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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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Assila N, Rushton PW, Duprey S, Begon M. Trunk and glenohumeral joint adaptations to manual wheelchair propulsion over a cross-slope: An exploratory study. Clin Biomech (Bristol, Avon) 2024; 111:106167. [PMID: 38184895 DOI: 10.1016/j.clinbiomech.2023.106167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/30/2023] [Accepted: 12/29/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Cross-slopes are often encountered by manual wheelchair users propelling within an urban setting. While propulsion over cross-slopes is more difficult than on level surfaces, little is known about how the users counter the downhill turning tendency of the wheelchair over cross-slopes. This study aimed to identify the adaptations of the manual wheelchair users to the presence of cross-slopes and examine how these might impact shoulder injury. METHODS Nine manual wheelchair users propelled themselves across a cross-slope and over a level surface. The trunk and glenohumeral joint kinematics, as well as the handrim contact tangential force were compared between both conditions for the uphill and downhill limbs. FINDINGS The uphill arm technique used to counter the downhill turning tendency varied greatly in terms of potential injury risk and efficiency between participants. Trunk flexion increased the turning tendency of the manual wheelchair, yet only one participant decreased his flexion when rolling over the cross-slope. Various potential pathomecanisms related to the trunk lateral flexion and the glenohumeral kinematics over a cross-slope were identified. INTERPRETATION Both the uphill arm technique and trunk kinematics are important to propel over a cross-slope both efficiently and safely. Accordingly, tips about posture and kinematics are needed to teach this skill to manual wheelchair users. Additionally, as wheelchair positioning seems to influence the cross-slope skill, more research is needed to explore the impact of positioning devices (e.g., lateral supports) and wheelchair modifications (e.g., power assist wheels, handrim projections) on this skill.
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Affiliation(s)
- Najoua Assila
- School of Kinesiology and Physical Activity Sciences, University of Montréal, Montréal, QC, Canada; CHU St-Justine Research Center, Montréal, QC, Canada; Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T9406, Lyon, France.
| | - Paula W Rushton
- CHU St-Justine Research Center, Montréal, QC, Canada; School of Rehabilitation, University of Montréal, Montréal, QC, Canada
| | - Sonia Duprey
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T9406, Lyon, France
| | - Mickaël Begon
- School of Kinesiology and Physical Activity Sciences, University of Montréal, Montréal, QC, Canada; CHU St-Justine Research Center, Montréal, QC, Canada
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Briley SJ, O'Brien TJ, Oh YT, Vegter RJK, Chan M, Mason BS, Goosey-Tolfrey VL. Wheelchair rugby players maintain sprint performance but alter propulsion biomechanics after simulated match play. Scand J Med Sci Sports 2023; 33:1726-1737. [PMID: 37278319 DOI: 10.1111/sms.14423] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/26/2023] [Accepted: 05/23/2023] [Indexed: 06/07/2023]
Abstract
The study aimed to explore the influence of a sports-specific intermittent sprint protocol (ISP) on wheelchair sprint performance and the kinetics and kinematics of sprinting in elite wheelchair rugby (WR) players with and without spinal cord injury (SCI). Fifteen international WR players (age 30.3 ± 5.5 years) performed two 10-s sprints on a dual roller wheelchair ergometer before and immediately after an ISP consisting of four 16-min quarters. Physiological measurements (heart rate, blood lactate concentration, and rating of perceived exertion) were collected. Three-dimensional thorax and bilateral glenohumeral kinematics were quantified. Following the ISP, all physiological parameters significantly increased (p ≤ 0.027), but neither sprinting peak velocity nor distance traveled changed. Players propelled with significantly reduced thorax flexion and peak glenohumeral abduction during both the acceleration (both -5°) and maximal velocity phases (-6° and 8°, respectively) of sprinting post-ISP. Moreover, players exhibited significantly larger mean contact angles (+24°), contact angle asymmetries (+4%), and glenohumeral flexion asymmetries (+10%) during the acceleration phase of sprinting post-ISP. Players displayed greater glenohumeral abduction range of motion (+17°) and asymmetries (+20%) during the maximal velocity phase of sprinting post-ISP. Players with SCI (SCI, n = 7) significantly increased asymmetries in peak power (+6%) and glenohumeral abduction (+15%) during the acceleration phase post-ISP. Our data indicates that despite inducing physiological fatigue resulting from WR match play, players can maintain sprint performance by modifying how they propel their wheelchair. Increased asymmetry post-ISP was notable, which may be specific to impairment type and warrants further investigation.
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Affiliation(s)
- Simon J Briley
- Human Sciences Research Centre, University of Derby, Derby, UK
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
| | - Thomas J O'Brien
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
| | - Yim-Taek Oh
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
| | - Riemer J K Vegter
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mui Chan
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
| | - Barry S Mason
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
| | - Victoria L Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
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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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Briley SJ, Vegter RJK, Goosey-Tolfrey VL, Mason BS. Alterations in shoulder kinematics are associated with shoulder pain during wheelchair propulsion sprints. Scand J Med Sci Sports 2022; 32:1213-1223. [PMID: 35620900 PMCID: PMC9545165 DOI: 10.1111/sms.14200] [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: 12/03/2021] [Revised: 01/27/2022] [Accepted: 04/04/2022] [Indexed: 12/02/2022]
Abstract
The study purpose was to examine the biomechanical characteristics of sports wheelchair propulsion and determine biomechanical associations with shoulder pain in wheelchair athletes. Twenty wheelchair court‐sport athletes (age: 32 ± 11 years old) performed one submaximal propulsion trial in their sports‐specific wheelchair at 1.67 m/s for 3 min and two 10 s sprints on a dual‐roller ergometer. The Performance Corrected Wheelchair User's Shoulder Pain Index (PC‐WUSPI) assessed shoulder pain. During the acceleration phase of wheelchair sprinting, participants propelled with significantly longer push times, larger forces, and thorax flexion range of motion (ROM) than both the maximal velocity phase of sprinting and submaximal propulsion. Participants displayed significantly greater peak glenohumeral abduction and scapular internal rotation during the acceleration phase (20 ± 9° and 45 ± 7°) and maximal velocity phase (14 ± 4° and 44 ± 7°) of sprinting, compared to submaximal propulsion (12 ± 6° and 39 ± 8°). Greater shoulder pain severity was associated with larger glenohumeral abduction ROM (r = 0.59, p = 0.007) and scapular internal rotation ROM (r = 0.53, p = 0.017) during the acceleration phase of wheelchair sprinting, but with lower peak glenohumeral flexion (r = −0.49, p = 0.030), peak abduction (r = −0.48, p = 0.034), and abduction ROM (r = −0.44, p = 0.049) during the maximal velocity phase. Biomechanical characteristics of wheelchair sprinting suggest this activity imposes greater mechanical stress than submaximal propulsion. Kinematic associations with shoulder pain during acceleration are in shoulder orientations linked to a reduced subacromial space, potentially increasing tissue stress.
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Affiliation(s)
- Simon J Briley
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,Human Sciences Research Centre, University of Derby, Derby, UK
| | - Riemer J K Vegter
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Victoria L Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Barry S Mason
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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