Effect of Wheelchair Stroke Pattern on Upper Extremity Muscle Fatigue

Temporo-spatial parameters, shoulder kinematics and acute tendon changes in four different stroke patterns in men wheelchair users with spinal cord injury

BACKGROUND

Manual wheelchair propulsion causes the shoulder tendon pathologies in wheelchair users with spinal cord injury due to its repetitive nature. Four different wheelchair stroke patterns can cause varying amounts of acute changes in the shoulder tendons.

OBJECTIVE

To evaluate and compare acute changes in the supraspinatus and biceps tendons and acromio-humeral distance (AHD) after propulsion between different stroke patterns in individuals with spinal cord injury. Additionally, to associate tendon changes with demographic and biomechanical characteristics.

DESIGN

Prospective and comparative study between four groups.

SETTING

Tertiary rehabilitation hospital.

PATIENTS

Men wheelchair users with spinal cord injury.

INTERVENTIONS

Participants were divided into 4 groups according to stroke pattern (arcing, semicirculer (SC), single-loop (SL) and double-loop (DL)), in which they used their wheelchair on a motorized treadmill at a speed of 1 m/s. A sample of 40 people was created, 10 in each group. All participants performed a propulsion test.

MAIN OUTCOME MEASURES

Temporo-spatial variables and shoulder kinematics were analyzed. Supraspinatus tendon thickness (SSTT), long head of biceps tendon thickness (LHBTT) and AHD were measured before and after the propulsion test.

RESULTS

SC pattern had lower cadance and larger contact angle. A reduction in SSTT and LHBTT in arcing pattern, LHBTT and AHD in SC pattern and, LHBTT in DL pattern was observed (all P < 0.05). However, SL pattern did not differ significantly in all ultrasonographic measurements (all P > 0.05). Body mass index was associated with a decrease in SSTT. Age and number of daily push-up were associated with a decrease in AHD.

CONCLUSIONS

Less tendon changes after the propulsion in the SL pattern suggested that the supraspinatus and biceps tendons were preserved in this pattern. The SL pattern may be a better choice for men wheelchair users with supraspinatus and biceps tendon pathologies. This article is protected by copyright. All rights reserved.

Reliability and normative values of the Wheelchair Propulsion Test: A preliminary investigation

BACKGROUND

Normative data for the equivalent of gait speed via the Wheelchair Propulsion Test (WPT) do not exist for wheelchair users.

OBJECTIVE

The purposes of the current study were to: 1) determine the reliability of the WPT, 2) propose and compare normative values for the WPT for young adult males and females utilizing three different propulsion techniques, and 3) compare how different wheelchair types affect performance on the WPT.

METHODS

50 young adults (25 of each sex) performed the WPT using three different propulsion techniques in three different types of wheelchairs. Participants were asked to propel a wheelchair over 10 m at a comfortable speed. Time and number of pushes were recorded for three trials for each propulsion technique in each type of wheelchair.

RESULTS

All of the ICC(2,2) values were >0.83 for speed and number of pushes. Normative values for speed, number of pushes, push frequency and effectiveness categorized by propulsion technique, sex and wheelchair type were developed.

CONCLUSIONS

Preliminary normative values have been established for young adults performing the WPT. This study highlights the need to maintain consistency of the wheelchair type and propulsion technique between trials in order for the WPT to be reliable.