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Assila N, Begon M, Duprey S. Finite Element Model of the Shoulder with Active Rotator Cuff Muscles: Application to Wheelchair Propulsion. Ann Biomed Eng 2024; 52:1240-1254. [PMID: 38376768 DOI: 10.1007/s10439-024-03449-5] [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: 09/06/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024]
Abstract
The rotator cuff is prone to injury, remarkably so for manual wheelchair users. To understand its pathomechanisms, finite element models incorporating three-dimensional activated muscles are needed to predict soft tissue strains during given tasks. This study aimed to develop such a model to understand pathomechanisms associated with wheelchair propulsion. We developed an active muscle model associating a passive fiber-reinforced isotropic matrix with an activation law linking calcium ion concentration to tissue tension. This model was first evaluated against known physiological muscle behavior; then used to activate the rotator cuff during a wheelchair propulsion cycle. Here, experimental kinematics and electromyography data was used to drive a shoulder finite element model. Finally, we evaluated the importance of muscle activation by comparing the results of activated and non-activated rotator cuff muscles during both propulsion and isometric contractions. Qualitatively, the muscle constitutive law reasonably reproduced the classical Hill model force-length curve and the behavior of a transversally loaded muscle. During wheelchair propulsion, the deformation and fiber stretch of the supraspinatus muscle-tendon unit pointed towards the possibility for this tendon to develop tendinosis due to the multiaxial loading imposed by the kinematics of propulsion. Finally, differences in local stretch and positions of the lines of action between activated and non-activated models were only observed at activation levels higher than 30%. Our novel finite element model with active muscles is a promising tool for understanding the pathomechanisms of the rotator cuff for various dynamic tasks, especially those with high muscle activation levels.
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Affiliation(s)
- Najoua Assila
- School of Kinesiology and Exercise Sciences, Faculty of Medicine, University of Montréal, Montréal, QC, Canada.
- Research Center of the Sainte-Justine University Hospital Center, Montréal, QC, Canada.
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR T_9406, 69622, Lyon, France.
| | - Mickaël Begon
- School of Kinesiology and Exercise Sciences, Faculty of Medicine, University of Montréal, Montréal, QC, Canada
- Research Center of the Sainte-Justine University Hospital Center, Montréal, QC, Canada
| | - Sonia Duprey
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR T_9406, 69622, Lyon, France
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Canori A, Coffman DL, Wright WG, Finley MA, Hiremath SV. Differential relationships between physical activity and pain phenotypes in individuals with spinal cord injury. J Spinal Cord Med 2024:1-10. [PMID: 38661677 DOI: 10.1080/10790268.2024.2344315] [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: 04/26/2024] Open
Abstract
BACKGROUND Chronic pain affects 70% of individuals with spinal cord injury (SCI) and leads to declines in health and quality of life. Neuropathic and nociceptive pain are phenotypes derived from different mechanisms that contribute to pain perception. The objective of this research was to investigate differential pain responses to moderate-to-vigorous physical activity (MVPA) in two chronic pain phenotypes: neuropathic and nociceptive pain. METHODS Community-based physical activity levels were collected for one week in 17 individuals with SCI using a wrist-worn accelerometer, and daily pain ratings were assessed and categorized by phenotype. Physical activity levels were summarized to calculate minutes of MVPA. Correlational analyses were conducted to compare relationships between pain intensity and MVPA across individual participants and between pain phenotype groups. RESULTS The neuropathic pain group revealed significant negative correlation between MVPA and pain intensity. In the nociceptive pain group, there was no significant correlation between MVPA and pain intensity. Further analysis revealed two subgroups of positive (N = 4) and negative (N = 3) correlations between MVPA and pain intensity. Pain location differed between the subgroups of nociceptive pain. Individuals with negative correlation experienced neck and upper back pain, whereas individuals with positive correlation experienced unilateral upper extremity pain. CONCLUSION Differential relationships exist between pain phenotypes and MVPA in individuals with SCI. Pain location differed between the subgroups of nociceptive pain, which we presume may indicate the presence of nociplastic pain in some individuals. These results may contribute to the advancement of personalized pain management by targeting non-pharmacological interventions for specific pain phenotypes.Trial registration: ClinicalTrials.gov identifier: NCT05236933..
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Affiliation(s)
- Alexandra Canori
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
| | - Donna L Coffman
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - W Geoffrey Wright
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
| | - Margaret A Finley
- Department of Physical Therapy and Rehabilitation Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - Shivayogi V Hiremath
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
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Minder U, Arnet U, Müller E, Boninger M, Bossuyt FM. Changes in neuromuscular activation, heart rate and rate of perceived exertion over the course of a wheelchair propulsion fatigue protocol. Front Physiol 2023; 14:1220969. [PMID: 37920802 PMCID: PMC10619735 DOI: 10.3389/fphys.2023.1220969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023] Open
Abstract
Shoulder pain is common in persons with spinal cord injury and has been associated with wheelchair use. Fatigue related compensation strategies have been identified as possibly impacting the development of shoulder injury and pain. The purpose of this study was to investigate the progression of performance fatigability (i.e., decline in objective measure of performance including neuromuscular activation and increase in heart rate) and perceived fatigability (i.e., increased perceived exertion) during a 15-min fatigue protocol including maximum voluntary overground wheelchair propulsion. Fifty participants with paraplegic spinal cord injury completed three 4-min rounds of wheelchair propulsion, separated by 90 s of rest, on a figure-8 course consisting of two turns and full stops per lap in their manual wheelchairs (ClinicalTrials.gov: NCT03153033). Electromyography (EMG) signal of five muscles acting on the shoulder joint, heart rate (HR), and rate of perceived exertion (RPE) were measured at the beginning and end of every 4 min of propulsion. Root Mean Square (RMS) and Mean Power Frequency were calculated from EMG data. There was a significant increase in %RMS of the pectoralis major pars sternalis and trapezius pars descendens, HR, and RPE with greatest changes during the first 4 min of the protocol. The observed changes in neuromuscular activation in only two of the shoulder muscles may impact muscular imbalances and the development of shoulder injuries and should be further studied. The current study gives clearer insight into the mechanisms of performance fatigability and perceived fatigability throughout a wheelchair propulsion fatigue protocol.
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Affiliation(s)
- Ursina Minder
- Neuro-musculoskeletal Functioning and Mobility Groupe, Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Ursina Arnet
- Neuro-musculoskeletal Functioning and Mobility Groupe, Swiss Paraplegic Research, Nottwil, Switzerland
| | - Erich Müller
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - Michael Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
| | - Fransiska M. Bossuyt
- Neuro-musculoskeletal Functioning and Mobility Groupe, Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zurich, Switzerland
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Vila-Dieguez O, Heindel MD, Awokuse D, Kulig K, Michener LA. Exercise for rotator cuff tendinopathy: Proposed mechanisms of recovery. Shoulder Elbow 2023; 15:233-249. [PMID: 37325389 PMCID: PMC10268139 DOI: 10.1177/17585732231172166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 06/17/2023]
Abstract
Rotator cuff (RC) tendinopathy is a common recurrent cause of shoulder pain, and resistance exercise is the first-line recommended intervention. Proposed causal mechanisms of resistance exercise for patients with RC tendinopathy consist of four domains: tendon structure, neuromuscular factors, pain and sensorimotor processing, and psychosocial factors. Tendon structure plays a role in RC tendinopathy, with decreased stiffness, increased thickness, and collagen disorganization. Neuromuscular performance deficits of altered kinematics, muscle activation, and force are present in RC tendinopathy, but advanced methods of assessing muscle performance are needed to fully assess these factors. Psychological factors of depression, anxiety, pain catastrophizing, treatment expectations, and self-efficacy are present and predict patient-reported outcomes. Central nervous system dysfunctions also exist, specifically altered pain and sensorimotor processing. Resisted exercise may normalize these factors, but limited evidence exists to explain the relationship of the four proposed domains to trajectory of recovery and defining persistent deficits limiting outcomes. Clinicians and researchers can use this model to understand how exercise mediates change in patient outcomes, develop subgroups to deliver patient-specific approach for treatment and define metrics to track recovery over time. Supporting evidence is limited, indicating the need for future studies characterizing mechanisms of recovery with exercise for RC tendinopathy.
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Affiliation(s)
- Oscar Vila-Dieguez
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Matthew D. Heindel
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Daniel Awokuse
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Kornelia Kulig
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Lori A. Michener
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Arnet U, Boninger ML, Cools A, Bossuyt FM. Effect of Fatiguing Wheelchair Propulsion and Weight Relief Lifts on Subacromial Space in Wheelchair Users. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:849629. [PMID: 36189050 PMCID: PMC9397688 DOI: 10.3389/fresc.2022.849629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022]
Abstract
ObjectiveThis study aimed to identify targets of intervention for reducing shoulder pain in wheelchair users with spinal cord injury (SCI) by (1) examining changes in subacromial space [acromiohumeral distance (AHD) and occupation ratio (OccRatio)] with fatiguing wheelchair propulsion, and different loading conditions [unloaded position vs. weight relief lifts (WRL)]; (2) associating these changes with wheelchair user capacity, as well as (3) identifying subject characteristics associated with subacromial space, such as sex, lesion level, time since injury, body mass index and impaired shoulder range of motion.MethodsFifty manual wheelchair users with SCI [11 females, age = 50.5 (9.7) years, time since injury = 26.2 (11.4) years] participated in this quasi-experimental one-group pretest-posttest study. Ultrasound images were used to define AHD during an unloaded position, and during personal and instructed WRL before and after fatiguing wheelchair propulsion. Furthermore, supraspinatus and biceps thickness defined from ultrasound images were used to calculate OccRatios. Wheelchair user capacity was quantified as functional strength (maximum resultant force reached during maximum isometric forward push) and anaerobic work capacity (highest power output reached during 15-m sprint test). Multilevel mixed-effects linear regression analyses controlling for between subject variability and covariables were performed to address the research questions.ResultsAHD was significantly smaller during personal WRL (p < 0.001) and instructed WRL (p = 0.009, AHD both 11.5 mm) compared to the unloaded position (11.9 mm). A higher wheelchair user capacity (higher anaerobic work capacity) reduced the impact of WRL on AHD decrease. The fatiguing wheelchair propulsion had no effect on AHD (p = 0.570) and on OccRatio of supraspinatus (p = 0.404) and biceps (p = 0.448). Subject characteristics related to a larger subacromial space were lower lesion level, shorter time since injury, impaired external rotation, a lower body mass index and a higher anaerobic work capacity.ConclusionThis study showed a significant reduction in AHD during WRL with no effect of fatiguing wheelchair propulsion on the subacromial space in wheelchair users with SCI. A higher anaerobic work capacity was beneficial in stabilizing the shoulder during WRL. Our findings may assist clinicians in designing a shoulder injury prevention program.
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Affiliation(s)
- Ursina Arnet
- Shoulder Health and Mobility Group, Swiss Paraplegic Research, Nottwil, Switzerland
- *Correspondence: Ursina Arnet
| | - Michael L. Boninger
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, University of Ghent, Ghent, Belgium
| | - Fransiska M. Bossuyt
- Shoulder Health and Mobility Group, Swiss Paraplegic Research, Nottwil, Switzerland
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
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Bossuyt FM, Mason BS, Briley S, O'Brien TJ, Boninger ML, Arnet U, Goosey-Tolfrey VL. Shoulder Tendon Adaptations Following a Graded Exercise Test to Exhaustion in Highly Trained Wheelchair Rugby Athletes With Different Impairments. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:755466. [PMID: 36188798 PMCID: PMC9397820 DOI: 10.3389/fresc.2021.755466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022]
Abstract
Objective This study aimed to identify acute changes in biceps and supraspinatus tendon characteristics before and after a graded exercise test to exhaustion (GXT) in highly trained wheelchair rugby (WR) athletes. A secondary aspect was to define chronic tendon adaptations related to the impairment of the athlete and the occupation of the tendon within the subacromial space (occupation ratio). Methods Twelve WR athletes with different impairments (age = 32 ± 6 years; body mass = 67.2 ± 11.2 kg; 9.0 ± 3.6 years competing) volunteered for this study. Performance Corrected Wheelchair Users Shoulder Pain Index was used to quantify shoulder pain. Quantitative Ultrasound Protocols (QUS) were used to define supraspinatus and biceps tendon thickness, echogenicity, and echogenicity ratio of both dominant and non-dominant shoulder before and after the GXT including 22 ± 3.1 min submaximal propulsion and 10.2 ± 1.7 min maximal propulsion on a treadmill. Furthermore, the acromio-humeral distance (AHD) defined from ultrasound (US) images was used to calculate the occupation ratios. Results A mixed-effect multilevel analysis that included shoulder as grouping variable, demonstrated a significant reduction in the echogenicity of the biceps following GXT whilst controlling for impairment [spinal cord injury (SCI) and non-SCI] and the occupation ratio (β = −9.01, SEβ = 2.72, p = 0.001, 95% CI = [−14.34; −3.68]). This points toward fluid inflow into the tendon that may be related to overload and acute inflammation. In addition, persons with a SCI (n = 8) had a thicker supraspinatus tendon in comparison to persons with non-SCI (n = 3) which may be related to chronic tendon adaptations (β = −0.53 mm, SEβ = 0.26, p = 0.038, 95% CI = [−1.04; −0.03]). Finally, a greater occupation ratio was associated with signs of tendinopathy (i.e., greater biceps and supraspinatus tendon thickness, and lower supraspinatus echogenicity and echogenicity ratio). Conclusion Acute biceps tendon adaptations in response to the GXT in highly trained WR athletes were evident with chronic adaptations in the supraspinatus tendon being related to the impairment of the athlete. Ultrasound can be used to monitor tendon adaptations in WR athletes for medical diagnosis to assist the scheduling and type of training.
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Affiliation(s)
- Fransiska Marie Bossuyt
- Shoulder, Health and Mobility Group, Swiss Paraplegic Research, Nottwil, Switzerland
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- *Correspondence: Fransiska Marie Bossuyt
| | - Barry S. Mason
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Simon Briley
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Thomas J. O'Brien
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Michael L. Boninger
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ursina Arnet
- Shoulder, Health and Mobility Group, Swiss Paraplegic Research, Nottwil, Switzerland
| | - Victoria Louise Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
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Changes to Biceps and Supraspinatus Tendons in Response to a Progressive Maximal Treadmill-Based Propulsion Aerobic Fitness Test in Manual Wheelchair Users: A Quantitative Musculoskeletal Ultrasound Study. Rehabil Res Pract 2021; 2021:6663575. [PMID: 33747566 PMCID: PMC7943286 DOI: 10.1155/2021/6663575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/04/2021] [Accepted: 02/12/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate if the completion of a recently developed treadmill-based wheelchair propulsion maximal progressive workload incremental test alters the integrity of the long head of the biceps and supraspinatus tendons using musculoskeletal ultrasound imaging biomarkers. Method Fifteen manual wheelchair users completed the incremental test. Ultrasound images of the long head of the biceps and supraspinatus tendons were recorded before, immediately after, and 48 hours after the completion of the test using a standardized protocol. Geometric, composition, and texture-related ultrasound biomarkers characterized tendon integrity. Results Participants propelled during 10.2 ± 2.9 minutes with the majority (N = 13/15) having reached at least the eighth stage of the test (speed = 0.8 m/s; slope = 3.6°). All ultrasound biomarkers characterizing tendon integrity, measured in the longitudinal and transversal planes for both tendons, were similar (p = 0.063 to 1.000) across measurement times. Conclusion The performance of the motorized treadmill wheelchair propulsion test to assess aerobic fitness produced no changes to ultrasound biomarkers of the biceps or supraspinatus tendons. Hence, there was no ultrasound imaging evidence of a maladaptive response due to overstimulation in these tendons immediately after and 48 hours after the performance of the test.
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Ferrer GA, Miller RM, Yoshida M, Wang JH, Musahl V, Debski RE. The Correlation of Quantitative Ultrasound Measures and Supraspinatus Tendon Quality: A Pilot Study. J Med Ultrasound 2020; 28:162-168. [PMID: 33282660 PMCID: PMC7709527 DOI: 10.4103/jmu.jmu_104_19] [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: 10/29/2019] [Revised: 11/12/2019] [Accepted: 12/23/2019] [Indexed: 11/07/2022] Open
Abstract
Background: The objective of this study was to determine the feasibility of assessing tendon quality as quantified by histology through changes in quantitative ultrasound measures. Methods: Eight cadaveric shoulders (four with a small supraspinatus tendon tear) were examined using conventional B-mode ultrasound in the transverse plane by internally rotating and hyperextending the humerus. Quantitative ultrasound measures (skewness, kurtosis, variance, and echogenicity) were calculated based on the grayscale distribution of the ultrasound image taken of the supraspinatus tendon near the insertion site. The specimens were then dissected to the supraspinatus tendon where tendon biopsies were taken near the insertion site, mid-substance, and myotendinous junction. Through histology, tendon quality was evaluated based on collagen fiber organization, fatty infiltration, nuclei shape, and cellularity. Correlations between quantitative ultrasound measures and histological grades of tendon quality were determined through Pearson or Spearman's rho correlations. Results: A total of three significant correlations between quantitative ultrasound measures and histological parameters of tendon quality were found. Significant correlations between kurtosis and cellularity at the insertion site (r = 0.724) (P < 0.05) as well as variance and fatty infiltration at the myotendinous junction (ρ = −0.843) (P < 0.05) and for the whole tendon (ρ = −0.826) (P < 0.05) were found. Conclusion: The results show the potential for quantitative ultrasound measures to assess factors of tendon quality that can only be determined through histology. With further development of the methodology that utilizes quantitative ultrasound measures, clinicians might be able to evaluate the tendon quality noninvasively in future.
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Affiliation(s)
- Gerald A Ferrer
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - R Matthew Miller
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Masahito Yoshida
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James H Wang
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard E Debski
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Koontz AM, Garfunkel CE, Crytzer TM, Anthony SJ, Nindl BC. Feasibility, acceptability, and preliminary efficacy of a handcycling high-intensity interval training program for individuals with spinal cord injury. Spinal Cord 2020; 59:34-43. [PMID: 32908194 PMCID: PMC7854955 DOI: 10.1038/s41393-020-00548-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 01/17/2023]
Abstract
Study Design: Pilot non-randomized clinical trial Objectives: To examine the feasibility, acceptability and preliminary efficacy of performing handcycling high intensity interval training (HIIT) for six weeks in wheelchair users with spinal cord injury. Setting: Participant’s home Methods: Participants completed pre and post graded exercise stress tests, exercise surveys and six weeks of handcycling HIIT. The HIIT program consisted of two weekly, 25 minute supervised at-home sessions (2-3 min warm-up, then 10 intervals of cycling with a ratio of 1 minute work at 90% peak power output (PPO) to 1 minute recovery at 0-20% PPO, then 2-3 min cool-down). Real-time power output and heart rate were recorded via sensors and a bike computer. The sensor data were analyzed to evaluate training efficacy. Results: Seven of the 10 enrolled participants (70%) completed the study. All but one completed the required 12 sessions. The participants met at least one of the HIIT target intensity criteria in 76 out of 89 total sessions (85.4%) performed. Participants expressed a high level of enjoyment on the Physical Activity Enjoyment Scale, mean (SD) = 114.8 (11.3), and satisfaction with the overall experience. Five of the seven participants (71%) who completed the study felt an increase in endurance, function and health. Objective physiological changes showed mixed results. Conclusions: Six weeks of handcycling HIIT appears to be safe, feasible and acceptable. A longer HIIT work interval may be needed to elicit significant physiological responses. Future investigation of the feasibility and efficacy of differing HIIT parameters is needed.
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Affiliation(s)
- Alicia M Koontz
- Department of Veterans Affairs, Rehabilitation Research and Development Service, Human Engineering Research Laboratories, Pittsburgh, PA, USA. .,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA. .,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Cecile E Garfunkel
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Theresa M Crytzer
- Department of Veterans Affairs, Rehabilitation Research and Development Service, Human Engineering Research Laboratories, Pittsburgh, PA, USA.,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA.,Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven J Anthony
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bradley C Nindl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
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Effects of Home Exercises on Shoulder Pain and Pathology in Chronic Spinal Cord Injury: A Randomized Controlled Trial. Am J Phys Med Rehabil 2020; 99:504-513. [PMID: 31851011 DOI: 10.1097/phm.0000000000001362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were to replicate findings that a home exercise program intervention improved shoulder pain and function and to assess changes in supraspinatus tendon pathology associated with the home exercise program in persons with chronic spinal cord injury. DESIGN The study is a single-blind randomized controlled trial. Individuals with spinal cord injury of at least 1 yr and chronic shoulder pain of moderate or greater average intensity were enrolled. Participants were randomized to a 12-wk home exercise program consisting of strengthening and stretching exercises or to an education-only control group, with immediate postintervention and 4-wk postintervention (16 wks) follow-ups. The main outcome measures were self-report measures of shoulder pain and impairment, the Physical Examination of the Shoulder Scale, quantitative ultrasound metrics of the supraspinatus tendon, and the Ultrasound Shoulder Pathology Rating Scale. RESULTS Thirty-two participants were randomized to home exercise program or education-only control condition. The mean ± SD age was 44.8 ± 12.5; 81.3% were male; 65.6% had motor complete paraplegia. Using a per-protocol, within-group analysis method, significant differences were observed between baseline and postintervention for the home exercise program group for the least pain intensity (P = 0.02), number of days with shoulder pain (P = 0.042), Physical Examination of the Shoulder Scale scores (dominant side, P = 0.036; nondominant side, P = 0.008), the Disabilities of the Arm, Shoulder, and Hand (P = 0.028), and the Patient Global Impression of Change (P = 0.015). The education-only control condition group demonstrated significant changes in average unpleasantness of shoulder pain after the intervention period (P = 0.049). Comparisons in changes from baseline between groups showed that the home exercise program group had greater improvements in nondominant-side Physical Examination of the Shoulder Scale scores and global impression of change, whereas the education-only control condition group had greater improvements in depressive symptoms.For quantitative ultrasound measures, no significant changes were found with within-group analyses for the home exercise program group, although the education-only control condition group demonstrated a decrease in tendon width in the nondominant-side supraspinatus tendon (P = 0.036). Comparison of changes between groups suggests that the education-only control condition group had a greater increase in dominant shoulder supraspinatus tendon ultrasound contrast at the end of the study. CONCLUSIONS Changes in several measures of shoulder pain and function occurred after the home exercise program intervention, although the magnitude of changes was only significantly greater than those of the education-only control condition group for two measures. Significant changes in supraspinatus pathology were not detected with quantitative ultrasound metrics.
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Bossuyt FM, Hogaboom NS, Worobey LA, Koontz AM, Arnet U, Boninger ML. Start-up propulsion biomechanics changes with fatiguing activity in persons with spinal cord injury. J Spinal Cord Med 2020; 43:476-484. [PMID: 30882284 PMCID: PMC7480480 DOI: 10.1080/10790268.2019.1582603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: Shoulder pathology is a common condition in wheelchair users that can considerably impact quality of life. Shoulder muscles are prone to fatigue, but it is unclear how fatigue affects start-up propulsion biomechanics. This study determines acute changes in start-up wheelchair propulsion biomechanics at the end of a fatiguing propulsion protocol. Design: Quasi-experimental one-group pretest-postest design. Setting: Biomechanics laboratory. Participants: Twenty-six wheelchair users with spinal cord injury (age: 35.5 ± 9.8 years, sex: 73% males and 73% with a paraplegia). Interventions: Protocol of 15 min including maximum voluntary propulsion, right- and left turns, full stops, start-up propulsion, and rests. Outcome measures: Maximum resultant force, maximum rate of rise of applied force, mean velocity, mean fraction of effective force, and mean contact time at the beginning and end of the protocol during start-up propulsion. Results: There was a significant reduction in maximum resultant force (P < 0.001) and mean velocity (P < 0.001) at the end of the protocol. Also, contact time was reduced in the first stroke of start-up propulsion (P < 0.001). Finally, propelling with a shorter contact time was associated with a greater reduction in performance (maximum velocity) at the end of the protocol. Conclusion: There are clear changes in overground propulsion biomechanics at the end of a fatiguing propulsion protocol. While reduced forces could protect the shoulder, these reduced forces come with shorter contact times and lower velocity. Investigating changes in start-up propulsion biomechanics with fatigue could provide insight into injury risk.
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Affiliation(s)
- Fransiska M. Bossuyt
- Swiss Paraplegic Research, Nottwil, Switzerland,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland,Correspondence to: Fransiska M. Bossuyt, Swiss Paraplegic Research, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland; Department of Health Sciences and Health Policy, University of Lucerne, Frohburgstrasse 3, 6002Lucerne, Switzerland.
| | - Nathan S. Hogaboom
- Department of Veterans Affairs, Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lynn A. Worobey
- Department of Veterans Affairs, Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alicia M. Koontz
- Department of Veterans Affairs, Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ursina Arnet
- Swiss Paraplegic Research, Nottwil, Switzerland,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Michael L. Boninger
- Department of Veterans Affairs, Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Changes in supraspinatus and biceps tendon thickness: influence of fatiguing propulsion in wheelchair users with spinal cord injury. Spinal Cord 2019; 58:324-333. [PMID: 31745246 PMCID: PMC7065940 DOI: 10.1038/s41393-019-0376-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/02/2019] [Accepted: 10/05/2019] [Indexed: 11/16/2022]
Abstract
Study design: Quasi-experimental, pretest-posttest design. Objectives: To identify acute changes in the supraspinatus and biceps tendon following fatiguing wheelchair propulsion and to associate tendon changes with risk factors associated with shoulder pain in persons with spinal cord injury (SCI). Setting: Biomechanical laboratory Swiss Paraplegic Research. Methods: A population-based sample of 50 wheelchair users with SCI at lesion level T2 or below participated. Fatigue was measured using the rate of perceived exertion and heart rate. Linear regression techniques were used to assess the association between the dependent and independent variables. Dependent variables included absolute differences in supraspinatus and biceps tendon thickness, contrast and echogenicity ratio assessed with ultrasound before and after a fatiguing wheelchair propulsion intervention. Independent variables included: susceptibility to fatigue (Yes/No), the acromio-humeral distance, sex, time since injury, activity levels and body weight. Results: A reduction in supraspinatus tendon thickness after fatiguing wheelchair propulsion (−1.39 mm; 95% CI: −2.28; −0.51) was identified after controlling for all potential confounders. Females who fatigued (n=4) displayed a greater reduction in supraspinatus tendon thickness as compared to those who did not fatigue (n=7). In contrast, higher body weight was associated with an increase in supraspinatus tendon thickness and a greater acromio-humeral distance before the intervention was associated with an increase in biceps tendon thickness. Conclusions: Acute changes in the supraspinatus and biceps tendon after fatiguing wheelchair propulsion may explain the high prevalence of tendon injuries in this population. Future research should determine the consequences of tendon changes and its relationship to tendinopathy.
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Compensation Strategies in Response to Fatiguing Propulsion in Wheelchair Users. Am J Phys Med Rehabil 2019; 99:91-98. [DOI: 10.1097/phm.0000000000001267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Milgrom R, Foreman M, Standeven J, Engsberg JR, Morgan KA. Reliability and validity of the Microsoft Kinect for assessment of manual wheelchair propulsion. ACTA ACUST UNITED AC 2018; 53:901-918. [PMID: 28475198 DOI: 10.1682/jrrd.2015.10.0198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 03/29/2016] [Indexed: 11/05/2022]
Abstract
Concurrent validity and test-retest reliability of the Microsoft Kinect in quantification of manual wheelchair propulsion were examined. Data were collected from five manual wheelchair users on a roller system. Three Kinect sensors were used to assess test-retest reliability with a still pose. Three systems were used to assess concurrent validity of the Kinect to measure propulsion kinematics (joint angles, push loop characteristics): Kinect, Motion Analysis, and Dartfish ProSuite (Dartfish joint angles were limited to shoulder and elbow flexion). Intraclass correlation coefficients revealed good reliability (0.87-0.99) between five of the six joint angles (neck flexion, shoulder flexion, shoulder abduction, elbow flexion, wrist flexion). ICCs suggested good concurrent validity for elbow flexion between the Kinect and Dartfish and between the Kinect and Motion Analysis. Good concurrent validity was revealed for maximum height, hand-axle relationship, and maximum area (0.92-0.95) between the Kinect and Dartfish and maximum height and hand-axle relationship (0.89-0.96) between the Kinect and Motion Analysis. Analysis of variance revealed significant differences (p < 0.05) in maximum length between Dartfish (mean 58.76 cm) and the Kinect (40.16 cm). Results pose promising research and clinical implications for propulsion assessment and overuse injury prevention with the application of current findings to future technology.
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Zukowski LA, Hass CJ, Shechtman O, Christou EA, Tillman MD. The effect of wheelchair propulsion style on changes in time spent in extreme wrist orientations after a bout of fatiguing propulsion. ERGONOMICS 2017; 60:1425-1434. [PMID: 28322620 DOI: 10.1080/00140139.2017.1303084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study compared how wheelchair propulsion styles affect changes in percentage of time spent in extreme wrist orientations, which have been associated with median nerve injury, after a fatiguing bout of propulsion. Twenty novice, non-disabled adult males learned arcing (ARC) and semicircular (SEMI) propulsion styles and utilised each to perform a wheelchair fatigue protocol. ARC and SEMI did not significantly differ in terms of changes after the fatigue protocol in percentage of time spent in extreme flexion/extension or radial/ulnar deviation at the push phase beginning or end. A pattern was observed, although not significant, of greater increases in percentage of time spent in extreme wrist extension and ulnar deviation during the push phase beginning and ulnar deviation during the push phase end while utilising SEMI relative to ARC. This study evinces that individual differences are greater than observed changes in extreme wrist orientations for both propulsion styles. Practitioner Summary: How wheelchair propulsion styles change with fatigue in terms of extreme wrist orientations was examined. This study evinces that individual differences are greater than observed changes in extreme wrist orientations for both propulsion styles and point towards the need for future research on individual differences utilising propulsion styles.
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Affiliation(s)
- Lisa A Zukowski
- a Division of Physical Therapy, Department of Allied Health Sciences , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
- b Department of Applied Physiology and Kinesiology , University of Florida , Gainesville , FL , USA
| | - Chris J Hass
- b Department of Applied Physiology and Kinesiology , University of Florida , Gainesville , FL , USA
| | - Orit Shechtman
- c Department of Occupational Therapy , University of Florida , Gainesville , FL , USA
| | - Evangelos A Christou
- b Department of Applied Physiology and Kinesiology , University of Florida , Gainesville , FL , USA
| | - Mark D Tillman
- b Department of Applied Physiology and Kinesiology , University of Florida , Gainesville , FL , USA
- d WellStar College of Health and Human Services , Kennesaw State University , Kennesaw , GA , USA
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Relationship between linear velocity and tangential push force while turning to change the direction of the manual wheelchair. BIOMED ENG-BIOMED TE 2017; 62:439-445. [DOI: 10.1515/bmt-2015-0173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 07/27/2016] [Indexed: 11/15/2022]
Abstract
AbstractWheelchair propulsion is a major cause of upper limb pain and injuries for manual wheelchair users with spinal cord injuries (SCIs). Few studies have investigated wheelchair turning biomechanics on natural ground surfaces. The purpose of this study was to investigate the relationship between tangential push force and linear velocity of the wheelchair during the turning portions of propulsion. Using an instrumented handrim, velocity and push force data were recorded for 25 subjects while they propel their own wheelchairs on a concrete floor along a figure-eight-shaped course at a maximum velocity. The braking force (1.03 N) of the inside wheel while turning was the largest of all other push forces (p<0.05). Larger changes in squared velocity while turning were significantly correlated with higher propulsive and braking forces used at the pre-turning, turning, and post-turning phases (p<0.05). Subjects with less change of velocity while turning needed less braking force to maneuver themselves successfully and safely around the turns. Considering the magnitude and direction of tangential force applied to the wheel, it seems that there are higher risks of injury and instability for upper limb joints when braking the inside wheel to turn. The results provide insight into wheelchair setup and mobility skills training for wheelchair users.
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POPCHAK ADAMJ, HOGABOOM NATHANS, VYAS DHARMESH, ABT JOHNP, DELITTO ANTHONY, IRRGANG JAMESJ, BONINGER MICHAELL. Acute Response of the Infraspinatus and Biceps Tendons to Pitching in Youth Baseball. Med Sci Sports Exerc 2017; 49:1168-1175. [DOI: 10.1249/mss.0000000000001205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kirby RL, Mitchell D, Sabharwal S, McCranie M, Nelson AL. Manual Wheelchair Skills Training for Community-Dwelling Veterans with Spinal Cord Injury: A Randomized Controlled Trial. PLoS One 2016; 11:e0168330. [PMID: 28002472 PMCID: PMC5176312 DOI: 10.1371/journal.pone.0168330] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/29/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To test the hypotheses that community-dwelling veterans with spinal cord injury (SCI) who receive the Wheelchair Skills Training Program (WSTP) in their own environments significantly improve their manual wheelchair-skills capacity, retain those improvements at one year and improve participation in comparison with an Educational Control (EC) group. METHODS We carried out a randomized controlled trial, studying 106 veterans with SCI from three Veterans Affairs rehabilitation centers. Each participant received either five one-on-one WSTP or EC sessions 30-45 minutes in duration. The main outcome measures were the total and subtotal percentage capacity scores from the Wheelchair Skills Test 4.1 (WST) and Craig Handicap Assessment and Reporting Technique (CHART) scores. RESULTS Participants in the WSTP group improved their total and Advanced-level WST scores by 7.1% and 30.1% relative to baseline (p < 0.001) and retained their scores at one year follow-up. The success rates for individual skills were consistent with the total and subtotal WST scores. The CHART Mobility sub-score improved by 3.2% over baseline (p = 0.021). CONCLUSIONS Individualized wheelchair skills training in the home environment substantially improves the advanced and total wheelchair skills capacity of experienced community-dwelling veterans with SCI but has only a small impact on participation.
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Affiliation(s)
- R. Lee Kirby
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- * E-mail:
| | - Doug Mitchell
- Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, United States of America
| | - Sunil Sabharwal
- Veterans Administration Boston Health Care System and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mark McCranie
- Health Services Research & Development Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans’ Hospital, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Audrey L. Nelson
- Health Services Research & Development Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans’ Hospital, College of Public Health, University of South Florida, Tampa, Florida, United States of America
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Nadeau MJ, Desrochers A, Lamontagne M, Larivière C, Gagnon DH. Quantitative ultrasound imaging of Achilles tendon integrity in symptomatic and asymptomatic individuals: reliability and minimal detectable change. J Foot Ankle Res 2016; 9:30. [PMID: 27540416 PMCID: PMC4989299 DOI: 10.1186/s13047-016-0164-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/11/2016] [Indexed: 12/13/2022] Open
Abstract
Background Quantifying the integrity of the Achilles tendon (AT) is a rehabilitation challenge. Adopting quantitative ultrasound measurements (QUS measurements) of the AT could fill this gap by 1) evaluating the test-retest reliability and accuracy of QUS measurements of the AT; 2) determining the best protocol for collecting QUS measurements in clinical practice. Methods A total of 23 ATs with symptoms of Achilles tendinopathy and 63 asymptomatic ATs were evaluated. Eight images were recorded for each AT (2 visits × 2 evaluators × 2 images). Multiple sets of QUS measurements were taken: geometric (thickness, width, area), first-order statistics (computed from a grayscale histogram distribution: echogenicity, variance, skewness, kurtosis, entropy) and texture features (computed from co-occurrence matrices: contrast, energy, homogeneity). A generalizability study quantified the reliability and standard error of measurement (accuracy) of each QUS measurement, and a decision study identified the best measurement taking protocols. Results Geometric QUS measurements demonstrated excellent accuracy and reliability. QUS measurements computed from the grayscale histogram distribution revealed poor accuracy and reliability. QUS measurements derived from co-occurrence matrices showed variable accuracy and moderate to excellent reliability. In clinical practice, using an average of the results of three images collected by a single evaluator during a single visit is recommended. Conclusions The use of geometric QUS measurements enables quantification of AT integrity in clinical practice and research settings. More studies on QUS measurements derived from co-occurrence matrices are warranted.
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Affiliation(s)
- Marie-Josée Nadeau
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) - Institut de réadaptation Lindsay-Gingras de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada ; School of Rehabilitation, Université de Montréal, Pavillon 7077 Avenue du Parc, Station Centre-Ville, P.O. Box 6128, Montreal, Quebec H3C 3J7 Canada
| | - Amélie Desrochers
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) - Institut de réadaptation Lindsay-Gingras de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada ; Faculty of Medicine, Université de Montréal, Montreal, Canada
| | | | - Christian Larivière
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) - Institut de réadaptation Lindsay-Gingras de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada ; Occupational Health and Safety Research Institute Robert-Sauvé (IRSST), Montreal, Canada
| | - Dany H Gagnon
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) - Institut de réadaptation Lindsay-Gingras de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada ; School of Rehabilitation, Université de Montréal, Pavillon 7077 Avenue du Parc, Station Centre-Ville, P.O. Box 6128, Montreal, Quebec H3C 3J7 Canada
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Zukowski LA, Christou EA, Shechtman O, Hass CJ, Tillman MD. The Effect of Propulsion Style on Wrist Movement Variability During the Push Phase After a Bout of Fatiguing Propulsion. PM R 2016; 9:265-274. [PMID: 27390056 DOI: 10.1016/j.pmrj.2016.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/18/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Wheelchair propulsion has been linked to overuse injuries regardless of propulsion style. Many aspects of the arcing (ARC) and semicircular (SEMI) propulsion styles have been compared, but differences in intracycle movement variability, which have been linked to overuse injuries, have not been examined. OBJECTIVE To explore how ARC and SEMI affect changes in intracycle wrist movement variability after a fatiguing bout of propulsion. DESIGN Repeated measures crossover design. SETTING Wheelchair rollers and wheelchair fatigue course in a research laboratory. PARTICIPANTS Twenty healthy, nondisabled adult men without previous wheelchair experience. INTERVENTIONS Participants learned ARC and SEMI and used each to perform a wheelchair fatigue protocol. MAIN OUTCOME MEASUREMENTS Thirty seconds of propulsion on rollers were recorded by motion-capture cameras before and after a fatigue protocol for each propulsion style on 2 testing days. Angular wrist orientations (flexion/extension and radial/ulnar deviation) and linear wrist trajectories (mediolateral direction) were computed, and intracycle movement variability was calculated as standard deviations of the detrended and filtered values during the push phase beginning and end. Paired samples t tests were used to compare ARC and SEMI based on the percent changes from pre- to postfatigue protocol. RESULTS Both propulsion styles resulted in increased intracycle wrist movement variability postfatigue, but observed increases did not significantly differ between ARC and SEMI. CONCLUSIONS This study evinces that intersubject variability exceeded average changes in intracycle wrist movement variability for both propulsion styles. Neither propulsion style resulting in a greater change in intracycle movement variability may suggest that no single propulsion style is ideal for everyone. The large intersubject variability may indicate that the propulsion style resulting in the smallest increase in intracycle movement variability after a fatiguing bout of propulsion may differ for each person and may help explain why wheelchair users self-select to use different propulsion styles.
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Affiliation(s)
- Lisa A Zukowski
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Bondurant 3007, CB# 7135, Chapel Hill, NC 27599; and Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL(∗).
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL(†)
| | - Orit Shechtman
- Department of Occupational Therapy, University of Florida, Gainesville, FL(‡)
| | - Christopher J Hass
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL(§)
| | - Mark D Tillman
- WellStar College of Health and Human Services, Kennesaw State University, Kennesaw, GA; and Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL(¶)
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Tao W, Fu Y, Hai-Xin S, Yan D, Jian-Hua L. The application of sonography in shoulder pain evaluation and injection treatment after stroke: a systematic review. J Phys Ther Sci 2015; 27:3007-10. [PMID: 26504346 PMCID: PMC4616147 DOI: 10.1589/jpts.27.3007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/25/2015] [Indexed: 01/12/2023] Open
Abstract
[Purpose] This review article is designed to expose the application of sonography in
shoulder pain after stroke. [Methods] A range of databases was searched to identify
articles that address sonography examination, with or without ultrasound guided
corticosteroid injection for hemiplegic shoulder pain (HSP). The electronic databases of
PubMed, CENTRAL, CINAHL, Cochrane Library, Medline were searched. [Results] According to
the articles identified in our databases research, sonographic technique has potential to
provide objective measurements in patients with HSP. The main sonography finding of HSP
included subacromial subdeltoid (SASD) bursal effusion, tendinosis of the supraspinatus
and subscapularis tendon, long head of biceps tendon sheath effusion, and shoulder
subluxation. Our analysis also revealed significantly decreased pain score (VAS) and
increased passive external rotation degree in the steroid injection group than control
group. [Conclusion] The sonography examination is useful for HSP assessment and ultrasound
guided technique is recommended for HSP injection treatment.
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Affiliation(s)
- Wu Tao
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, China
| | - Yu Fu
- Department of Rehabilitation Medicine, Alxa League Central Hospital, China
| | - Song Hai-Xin
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, China
| | - Dong Yan
- Department of Rehabilitation Medicine, Hangzhou Hospital of Zhejiang CAPF, China
| | - Li Jian-Hua
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, China
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Gil-Agudo A, Mozos MS, Crespo-Ruiz B, del-Ama AJ, Pérez-Rizo E, Segura-Fragoso A, Jiménez-Díaz F. Shoulder kinetics and ultrasonography changes after performing a high-intensity task in spinal cord injury subjects and healthy controls. Spinal Cord 2015; 54:277-82. [PMID: 26282495 DOI: 10.1038/sc.2015.140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/19/2015] [Accepted: 07/03/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This is a prospective and comparative study between two groups. OBJECTIVES The objective of this study was to compare the changes in shoulder joint forces and their moments, as well as any possible ultrasound changes, when subjects with spinal cord injury (SCI) and healthy controls (CG) undertake a high-intensity manual wheelchair propulsion test. SETTING This study was conducted in an inpatient SCI rehabilitation center. METHODS A group of 22 subjects with SCI at level T2 or below who use a manual wheelchair (MWU), categorized as AIS grade A or B, were compared with a CG of 12 healthy subjects. Subjects in each group performed a high-intensity wheelchair propulsion test. The variables analyzed were shoulder joint forces and the moments at the beginning and at the end of the test. Ultrasound variables before and after the propulsion test were also analyzed. Correlations were also drawn between the ultrasonography and demographic variables. RESULTS In both groups, peak shoulder forces and moments increased after the test in almost all directions. No differences in the ultrasound parameters were found. A greater long-axis biceps tendon thickness (LBTT) was associated with more shoulder pain according to WUSPI or VAS (r=0.428, P<0.05 and r=0.452, P<0.05, respectively). CONCLUSIONS Shoulder joint forces and moments increase after an intense propulsion task. In subjects with SCI, these increases center on forces with less chance of producing subacromial damage. No changes are produced in ultrasonography variables, whereas a poorer clinical and functional evaluation of the shoulder of the MWUs appears to be related to a thicker long-axis biceps tendon.
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Affiliation(s)
- A Gil-Agudo
- Department of Physical Medicine and Rehabilitation, Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, SESCAM, Toledo, Spain
| | - M S Mozos
- Department of Physical Medicine and Rehabilitation, Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, SESCAM, Toledo, Spain
| | - B Crespo-Ruiz
- Department of Physical Medicine and Rehabilitation, Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, SESCAM, Toledo, Spain
| | - A J del-Ama
- Department of Physical Medicine and Rehabilitation, Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, SESCAM, Toledo, Spain
| | - E Pérez-Rizo
- Department of Physical Medicine and Rehabilitation, Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, SESCAM, Toledo, Spain
| | | | - F Jiménez-Díaz
- Faculty of Sport Science, Laboratory of Performance and Sports Rehabilitation, University of Castilla-La Mancha Toledo, Spain
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Abstract
Occupational therapy practice is grounded in the delivery of occupation-centered, patient-driven treatments that engage clients in the process of doing to improve health. As emerging technologies, such as medical imaging, find their way into rehabilitation practice, it is imperative that occupational therapy practitioners assess whether and how these tools can be incorporated into treatment regimens that are dually responsive to the medical model of health care and to the profession's foundation in occupation. Most medical imaging modalities have a discrete place in occupation-based intervention as outcome measures or for patient education; however, sonographic imaging has the potential to blend multiple occupational therapy practice forms to document treatment outcomes, inform clinical reasoning, and facilitate improved functional performance when used as an accessory tool in direct intervention. Use of medical imaging is discussed as it relates to occupational foundations and the professional role within the context of providing efficient, effective patient-centered rehabilitative care.
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Affiliation(s)
- Shawn C Roll
- Shawn C. Roll, PhD, OTR/L, CWCE, RMSK, FAOTA, is Assistant Professor, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles;
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Proportion of Wheelchair Users Who Receive Wheelchair Skills Training During an Admission to a Canadian Rehabilitation Center. TOPICS IN GERIATRIC REHABILITATION 2015. [DOI: 10.1097/tgr.0000000000000046] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gil-Agudo Á, Solís-Mozos M, Crespo-Ruiz B, Del-Ama Eng AJ, Pérez-Rizo E, Segura-Fragoso A, Jiménez-Díaz F. Echographic and kinetic changes in the shoulder joint after manual wheelchair propulsion under two different workload settings. Front Bioeng Biotechnol 2014; 2:77. [PMID: 25566539 PMCID: PMC4275037 DOI: 10.3389/fbioe.2014.00077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/07/2014] [Indexed: 11/13/2022] Open
Abstract
Manual wheelchair users with spinal cord injury (SCI) have a high prevalence of shoulder pain due to the use of the upper extremity for independent mobility, transfers, and other activities of daily living. Indeed, shoulder pain dramatically affects quality of life of these individuals. There is limited evidence obtained through radiographic techniques of a relationship between the forces acting on the shoulder during different propulsion conditions and shoulder pathologies. Today, ultrasound is widely accepted as a precise tool in diagnosis, displaying particularly effectiveness in screening the shoulder rotator cuff. Thus, we set out to perform an ultrasound-based study of the acute changes to the shoulder soft tissues after propelling a manual wheelchair in two workload settings. Shoulder joint kinetics was recorded from 14 manual wheelchair users with SCI while they performed high- and low-intensity wheelchair propulsion tests (constant and incremental). Shoulder joint forces and moments were obtained from inverse dynamic methods, and ultrasound screening of the shoulder was performed before and immediately after the test. Kinetic changes were more relevant after the most intensive task, showing the significance of high-intensity activity, yet no differences were found in ultrasound-related parameters before and after each propulsion task. It therefore appears that further studies will be needed to collect clinical data and correlate data regarding shoulder pain with both ultrasound images and data from shoulder kinetics.
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Affiliation(s)
- Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Marta Solís-Mozos
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Beatriz Crespo-Ruiz
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Antonio J Del-Ama Eng
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Enrique Pérez-Rizo
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | | | - Fernando Jiménez-Díaz
- Laboratory of Performance and Sports Rehabilitation, Faculty of Sport Science, University of Castilla-La Mancha , Toledo , Spain
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Wearing SC, Smeathers JE, Hooper SL, Locke S, Purdam C, Cook JL. The time course of in vivo recovery of transverse strain in high-stress tendons following exercise. Br J Sports Med 2013; 48:383-7. [PMID: 23525554 DOI: 10.1136/bjsports-2012-091707] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the time course of the recovery of transverse strain in the Achilles and patellar tendon following a bout of resistance exercise. METHODS Seventeen healthy adults underwent sonographic examination of the right patellar (n=9) and Achilles (n=8) tendons immediately prior to and following 90 repetitions of weight-bearing quadriceps and gastrocnemius-resistance exercise performed against an effective resistance of 175% and 250% body weight, respectively. Sagittal tendon thickness was determined 20 mm from the enthesis and transverse strain, as defined by the stretch ratio, was repeatedly monitored over a 24 h recovery period. RESULTS Resistance exercise resulted in an immediate decrease in Achilles (t7=10.6, p<0.01) and patellar (t8=8.9, p<0.01) tendon thickness, resulting in an average transverse stretch ratio of 0.86±0.04 and 0.82±0.05, which was not significantly different between tendons. The magnitude of the immediate transverse strain response, however, was reduced with advancing age (r=0.63, p<0.01). Recovery in transverse strain was prolonged compared with the duration of loading and exponential in nature. The average primary recovery time was not significantly different between the Achilles (6.5±3.2 h) and patellar (7.1±3.2 h) tendons. Body weight accounted for 62% and 64% of the variation in recovery time, respectively. CONCLUSIONS Despite structural and biochemical differences between the Achilles and patellar tendon, the mechanisms underlying transverse creep recovery in vivo appear similar and are highly time dependent. These novel findings have important implications concerning the time required for the mechanical recovery of high-stress tendons following an acute bout of exercise.
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Affiliation(s)
- Scott C Wearing
- Faculty of Health Sciences and Medicine, Bond University, , Gold Coast, Queensland, Australia
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Routhier F, Kirby RL, Demers L, Depa M, Thompson K. Efficacy and retention of the French-Canadian version of the wheelchair skills training program for manual wheelchair users: a randomized controlled trial. Arch Phys Med Rehabil 2012; 93:940-8. [PMID: 22494946 PMCID: PMC3708861 DOI: 10.1016/j.apmr.2012.01.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 01/24/2012] [Accepted: 01/24/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To test the hypotheses that, in comparison with a control group that received standard care, users of manual wheelchairs who also received the French-Canadian version of the Wheelchair Skills Training Program (WSTP) would significantly improve their wheelchair-skills capacity and that these improvements would be retained at 3 months. DESIGN Multicenter, single-blind, randomized controlled trial. SETTING Three rehabilitation centers in Montréal, Quebec, Canada. PARTICIPANTS Manual wheelchair users (N=39), a sample of convenience. INTERVENTION Participants were randomly allocated to the WSTP or control groups. Participants in both groups received standard care. Participants in the WSTP group also received a mean of 5.9 training sessions (a mean total duration of 5h and 36min). MAIN OUTCOME MEASURES The French-Canadian version of the Wheelchair Skills Test (WST) (Version 3.2) was administered at evaluation at first time period (baseline) (t1), evaluation at second time period (posttraining) (t2) (a mean of 47d after t1), and at evaluation at third time period (follow-up) (t3) (a mean of 101d after t2). RESULTS At t2, the mean ± SD total percentage WST capacity scores were 77.4%±13.8% for the WSTP group and 69.8%±18.4% for the control group (P=.030). Most of this difference was due to the community-level skills (P=.002). The total and subtotal Wheelchair Skills Test scores at t3 decreased by ≤0.5% from the t2 values, but differences between groups at t3, adjusting for t1, did not reach statistical significance (P≥.017 at a Bonferroni-adjusted α level of .005). CONCLUSION WSTP training improves wheelchair skills immediately after training, particularly at the community-skills level, but this study did not show statistically significant differences between the groups at 3 months.
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Affiliation(s)
- François Routhier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Institut de réadaptation en déficience physique de Québec, Québec City, Québec, Canada.
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