studied how early-identified motor learning styles in novice able-bodied participants impact the outcome of a low-intensity wheelchair-practice intervention. Over a 12-minute pre-test, 39 participants were split in two groups based on a relative 10% increase in mechanical efficiency. Following the pretest the participants continued one of four different low-intensity wheelchair practice interventions, yet all performed in the same trial-setup with a total 80-minute dose at 1.11 m/s at 0.20 W/kg. Instead of focusing on the effect of the different interventions, we focused on differences in motor learning between participants over the intervention. Twenty-six participants started the pretest with a lower mechanical efficiency and a less optimal propulsion technique, but showed a fast improvement during the first 12 minutes and this effect continued over the 80 minutes of practice. Eventually these initially fast improvers benefitted more from the given practice indicated by a better propulsion technique (like reduced frequency and increased stroke angle) and a higher mechanical efficiency. The initially fast improvers also had a higher intra-individual variability in the pre and posttest, which possibly relates to the increased motor learning of the initially fast improvers. Further exploration of the common characteristics of different types of learners will help to better tailor rehabilitation to the needs of wheelchair-dependent persons and improve our understanding of cyclic motor learning processes.
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Affiliation(s)
- Riemer J. K. Vegter
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- * E-mail:
| | - Claudine J. Lamoth
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Sonja de Groot
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands
| | - Dirkjan H. E. J. Veeger
- Faculty of Human Movement Sciences, Research Institute MOVE, Vrije Universiteit, Amsterdam, The Netherlands
- Faculty of Mechanical, Maritime and Materials Engineering, section Biomechatronics & Biorobotics, Delft University of Technology, Delft, The Netherlands
| | - Lucas H. V. van der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
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