No abstract

Over 50 percent of manual wheelchair users with spinal cord injury (SCI) are likely to develop upper-limb pain and injury. The majority of studies related to pain have implicated wheelchair propulsion as a cause. This paper draws from a large multisite trial and a long-standing research program to make specific recommendations related to wheelchair propulsion that may decrease the risk of upper-limb injury. The studies include over 60 subjects over 1 yr after a traumatic SCI below the second thoracic level. Specific aspects of the propulsive stroke that may relate to injury include cadence, magnitude of force, and the pattern of the hand during the nonpropulsive part of the stroke. Lower peak forces, slower cadence, and a circular propulsive stroke in which the hand falls below the pushrim during recovery may help prevent injury. In addition, wheelchair users should use the lightest weight adjustable wheelchair possible. Future work should include interventional trials and larger studies that allow for more complex statistical models that can further detail the relationship between wheelchair propulsion, user characteristics, and upper-limb injuries.

No abstract

Abstract-Persons with a spinal cord injury (SCI) demonstrate strength deficits that can limit their functional ability to perform activities of daily living. For a specific lesion level, performance of functional activities is related to the level of muscle strength. Consequently, in clinical practice, we need reliable measures of muscle strength to determine mobility and selfcare ability. Muscle-strength testing is used to document recovery or loss of motor function early in SCI, as well as measure improvements in strength in chronic SCI. We also need such measures for research purposes to determine the efficacy of clinical trials. Several methods are available for testing muscle strength of persons with SCI, such as handheld, handgrip, and isokinetic dynamometers. This article provides an overview of muscle-contraction definitions and testing methodologies and discusses the reliability of these testing methods and dynamometry devices.

2018 Paralyzed Veterans of America. Copies of the PVA's Guidelines are available at www.pva.org.These guidelines have been prepared based on scientific and professional information available in 2018. Users should periodically review this material to ensure that the advice herein is consistent with current reasonable clinical practice. The websites noted in this document were current at the time of publication; however, because web addresses and the information contained therein change frequently the reader is encouraged to stay apprised of the most current information.