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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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van Dijk MP, Hoozemans MJM, Berger MAM, Veeger HEJ. From theory to practice: Monitoring mechanical power output during wheelchair field and court sports using inertial measurement units. J Biomech 2024; 166:112052. [PMID: 38560959 DOI: 10.1016/j.jbiomech.2024.112052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 03/06/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
An important performance determinant in wheelchair sports is the power exchanged between the athlete-wheelchair combination and the environment, in short, mechanical power. Inertial measurement units (IMUs) might be used to estimate the exchanged mechanical power during wheelchair sports practice. However, to validly apply IMUs for mechanical power assessment in wheelchair sports, a well-founded and unambiguous theoretical framework is required that follows the dynamics of manual wheelchair propulsion. Therefore, this research has two goals. First, to present a theoretical framework that supports the use of IMUs to estimate power output via power balance equations. Second, to demonstrate the use of the IMU-based power estimates during wheelchair propulsion based on experimental data. Mechanical power during straight-line wheelchair propulsion on a treadmill was estimated using a wheel mounted IMU and was subsequently compared to optical motion capture data serving as a reference. IMU-based power was calculated from rolling resistance (estimated from drag tests) and change in kinetic energy (estimated using wheelchair velocity and wheelchair acceleration). The results reveal no significant difference between reference power values and the proposed IMU-based power (1.8% mean difference, N.S.). As the estimated rolling resistance shows a 0.9-1.7% underestimation, over time, IMU-based power will be slightly underestimated as well. To conclude, the theoretical framework and the resulting IMU model seems to provide acceptable estimates of mechanical power during straight-line wheelchair propulsion in wheelchair (sports) practice, and it is an important first step towards feasible power estimations in all wheelchair sports situations.
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Affiliation(s)
- Marit P van Dijk
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands.
| | - Marco J M Hoozemans
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Monique A M Berger
- Centre of Expertise Health Innovation, The Hague University of Applied Sciences, The Hague, the Netherlands
| | - H E J Veeger
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
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Best KL, Rushton PW, Sheriko J, Arbour-Nicitopoulos KP, Dib T, Kirby RL, Lamontagne ME, Moore SA, Ouellet B, Routhier F. Effectiveness of wheelchair skills training for improving manual wheelchair mobility in children and adolescents: protocol for a multicenter randomized waitlist-controlled trial. BMC Pediatr 2023; 23:485. [PMID: 37752480 PMCID: PMC10521483 DOI: 10.1186/s12887-023-04303-8] [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: 04/27/2023] [Accepted: 09/09/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Self-directed mobility during childhood can influence development, social participation, and independent living later in life. For children who experience challenges with walking, manual wheelchairs (MWCs) provide a means for self-directed mobility. An effective MWC skills training program exists for adults, but controlled trials have not yet been documented in children and adolescents. This paper outlines the protocol for a multi-centre randomized wait-list controlled trial. The primary objective is to test the hypothesis that children and adolescents who receive MWC skills training will have higher MWC skills capacity compared to children and adolescents in the control group who receive usual care. The secondary objectives are to explore the influence of MWC skills training in children and adolescents (MWC use self-efficacy and satisfaction with participation in meaningful activities), and parents (perceived MWC skills); and to measure retention three months later. METHODS A multi-centre, parallel-group, single-blind randomized wait-list controlled trial will be conducted. A sample of 60 children and adolescents who use MWCs will be recruited in rehabilitation centres, specialized schools, and the communities of three Canadian cities. Participants will be randomized (1:1) to the experimental (Wheelchair Skills Training Program [WSTP]) or wait-list control group (usual care). Performance-based and self-report measures will be completed at baseline (T1), three months (post-intervention, T2), and three months post-intervention (T3). The primary outcome will be MWC skills capacity post-intervention. Secondary outcomes will be MWC use self-efficacy and satisfaction with participation of the child/adolescent, and parent-perceived MWC skills. The WSTP will consist of 12 sessions, 45-60 min each, delivered 1-2 times per week by trained personnel with health professions education. Training will be customized according to the child's baseline skills and participation goals that require the use of the MWC. The wait-list control group will receive usual care for 3 months and then receive the WSTP after completing T2 evaluations. Data will be analysed using ANCOVA (controlling for baseline scores). DISCUSSION MWC skills training may be one way to improve self-directed mobility and related outcomes for children and adolescents. The results of this multi-centre randomized wait-list controlled trial will allow for the effectiveness of the intervention to be evaluated in a variety of clinical contexts and geographical regions. TRIAL REGISTRATION ClinicalTrials.gov: NCT05564247, Version October 3, 2022.
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Affiliation(s)
- K L Best
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec City, QC, G1V 0A6, Canada.
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé Et de Services Sociaux de La Capitale-Nationale, 525 Wilfrid-Hamel Boulevard, Quebec City, QC, G1M 2S8, Canada.
| | - P W Rushton
- School of Rehabilitation, Université de Montréal, Montréal, QC, Canada
- CHU Sainte-Justine Research Center, Marie Enfant Rehabilitation, Montréal, QC, H1T 1C9, Canada
| | - J Sheriko
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, NS, B3H 4R2, Canada
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - K P Arbour-Nicitopoulos
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, M5S 2W6, Canada
| | - T Dib
- School of Rehabilitation, Université de Montréal, Montréal, QC, Canada
- CHU Sainte-Justine Research Center, Marie Enfant Rehabilitation, Montréal, QC, H1T 1C9, Canada
| | - R L Kirby
- Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, NS, B3H 4K4, Canada
| | - M E Lamontagne
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec City, QC, G1V 0A6, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé Et de Services Sociaux de La Capitale-Nationale, 525 Wilfrid-Hamel Boulevard, Quebec City, QC, G1M 2S8, Canada
| | - S A Moore
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, NS, B3H 4R2, Canada
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - B Ouellet
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec City, QC, G1V 0A6, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé Et de Services Sociaux de La Capitale-Nationale, 525 Wilfrid-Hamel Boulevard, Quebec City, QC, G1M 2S8, Canada
| | - F Routhier
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec City, QC, G1V 0A6, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé Et de Services Sociaux de La Capitale-Nationale, 525 Wilfrid-Hamel Boulevard, Quebec City, QC, G1M 2S8, Canada
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Leonardis JM, Schnorenberg AJ, Vogel LC, Harris GF, Slavens BA. The Influence of Age at Pediatric-Onset Spinal Cord Injury and Years of Wheelchair Use on Shoulder Complex Joint Dynamics During Manual Wheelchair Propulsion. Arch Rehabil Res Clin Transl 2022; 4:100235. [PMID: 36545526 PMCID: PMC9761265 DOI: 10.1016/j.arrct.2022.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To assess the association of age at pediatric-onset spinal cord injury (SCI) and years of manual wheelchair use with shoulder dynamics. Design Upper extremity kinematics and hand-rim kinetics were obtained during manual wheelchair propulsion. An inverse dynamics model computed three-dimensional acromioclavicular, sternoclavicular, and glenohumeral joint dynamics. Linear mixed effects models evaluated the association of age at injury onset and years of wheelchair use with shoulder dynamics. Setting Motion laboratory within a children's hospital. Participants Seventeen manual wheelchair users (N=17; 6 female, 11 male; mean age: 17.2 years, mean age at SCI onset: 11.5 years) with pediatric-onset SCI (levels: C4-T11) and International Standards for Neurological Classification of SCI grades: A (11), B (3), C (2), and N/A (2). Interventions Not applicable. Main Outcome Measures Acromioclavicular, sternoclavicular, and glenohumeral angles and ranges of motion, and glenohumeral forces and moments. Results We observed a decrease in maximum acromioclavicular upward rotation (ß [95% confidence interval {CI}]=3.02 [0.15,5.89], P=.039) and an increase in acromioclavicular downward/upward rotation range of motion (ß [95% CI]=0.44 [0.08,0.80], P=.016) with increasing age at SCI onset. We found interactions between age at onset and years of use for maximum glenohumeral abduction (ß [95% CI]=0.16 [0.03,0.29], P=.017), acromioclavicular downward/upward rotation range of motion (ß [95% CI]=-0.05 [-0.09,-0.01], P=.008), minimum acromioclavicular upward rotation (ß [95% CI]=-0.34 [-0.64,-0.04], P=.026). A decrease in glenohumeral internal rotation moment (ß [95% CI]=-0.09 [-0.17,-0.009], P=.029) with increasing years of use was found. Conclusions Age at injury and the years of wheelchair use are associated with shoulder complex biomechanics during wheelchair propulsion. These results are noteworthy, as both age at SCI onset and years of wheelchair use are considered important factors in the incidence of shoulder pain. These results suggest that investigations of biomechanical changes over the lifespan are critical.
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Affiliation(s)
- Joshua M. Leonardis
- Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Alyssa J. Schnorenberg
- Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI
| | | | - Gerald F. Harris
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI
| | - Brooke A. Slavens
- Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI
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Jones C, Schnorenberg AJ, Garlanger K, Leonardis JM, Kortes S, Riebe J, Plesnik J, Lee K, Slavens BA. Biomechanical analysis of wheelchair athletes with paraplegia during cross-training exercises. J Spinal Cord Med 2022; 45:882-897. [PMID: 34100694 PMCID: PMC9662041 DOI: 10.1080/10790268.2021.1928868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
CONTEXT Extreme conditioning programs (ECPs), such as CrossFit®, are a relatively new method of fitness with rapid growth in individuals with paraplegia. However, it is unknown if wheelchair users are at an additional risk of musculoskeletal injury during these exercises. Biomechanical characterization is necessary to determine the safety and efficacy of ECPs as an exercise modality for wheelchair users with paraplegia. OBJECTIVE To characterize the three-dimensional (3-D) thorax and upper extremity joint kinematics of paraplegic wheelchair athletes during exercises commonly prescribed as part of ECPs. DESIGN Observational study. PARTICIPANTS Three male wheelchair athletes, average age of 37.1 ± 4.6 years, with spinal cord injury levels of T8, L2, and T10, with varying exercise experience. METHODS 3-D movement was acquired using motion capture during the performance of four exercises: battle ropes, sled pull, overhead press, and sledgehammer swing. A custom upper extremity inverse kinematics model was applied to compute 3-D joint angles. OUTCOME MEASURES 3-D peak thorax, glenohumeral, elbow, and wrist joint angles and ranges of motion (ROM), Visual Analog Scale (VAS), and Borg Scale of Perceived Exertion. RESULTS Large joint motions were required for the exercises, at times demanding extreme shoulder and/or wrist flexion and extension, abduction, and external rotation, which are concerning for injury risk in wheelchair users. Participants, however, were able to perform the exercises pain free. CONCLUSION These quantitative findings highlight that wheelchair athletes may be exposed to potentially injurious positions during common ECP exercises. These findings provide insight that may lead to improved clinical guidelines for prescription and training of exercise regimens, particularly involving ECPs, for wheelchair users.
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Affiliation(s)
- Carrie Jones
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Alyssa J. Schnorenberg
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA,Correspondence to: Alyssa J. Schnorenberg, University of Wisconsin Milwaukee, Innovation Campus – Accelerator Building, Mobility Lab, Suite 131, 1225, Discovery Parkway, Wauwatosa, WI, USA; Ph: (414) 251-7746.
| | - Kristin Garlanger
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joshua M. Leonardis
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Sam Kortes
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Justin Riebe
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Justin Plesnik
- Body by Design, Brookfield, USA,Aqua-Endurance, Milwaukee, Wisconsin, USA
| | - Kenneth Lee
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brooke A. Slavens
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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Manual Wheelchair Equipped with a Planetary Gear-Research Methodology and Preliminary Results. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The purpose of the study was to create a research methodology for testing the newly developed wheelchair drive, which allows the operator to choose the gear ratio and, thus, makes it possible to change the propulsion torque value. The aim was to choose such conditions in the experiment, that would result in great enough changes in the participant’s muscle load and body kinematics for it to be possible to register them with applied measuring methods. Surface electromyography was used to assess the effort that was required for the propulsion of a wheelchair under different conditions. Additionally, upper limb motion capture measurements were also performed. The preliminary results show that the muscular effort of the participant propelling the wheelchair increases with the load—resulting from both the gear ratio and the inclination angle. At the same time, the position of the motion range of upper limb individual segments changes significantly. Simultaneously, the mean value of the shoulder displacement and its angle of rotation decreases.
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Rouvier T, Louessard A, Simonetti E, Hybois S, Bascou J, Pontonnier C, Pillet H, Sauret C. Manual wheelchair biomechanics while overcoming various environmental barriers: A systematic review. PLoS One 2022; 17:e0269657. [PMID: 35737733 PMCID: PMC9223621 DOI: 10.1371/journal.pone.0269657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
During manual wheelchair (MWC) locomotion, the user's upper limbs are subject to heavy stresses and fatigue because the upper body is permanently engaged to propel the MWC. These stresses and fatigue vary according to the environmental barriers encountered outdoors along a given path. This study aimed at conducting a systematic review of the literature assessing the biomechanics of MWC users crossing various situations, which represent physical environmental barriers. Through a systematic search on PubMed, 34 articles were selected and classified according to the investigated environmental barriers: slope; cross-slope; curb; and ground type. For each barrier, biomechanical parameters were divided into four categories: spatiotemporal parameters; kinematics; kinetics; and muscle activity. All results from the different studies were gathered, including numerical data, and assessed with respect to the methodology used in each study. This review sheds light on the fact that certain situations (cross-slopes and curbs) or parameters (kinematics) have scarcely been studied, and that a wider set of situations should be studied. Five recommendations were made at the end of this review process to standardize the procedure when reporting materials, methods, and results for the study of biomechanics of any environmental barrier encountered in MWC locomotion: (i) effectively reporting barriers' lengths, grades, or heights; (ii) striving for standardization or a report of the approach conditions of the barrier, such as velocity, especially on curbs; (iii) reporting the configuration of the used MWC, and if it was fitted to the subject's morphology; (iv) reporting rotation sequences for the expression of moments and kinematics, and when used, the definition of the musculoskeletal model; lastly (v) when possible, reporting measurement uncertainties and model reconstruction errors.
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Affiliation(s)
- Théo Rouvier
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Aude Louessard
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Emeline Simonetti
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
- Centre d’Études et de Recherche sur l’Appareillage des Handicapés, Institution Nationale des Invalides, Créteil, France
| | - Samuel Hybois
- Complexité Innovation Activités Motrices et Sportives, Faculté des Sciences du Sport, Université Paris-Saclay, Orsay, France
| | - Joseph Bascou
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
- Centre d’Études et de Recherche sur l’Appareillage des Handicapés, Institution Nationale des Invalides, Créteil, France
| | - Charles Pontonnier
- Université de Rennes, Centre National de la Recherche Scientifique, Institut National de Recherche en Informatique et en Automatique, Institut de Recherche en Informatique et Systèmes Aléatoires–Unité Mixte de Recherche 6074, Rennes, France
| | - Hélène Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Christophe Sauret
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
- Centre d’Études et de Recherche sur l’Appareillage des Handicapés, Institution Nationale des Invalides, Créteil, France
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Evaluating Anthropometric Scaling of a Generic Adult Model to Represent Pediatric Shoulder Strength. J Biomech 2022; 141:111170. [DOI: 10.1016/j.jbiomech.2022.111170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/24/2022] [Accepted: 05/29/2022] [Indexed: 11/18/2022]
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9
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Jahanian O, Schnorenberg AJ, Muqeet V, Hsiao-Wecksler ET, Slavens BA. Glenohumeral joint dynamics and shoulder muscle activity during geared manual wheelchair propulsion on carpeted floor in individuals with spinal cord injury. J Electromyogr Kinesiol 2022; 62:102318. [PMID: 31178393 PMCID: PMC6885114 DOI: 10.1016/j.jelekin.2019.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 05/08/2019] [Accepted: 05/30/2019] [Indexed: 02/03/2023] Open
Abstract
This study investigated the effects of using geared wheels on glenohumeral joint dynamics and shoulder muscle activity during manual wheelchair propulsion. Seven veterans with spinal cord injury propelled their wheelchairs equipped with geared wheels over a carpeted floor in low gear (1.5:1) and standard gear (1:1) conditions. Hand-rim kinetics, glenohumeral joint dynamics, and muscle activity were measured using a custom instrumented geared wheel, motion analysis, and surface electromyography. Findings indicated that the propulsion speed and stroke distance decreased significantly during the low gear condition. The peak hand-rim resultant force and propulsive moment, as well as the peak glenohumeral inferior force and flexion moment, were significantly less during the low gear condition. The peak and integrated muscle activity of the anterior deltoid and pectoralis major decreased significantly, while the normalized integrated muscle activity (muscle activity per stroke distance) was not significantly different between the two conditions. Propulsion on carpeted floor in the low gear condition was accompanied by a reduced perception of effort. The notable decrease in the peak shoulder loading and muscle activity suggests that usage of geared wheels may be beneficial for wheelchair users to enhance independent mobility in their homes and communities while decreasing their shoulder demands.
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Affiliation(s)
- Omid Jahanian
- Department of Occupational Science and Technology, University of Wisconsin–Milwaukee, Milwaukee, WI, USA
| | - Alyssa J Schnorenberg
- Department of Occupational Science and Technology, University of Wisconsin–Milwaukee, Milwaukee, WI, USA
| | - Vaishnavi Muqeet
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Brooke A. Slavens
- Department of Occupational Science and Technology, University of Wisconsin–Milwaukee, Milwaukee, WI, USA,Department of Biomedical Engineering, University of Wisconsin–Milwaukee, Milwaukee, WI, USA
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McIntyre A, Sadowsky C, Behrman A, Martin R, Augutis M, Cassidy C, Betz R, Ertzgaard P, Mulcahey MJ. A Systematic Review of the Scientific Literature for Rehabilitation/Habilitation Among Individuals With Pediatric-Onset Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2022; 28:13-90. [PMID: 35521053 PMCID: PMC9009193 DOI: 10.46292/sci21-00046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives To conduct a systematic review to examine the scientific literature for rehabilitation/habilitation among individuals with pediatric-onset spinal cord injury (SCI). Methods A literature search of multiple databases (i.e., PubMed/MEDLINE, CINAHL, EMBASE, PsychINFO) was conducted and was filtered to include studies involving humans, published as full-length articles up to December 2020, and in English. Included studies met the following inclusion criteria: (1) ≥50% of the study sample had experienced a traumatic, acquired, nonprogressive spinal cord injury (SCI) or a nontraumatic, acquired, noncongenital SCI; (2) SCI onset occurred at ≤21 years of age; and (3) sample was assessed for a rehabilitation/habilitation-related topic. Studies were assigned a level of evidence using an adapted Sackett scale modified down to five levels. Data extracted from each study included author(s), year of publication, country of origin, study design, subject characteristics, rehabilitation/habilitation topic area, intervention (if applicable), and outcome measures. Results One hundred seventy-six studies were included for review (1974-2020) with the majority originating from the United States (81.3%). Most studies were noninterventional observational studies (n = 100; 56.8%) or noninterventional case report studies (n = 5; 2.8%). Sample sizes ranged from 1 to 3172 with a median of 26 (interquartile range [IQR], 116.5). Rehabilitation/habilitation topics were categorized by the International Classification of Functioning, Disability and Health (ICF); most studies evaluated ICF Body Function. There were 69 unique clinical health outcome measures reported. Conclusion The evidence for rehabilitation/habilitation of pediatric-onset SCI is extremely limited; nearly all studies (98%) are level 4-5 evidence. Future studies across several domains should be conducted with novel approaches to research design to alleviate issues related to sample sizes and heterogeneity.
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Affiliation(s)
- Amanda McIntyre
- Parkwood Institute Research, Parkwood Institute, London, Canada
| | - Cristina Sadowsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, John Hopkins University, Baltimore, Maryland
,International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Andrea Behrman
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
,Kosair Charities Center for Pediatric Neurorecovery, Louisville, Kentucky
| | - Rebecca Martin
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, John Hopkins University, Baltimore, Maryland
,International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Marika Augutis
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institute, Solna, Sweden
| | - Caitlin Cassidy
- St. Joseph’s Health Care London, Parkwood Institute, London, Canada
| | - Randal Betz
- Institute for Spine and Scoliosis, Lawrenceville, New Jersey
,Department of Orthopedics, Mount Sinai Hospital, New York, New York
| | - Per Ertzgaard
- Department of Rehabilitation Medicine, Linköping University, Linköping, Sweden
| | - MJ Mulcahey
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Woodbury, New Jersey
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Chénier F, Alberca I, Marquis E, Gagnon DH, Faupin A. Impact of dribbling on spatiotemporal and kinetic parameters in wheelchair basketball athletes. Clin Biomech (Bristol, Avon) 2022; 91:105545. [PMID: 34915435 DOI: 10.1016/j.clinbiomech.2021.105545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Wheelchair basketball is one of the most popular Paralympic sports. Dribbling a ball while propelling is a key feature of wheelchair basketball. Very few studies have investigated the biomechanical impact of dribbling. This study aims to analyze the impact of dribbling on the amplitude and symmetry of spatiotemporal and kinetic parameters of wheelchair propulsion. METHODS Ten experienced wheelchair basketball athletes (31.5 ± 10.6 years old; 7 men, 3 women) with various classifications performed eight 9-m sprints along a straight line on a basketball court: four sprints using classic synchronous propulsion, and four sprints while dribbling a ball down the court. FINDINGS Dribbling decreased velocity, mean propulsive moments and the force rate of rise, as well as increased push time, force rate of rise asymmetry and angular impulse asymmetry. All kinetic variables were asymmetric and higher on the dominant limb. INTERPRETATION The combination of reduced velocity and propulsive moments when dribbling indicates that wheelchair basketball athletes may deliberately preserve a safety margin of acceleration to adapt to uncontrolled ball rebounds. Dribbling was not associated with any factors associated with an increased risk of musculoskeletal disorders.
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Affiliation(s)
- Félix Chénier
- Université du Québec à Montréal, Faculty of Sciences, Department of Physical Activity Sciences, Montreal, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada.
| | - Ilona Alberca
- Université de Toulon, Impact de l'Activité Physique sur la Santé (UR IAPS n°201723207F), Campus de La Garde, CS60584, F-83041 Toulon, France
| | - Etienne Marquis
- Université du Québec à Montréal, Faculty of Sciences, Department of Physical Activity Sciences, Montreal, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
| | - Dany H Gagnon
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada; Université de Montréal, Faculty of Medicine, School of Rehabilitation, Montreal, Canada
| | - Arnaud Faupin
- Université de Toulon, Impact de l'Activité Physique sur la Santé (UR IAPS n°201723207F), Campus de La Garde, CS60584, F-83041 Toulon, France
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12
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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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Schnorenberg AJ, Slavens BA. Effect of Rotation Sequence on Thoracohumeral Joint Kinematics during Various Shoulder Postures . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4912-4915. [PMID: 34892309 PMCID: PMC9817035 DOI: 10.1109/embc46164.2021.9629667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Current methods for selecting a rotation sequence to biomechanically model shoulder joint angles during motion assessment are challenging and controversial due to insufficient knowledge of their effect on the clinical interpretation of movement. Seven rotation sequences were examined by factors including incidences of gimbal lock and joint angle error in two healthy adults during 12 postures using right and left arms. This work was the first to explore the effects of each of the six Cardan angle sequences and the International Society of Biomechanics recommended YXY Euler sequence on the thoracohumeral joint in an array of postures. Results of this work show that there is not a "one size fits all" approach via rotation sequence selection for reliable and coherent expression of shoulder joint postures, particularly of the thoracohumeral joint. For best biomechanical modeling practice, it is recommended that researchers carefully consider the implications of a particular rotation sequence based on the posture or task of interest and resulting incidences of gimbal lock and joint angle error.Clinical Relevance- This work examines the effect of seven different mathematical computations for assessing shoulder joint angles in different postures for application of clinical movement analysis.
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Affiliation(s)
- Alyssa J. Schnorenberg
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI 53233 USA; Department of Rehabilitation Sciences and Technology, University of Wisconsin Milwaukee, Milwaukee, WI 53233 USA
| | - Brooke A. Slavens
- Department of Rehabilitation Sciences and Technology, University of Wisconsin Milwaukee, Milwaukee, WI 53233 USA
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14
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Hanks MM, Leonardis JM, Schnorenberg AJ, Krzak JJ, Graf A, Vogel LC, Harris GF, Slavens BA. The Influence of Sex on Upper Extremity Joint Dynamics in Pediatric Manual Wheelchair Users With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 27:26-37. [PMID: 34456544 PMCID: PMC8370704 DOI: 10.46292/sci20-00057] [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] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Manual wheelchair propulsion is a physically demanding task associated with upper extremity pain and pathology. Shoulder pain is reported in over 25% of pediatric manual wheelchairs users, and this number rises over the lifespan. Upper extremity biomechanics in adults has been associated with shoulder pain and pathology; however, few studies have investigated upper extremity joint dynamics in children. Furthermore, sex may be a critical factor that is currently unexplored with regard to pediatric wheelchair mobility. OBJECTIVES To investigate differences in upper extremity joint dynamics between pediatric male and female manual wheelchair users with spinal cord injury (SCI) during wheelchair propulsion. METHODS Novel instrumented wheelchair hand-rims synchronized with optical motion capture were used to acquire upper extremity joint dynamics of 20 pediatric manual wheelchair users with SCI (11 males, 9 females). Thorax, sternoclavicular, acromioclavicular, glenohumeral, elbow, and wrist joint kinematics and kinetics were calculated during wheelchair propulsion. Linear mixed models were used to assess differences between sexes. RESULTS Females exhibited significantly greater peak forearm pronation (p = .007), normalized wrist lateral force (p = .03), and normalized elbow posterior force (p = .04) than males. Males exhibited significantly greater peak sternoclavicular joint retraction (p < .001) than females. No significant differences between males and females were observed for the glenohumeral joint (p > .012). CONCLUSION This study found significant differences in upper extremity joint dynamics between sexes during manual wheelchair propulsion. Our results underscore the importance of considering sex when evaluating pediatric wheelchair mobility and developing comprehensive wheelchair training interventions for early detection and prevention of upper extremity pain and pathology.
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Affiliation(s)
- Matthew M. Hanks
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Joshua M. Leonardis
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Alyssa J. Schnorenberg
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Joseph J. Krzak
- Shriners Hospitals for Children, Chicago, Illinois
- Department of Physical Therapy, Midwestern University, Downers Grove, Illinois
| | - Adam Graf
- Shriners Hospitals for Children, Chicago, Illinois
| | | | - Gerald F. Harris
- Shriners Hospitals for Children, Chicago, Illinois
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brooke A. Slavens
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
- Shriners Hospitals for Children, Chicago, Illinois
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Zhang C, Dong M, Li J, Cao Q. A Modified Kinematic Model of Shoulder Complex Based on Vicon Motion Capturing System: Generalized GH Joint with Floating Centre. SENSORS (BASEL, SWITZERLAND) 2020; 20:E3713. [PMID: 32630828 PMCID: PMC7374450 DOI: 10.3390/s20133713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/28/2020] [Accepted: 07/01/2020] [Indexed: 11/30/2022]
Abstract
Due to the complex coupling motion of shoulder mechanism, only a small amount of quantitative information is available in the existing literature, although various kinematic models of the shoulder complex have been proposed. This study focused on the specific motion coupling relationship between glenohumeral (GH) joint center displacement variable quantity relative to the thorax coordinate system and humeral elevation angle to describe the shoulder complex. The mechanism model of shoulder complex was proposed with an algorithm designed. Subsequently, twelve healthy subjects performed right arm raising, lowering, as well as raising and lowering (RAL) movements in sixteen elevation planes, and the motion information of the markers attached to the thorax, scapula, and humerus was captured by using Vicon motion capturing system. Then, experimental data was processed and the generalized GH joint with floating center was quantized. Simultaneously, different coupling characteristics were detected during humerus raising as well as lowering movements. The motion coupling relationships in different phases were acquired, and a modified kinematic model was established, with the description of overall motion characteristics of shoulder complex validated by comparing the results with a prior kinematic model from literature, showing enough accuracy for the design of upper limb rehabilitation robots.
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Affiliation(s)
| | | | - Jianfeng Li
- Beijing Key Laboratory of Advanced Manufacturing Technology, Faculty of Materials and Manufacturing, Beijing University of Technology, Beijing 100124, China; (C.Z.); (M.D.); (Q.C.)
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16
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A Kinematic Model of the Shoulder Complex Obtained from a Wearable Detection System. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10113696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Due to the complex coupled motion of the shoulder mechanism, the design of the guiding movement rules of rehabilitation robots generally lacks specific motion coupling information between the glenohumeral (GH) joint center and humeral elevation angle. This study focuses on establishing a kinematic model of the shoulder complex obtained from a wearable detection system, which can describe the specific motion coupling relationship between the GH joint center displacement variable quantity relative to the thorax coordinate system and the humeral elevation angle. A kinematic model, which is a generalized GH joint with a floating center, was proposed to describe the coupling motion. Twelve healthy subjects wearing the designed detection system performed a right-arm elevation in the sagittal and coronal planes respectively, and the motion information of the GH joint during humeral elevation in the sagittal and coronal planes was detected and quantized, with the analytical formulas acquired based on the experimental data. The differences in GH joint motion during humeral elevation in the sagittal and coronal planes were also evaluated respectively, which also verified the effectiveness of the proposed kinematic model.
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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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Abstract
PURPOSE Children who use manual wheelchairs encounter pain and injury risks to the upper body. Current literature does not describe how propulsion pattern and physiotherapeutic training methodologies impact response to treatment. METHODS This study assesses the effect of community-based intensive physical and occupational therapy on functional outcomes over a 7-week period in pediatric manual wheelchair users. RESULTS Key results include significant joint and musculotendon kinematic differences at the shoulder, improved speed and propulsion effectiveness, and changed propulsion pattern. CONCLUSIONS Statistics also revealed that propulsion pattern was a predictor of response to therapy, as was weekly therapeutic duration, wheelchair-specific focus by the therapists, and stretching.
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19
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Slavens BA, Jahanian O, Schnorenberg AJ, Hsiao-Wecksler ET. A comparison of glenohumeral joint kinematics and muscle activation during standard and geared manual wheelchair mobility. Med Eng Phys 2019; 70:1-8. [PMID: 31285137 DOI: 10.1016/j.medengphy.2019.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 06/17/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Abstract
The high prevalence of upper extremity joint injuries among manual wheelchair users is largely attributed to the high repetitive loading during propulsion. The purpose of this study was to evaluate the effects of using geared wheels for manual wheelchair mobility on shoulder joint biomechanics. Fourteen able-bodied participants performed overground propulsion and ramp ascension using standard and geared manual wheelchair wheels. Spatial temporal parameters, glenohumeral joint kinematics, and shoulder muscle activity were quantified. Findings indicated that regardless of the level of slope, the propulsion speed and stroke distance decreased significantly (p ≪ 0.001), and the stroke frequency increased significantly (p ≤ 0.025) during geared manual wheelchair propulsion. The glenohumeral joint ranges of motion in the coronal plane (p ≤ 0.005) and peak joint angles in the coronal (p ≤ 0.023) and transverse (p ≤ 0.012) planes were significantly different between standard and geared wheels usage. Shoulder muscle activity was substantially less using the geared wheels with significant findings in the pectoralis major (level floor, p ≤ 0.008) and infraspinatus (p ≤ 0.014) peak muscle activity, and the anterior deltoid (p ≤ 0.014) and pectoralis major (p ≤ 0.015) integrated muscle activity. However, the shoulder flexor normalized integrated muscle activity (muscle activity per stroke distance) was not different between the wheels.
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Affiliation(s)
- Brooke A Slavens
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
| | - Omid Jahanian
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Alyssa J Schnorenberg
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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20
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Schnorenberg AJ, French ME, Riebe JM, Grindel SI, Slavens BA. Shoulder complex kinematics pre- and post- rotator cuff repair. J Electromyogr Kinesiol 2019; 62:102331. [DOI: 10.1016/j.jelekin.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 01/08/2023] Open
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21
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Felter CE, Neuland EE, Iuculano SC, Dean J. Interdisciplinary, Intensive, Activity-Based Treatment for Intrauterine Spinal Cord Infarct: A Case Report. Top Spinal Cord Inj Rehabil 2019; 25:97-103. [PMID: 30774293 DOI: 10.1310/sci18-00025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intrauterine spinal cord infarcts (IUSCI) with resulting tetraplegia are extremely rare, and there is minimal evidence describing outcomes in this population. This case describes the functional progress of a 3-year-old girl born with IUSCI who participated in activity-based therapies (ABT). Children have developing nervous systems and are particularly suited to benefit from ABT. Over the course of treatment, the child in this case has demonstrated improvements in developmental milestone achievement including fine and gross motor skills and social/cognitive development. Intense, interdisciplinary ABT should be considered for the treatment of children with IUSCI.
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Affiliation(s)
- Cara E Felter
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, Maryland
| | - Erin E Neuland
- International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger Institute, Baltimore, Maryland
| | - Shannon C Iuculano
- International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger Institute, Baltimore, Maryland
| | - Janet Dean
- International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger Institute, Baltimore, Maryland
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22
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Rammer J, Slavens B, Krzak J, Winters J, Riedel S, Harris G. Assessment of a markerless motion analysis system for manual wheelchair application. J Neuroeng Rehabil 2018; 15:96. [PMID: 30400917 PMCID: PMC6219189 DOI: 10.1186/s12984-018-0444-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 10/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Wheelchair biomechanics research advances accessibility and clinical care for manual wheelchair users. Standardized outcome assessments are vital tools for tracking progress, but there is a strong need for more quantitative methods. A system offering kinematic, quantitative detection, with the ease of use of a standardized outcome assessment, would be optimal for repeated, longitudinal assessment of manual wheelchair users' therapeutic progress, but has yet to be offered. RESULTS This work evaluates a markerless motion analysis system for manual wheelchair mobility in clinical, community, and home settings. This system includes Microsoft® Kinect® 2.0 sensors, OpenSim musculoskeletal modeling, and an automated detection, processing, and training interface. The system is designed to be cost-effective, easily used by caregivers, and capable of detecting key kinematic metrics involved in manual wheelchair propulsion. The primary technical advancements in this research are the software components necessary to detect and process the upper extremity kinematics during manual wheelchair propulsion, along with integration of the components into a complete system. The study defines and evaluates an adaptable systems methodology for processing kinematic data using motion capture technology and open-source musculoskeletal models to assess wheelchair propulsion pattern and biomechanics, and characterizes its accuracy, sensitivity and repeatability. Inter-trial repeatability of spatiotemporal parameters, joint range of motion, and musculotendon excursion were all found to be significantly correlated (p < 0.05). CONCLUSIONS The system is recommended for use in clinical settings for frequent wheelchair propulsion assessment, provided the limitations in precision are considered. The motion capture-model software bridge methodology could be applied in the future to any motion-capture system or specific application, broadening access to detailed kinematics while reducing assessment time and cost.
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Affiliation(s)
- Jacob Rammer
- Orthopaedic and Rehabilitation Engineering Center (OREC), Marquette University, Olin Engineering Suite 323, Milwaukee, WI, 53201-1881, USA. .,Department of Biomedical Engineering, Marquette University, Olin Engineering Suite 323, Milwaukee, WI, 53201-1881, USA. .,Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, 53201-1881, USA.
| | - Brooke Slavens
- University of Wisconsin-Milwaukee, 2400 E Hartford Ave, Rm. 983, Milwaukee, WI, 53211, USA
| | - Joseph Krzak
- Shriners Hospitals for Children, Chicago, IL, USA.,Midwestern University, Physical Therapy Program, 555 31st St., Alumni Hall 340C, Downers Grove, IL, 60515, USA
| | - Jack Winters
- Marquette University, Biomedical Engineering, Milwaukee, WI, 53201-1881, USA
| | - Susan Riedel
- Orthopaedic and Rehabilitation Engineering Center (OREC), Marquette University, Olin Engineering Suite 323, Milwaukee, WI, 53201-1881, USA.,Department of Biomedical Engineering, Marquette University, Olin Engineering Suite 323, Milwaukee, WI, 53201-1881, USA.,Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, 53201-1881, USA
| | - Gerald Harris
- Orthopaedic and Rehabilitation Engineering Center (OREC), Marquette University, Olin Engineering Suite 323, Milwaukee, WI, 53201-1881, USA.,Department of Biomedical Engineering, Marquette University, Olin Engineering Suite 323, Milwaukee, WI, 53201-1881, USA.,Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, 53201-1881, USA.,Shriners Hospitals for Children, Chicago, IL, USA
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23
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Mason BS, Vegter RJK, Paulson TAW, Morrissey D, van der Scheer JW, Goosey-Tolfrey VL. Bilateral scapular kinematics, asymmetries and shoulder pain in wheelchair athletes. Gait Posture 2018; 65:151-156. [PMID: 30558924 DOI: 10.1016/j.gaitpost.2018.07.170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/09/2018] [Accepted: 07/19/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Shoulder pain is the most common complaint for wheelchair athletes. Scapular orientation and dyskinesia are thought to be associated with shoulder pathology, yet no previous studies have examined the bilateral scapula kinematics of wheelchair athletes during propulsion. RESEARCH QUESTION To examine bilateral scapular kinematics of highly trained wheelchair rugby (WR) players and any associations with self-reported shoulder pain during everyday wheelchair propulsion. METHODS Ten WR players (5 with shoulder pain, 5 without) performed 2 × 3-minute bouts of exercise in their everyday wheelchair on a wheelchair ergometer at two sub-maximal speeds (3 and 6 km h-1). During the final minute, 3D kinematic data were collected at 100 Hz to describe scapulothoracic motion relative to each propulsion cycle. Instantaneous asymmetries in scapular orientation between dominant and non-dominant sides were also reported. Differences in scapular kinematics and propulsion asymmetries were compared across shoulders symptomatic and asymptomatic of pain. RESULTS An internally rotated, upwardly rotated and anteriorly tilted scapula was common during wheelchair propulsion and asymmetries ≤14° did exist, yet minimal changes were observed across speeds. Participants with bilateral shoulder pain displayed a less upwardly rotated scapula during propulsion, however large inter-individual variability in scapular kinematics was noted. SIGNIFICANCE Scapular asymmetries are exhibited by wheelchair athletes during wheelchair propulsion, yet these were not exacerbated by increased speed and had limited associations to shoulder pain. This suggests that propulsion kinematics of highly trained athletes may not be the primary cause of pain experienced by this population.
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Affiliation(s)
- Barry S Mason
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise & Health Sciences, Loughborough University, UK(1).
| | - Riemer J K Vegter
- Faculty of Medical Sciences, University of Groningen, The Netherlands
| | - Thomas A W Paulson
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise & Health Sciences, Loughborough University, UK(1)
| | - Dylan Morrissey
- Sport and Exercise Medicine, Queen Mary University of London, UK; Barts Health NHS Trust, London, UK
| | - Jan W van der Scheer
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise & Health Sciences, Loughborough University, UK(1)
| | - Victoria L Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise & Health Sciences, Loughborough University, UK(1)
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Reinkensmeyer DJ, Blackstone S, Bodine C, Brabyn J, Brienza D, Caves K, DeRuyter F, Durfee E, Fatone S, Fernie G, Gard S, Karg P, Kuiken TA, Harris GF, Jones M, Li Y, Maisel J, McCue M, Meade MA, Mitchell H, Mitzner TL, Patton JL, Requejo PS, Rimmer JH, Rogers WA, Zev Rymer W, Sanford JA, Schneider L, Sliker L, Sprigle S, Steinfeld A, Steinfeld E, Vanderheiden G, Winstein C, Zhang LQ, Corfman T. How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR's Rehabilitation Engineering Research Centers. J Neuroeng Rehabil 2017; 14:109. [PMID: 29110728 PMCID: PMC5674748 DOI: 10.1186/s12984-017-0321-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 10/26/2017] [Indexed: 01/14/2023] Open
Abstract
Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a "total approach to rehabilitation", combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970's, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program.
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Affiliation(s)
| | | | | | - John Brabyn
- The Smith-Kettlewell Eye Research Institute, San Francesco, USA
| | | | | | | | | | - Stefania Fatone
- Northwestern University Prosthetics-Orthotics Center, Evanston, USA
| | - Geoff Fernie
- Toronto Rehabilitation Institute, Toronto, Canada
| | - Steven Gard
- Northwestern University Prosthetics-Orthotics Center, Evanston, USA
| | | | | | | | | | - Yue Li
- Toronto Rehabilitation Institute, Toronto, Canada
| | | | | | | | | | | | - James L. Patton
- Rehabilitation Institute of Chicago, University of Illinois at Chicago, Chicago, USA
| | | | - James H. Rimmer
- Lakeshore FoundationUniversity of Alabama-Birmingham, Birmingham, USA
| | | | - W. Zev Rymer
- Rehabilitation Institute of Chicago, Chicago, USA
| | | | | | | | | | - Aaron Steinfeld
- Robotics Institute, Carnegie Mellon University, Pittsburgh, USA
| | | | | | | | | | - Thomas Corfman
- National Institute on Disability, Independent Living, and Rehabilitation Research, Washington, DC, USA
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Jahanian O, Schnorenberg AJ, Slavens BA. Evaluation of shoulder joint kinematics and muscle activity during geared and standard manual wheelchair mobility. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:6162-6165. [PMID: 28269659 DOI: 10.1109/embc.2016.7592135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Manual wheelchairs often lead to reduced independent function and an increase in shoulder pain and injuries. Geared manual wheelchairs may be a promising alternative that reduces the biomechanical demands of the shoulder needed for tasks such as propulsion on ramps and carpeted floors, while maximizing function and participation. To investigate the effects of geared manual wheelchair mobility during demanding tasks such as ramp ascent, six able-bodied subjects were evaluated in this study. Subjects were asked to propel both standard and geared manual wheelchairs on a tiled level floor and on a wheelchair ADA ramp. Shoulder muscle activity and glenohumeral joint kinematics were investigated. The results indicated that using geared manual wheelchair wheels did not alter the shoulder joint kinematics, but notably affected peak and integrated shoulder muscle activity. Muscle activity results normalized by stroke distance, indicated that using geared manual wheelchairs could decrease anterior deltoid, pectoralis major and infraspinatus muscle activity during ramp ascending, but on level floor infraspinatus muscle activity may increase. These results could have clinical implications for determining the types of functional mobility tasks for which geared manual wheelchairs are beneficial.
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Slavens BA, Schnorenberg AJ, Aurit CM, Tarima S, Vogel LC, Harris GF. Biomechanics of Pediatric Manual Wheelchair Mobility. Front Bioeng Biotechnol 2015; 3:137. [PMID: 26442251 PMCID: PMC4564732 DOI: 10.3389/fbioe.2015.00137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/26/2015] [Indexed: 12/02/2022] Open
Abstract
Currently, there is limited research of the biomechanics of pediatric manual wheelchair mobility. Specifically, the biomechanics of functional tasks and their relationship to joint pain and health is not well understood. To contribute to this knowledge gap, a quantitative rehabilitation approach was applied for characterizing upper extremity biomechanics of manual wheelchair mobility in children and adolescents during propulsion, starting, and stopping tasks. A Vicon motion analysis system captured movement, while a SmartWheel simultaneously collected three-dimensional forces and moments occurring at the handrim. A custom pediatric inverse dynamics model was used to evaluate three-dimensional upper extremity joint motions, forces, and moments of 14 children with spinal cord injury (SCI) during the functional tasks. Additionally, pain and health-related quality of life outcomes were assessed. This research found that joint demands are significantly different amongst functional tasks, with greatest demands placed on the shoulder during the starting task. Propulsion was significantly different from starting and stopping at all joints. We identified multiple stroke patterns used by the children, some of which are not standard in adults. One subject reported average daily pain, which was minimal. Lower than normal physical health and higher than normal mental health was found in this population. It can be concluded that functional tasks should be considered in addition to propulsion for rehabilitation and SCI treatment planning. This research provides wheelchair users and clinicians with a comprehensive, biomechanical, mobility assessment approach for wheelchair prescription, training, and long-term care of children with SCI.
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Affiliation(s)
- Brooke A Slavens
- Movement Analysis for Biomedical Innovation & Technology (Mobility) Laboratory, Department of Occupational Science and Technology, University of Wisconsin-Milwaukee , Milwaukee, WI , USA ; Shriners Hospitals for Children - Chicago , Chicago, IL , USA ; Orthopaedic and Rehabilitation Engineering Center (OREC), Medical College of Wisconsin and Marquette University , Milwaukee, WI , USA
| | - Alyssa J Schnorenberg
- Movement Analysis for Biomedical Innovation & Technology (Mobility) Laboratory, Department of Occupational Science and Technology, University of Wisconsin-Milwaukee , Milwaukee, WI , USA
| | - Christine M Aurit
- Movement Analysis for Biomedical Innovation & Technology (Mobility) Laboratory, Department of Occupational Science and Technology, University of Wisconsin-Milwaukee , Milwaukee, WI , USA
| | - Sergey Tarima
- Department of Biostatistics, Medical College of Wisconsin , Milwaukee, WI , USA
| | | | - Gerald F Harris
- Shriners Hospitals for Children - Chicago , Chicago, IL , USA ; Orthopaedic and Rehabilitation Engineering Center (OREC), Medical College of Wisconsin and Marquette University , Milwaukee, WI , USA
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Soltau SL, Slowik JS, Requejo PS, Mulroy SJ, Neptune RR. An Investigation of Bilateral Symmetry During Manual Wheelchair Propulsion. Front Bioeng Biotechnol 2015; 3:86. [PMID: 26125019 PMCID: PMC4464056 DOI: 10.3389/fbioe.2015.00086] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 05/25/2015] [Indexed: 11/13/2022] Open
Abstract
Studies of manual wheelchair propulsion often assume bilateral symmetry to simplify data collection, processing, and analysis. However, the validity of this assumption is unclear. Most investigations of wheelchair propulsion symmetry have been limited by a relatively small sample size and a focus on a single propulsion condition (e.g., level propulsion at self-selected speed). The purpose of this study was to evaluate bilateral symmetry during manual wheelchair propulsion in a large group of subjects across different propulsion conditions. Three-dimensional kinematics and handrim kinetics along with spatiotemporal variables were collected and processed from 80 subjects with paraplegia while propelling their wheelchairs on a stationary ergometer during three different conditions: level propulsion at their self-selected speed (free), level propulsion at their fastest comfortable speed (fast), and propulsion on an 8% grade at their level, self-selected speed (graded). All kinematic variables had significant side-to-side differences, primarily in the graded condition. Push angle was the only spatiotemporal variable with a significant side-to-side difference, and only during the graded condition. No kinetic variables had significant side-to-side differences. The magnitudes of the kinematic differences were low, with only one difference exceeding 5°. With differences of such small magnitude, the bilateral symmetry assumption appears to be reasonable during manual wheelchair propulsion in subjects without significant upper-extremity pain or impairment. However, larger asymmetries may exist in individuals with secondary injuries and pain in their upper extremity and different etiologies of their neurological impairment.
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Affiliation(s)
- Shelby L Soltau
- Department of Mechanical Engineering, The University of Texas at Austin , Austin, TX , USA
| | - Jonathan S Slowik
- Department of Mechanical Engineering, The University of Texas at Austin , Austin, TX , USA
| | - Philip S Requejo
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center , Downey, CA , USA ; Rehabilitation Engineering, Rancho Los Amigos National Rehabilitation Center , Downey, CA , USA
| | - Sara J Mulroy
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center , Downey, CA , USA
| | - Richard R Neptune
- Department of Mechanical Engineering, The University of Texas at Austin , Austin, TX , USA
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Evaluation of pediatric manual wheelchair mobility using advanced biomechanical methods. BIOMED RESEARCH INTERNATIONAL 2015; 2015:634768. [PMID: 25802860 PMCID: PMC4352734 DOI: 10.1155/2015/634768] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/03/2014] [Accepted: 07/21/2014] [Indexed: 11/17/2022]
Abstract
There is minimal research of upper extremity joint dynamics during pediatric wheelchair mobility despite the large number of children using manual wheelchairs. Special concern arises with the pediatric population, particularly in regard to the longer duration of wheelchair use, joint integrity, participation and community integration, and transitional care into adulthood. This study seeks to provide evaluation methods for characterizing the biomechanics of wheelchair use by children with spinal cord injury (SCI). Twelve subjects with SCI underwent motion analysis while they propelled their wheelchair at a self-selected speed and propulsion pattern. Upper extremity joint kinematics, forces, and moments were computed using inverse dynamics methods with our custom model. The glenohumeral joint displayed the largest average range of motion (ROM) at 47.1° in the sagittal plane and the largest average superiorly and anteriorly directed joint forces of 6.1% BW and 6.5% BW, respectively. The largest joint moments were 1.4% body weight times height (BW × H) of elbow flexion and 1.2% BW × H of glenohumeral joint extension. Pediatric manual wheelchair users demonstrating these high joint demands may be at risk for pain and upper limb injuries. These evaluation methods may be a useful tool for clinicians and therapists for pediatric wheelchair prescription and training.
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Relationships between wheeling parameters and wheelchair skills in adults and children with SCI. Spinal Cord 2015; 53:561-4. [PMID: 25687512 DOI: 10.1038/sc.2015.29] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 01/06/2015] [Accepted: 01/15/2015] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES To determine the relationships between (1) wheeling parameters using the SmartWheel Clinical Protocol (SCP) and wheelchair skills (wheelchair skills test 4.1 (WST)) and (2) push effectiveness (m per push) and the WST, among individuals with spinal cord injury. SETTING Biomechanics Laboratory, Canada. METHODS Sixteen adults and eight children participated in this study. Multiple regression analyses were used to determine significant SCP predictors (that is, weight-normalised peak force, speed, push frequency and mechanical effectiveness) of WST score. To determine relationships between push effectiveness and WST scores, Pearson's correlations were calculated. RESULTS SCP-TILE: speed and mechanical effectiveness explained 36% of the variance in the WST score. SCP-RAMP and SCP-CARPET: speed explained 58% and 37% of the variance in the WST score, respectively. Push effectiveness was significantly correlated with the WST score on all three surfaces (tile, ramp and carpet). CONCLUSION Wheeling speed was a significant predictor of the WST score for all surfaces tested. Regression analyses demonstrated that SCP-RAMP had the strongest relationship with WST score. Therefore, when time is restricted, the SCP-RAMP may be the most predictive test and speed may be the most useful variable to evaluate. However, the authors do not believe that one single variable should ever replace a full assessment of skills.
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Schnorenberg AJ, Slavens BA, Graf A, Krzak J, Vogel L, Harris GF. Upper extremity biomechanics of children with spinal cord injury during wheelchair mobility. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:4338-41. [PMID: 25570952 DOI: 10.1109/embc.2014.6944584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
While much work is being done evaluating the upper extremity joint dynamics of adult manual wheelchair propulsion, limited work has examined the pediatric population of manual wheelchair users. Our group used a custom pediatric biomechanical model to characterize the upper extremity joint dynamics of 12 children and adolescents with spinal cord injury (SCI) during wheelchair propulsion. Results show that loading appears to agree with that of adult manual wheelchair users, with the highest loading primarily seen at the glenohumeral joint. This is concerning due to the increased time of wheelchair use in the pediatric population and the impact of this loading during developmental years. This research may assist clinicians with improved mobility assessment methods, wheelchair prescription, training, and long-term care of children with orthopaedic disabilities.
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