Biomechanical model for evaluation of pediatric upper extremity joint dynamics during wheelchair mobility

Abstract

Pediatric manual wheelchair users (MWU) require high joint demands on their upper extremity (UE) during wheelchair mobility, leading them to be at risk of developing pain and pathology. Studies have examined UE biomechanics during wheelchair mobility in the adult population; however, current methods for evaluating UE joint dynamics of pediatric MWU are limited. An inverse dynamics model is proposed to characterize three-dimensional UE joint kinematics and kinetics during pediatric wheelchair mobility using a SmartWheel instrumented handrim system. The bilateral model comprises thorax, clavicle, scapula, upper arm, forearm, and hand segments and includes the sternoclavicular, acromioclavicular, glenohumeral, elbow and wrist joints. A single 17 year-old male with a C7 spinal cord injury (SCI) was evaluated while propelling his wheelchair across a 15-meter walkway. The subject exhibited wrist extension angles up to 60°, large elbow ranges of motion and peak glenohumeral joint forces up to 10% body weight. Statistically significant asymmetry of the wrist, elbow, glenohumeral and acromioclavicular joints was detected by the model. As demonstrated, the custom bilateral UE pediatric model may provide considerable quantitative insight into UE joint dynamics to improve wheelchair prescription, training, rehabilitation and long-term care of children with orthopaedic disabilities. Further research is warranted to evaluate pediatric wheelchair mobility in a larger population of children with SCI to investigate correlations to pain, function and transitional changes to adulthood.

Bilateral scapular kinematics, asymmetries and shoulder pain in wheelchair athletes

“…Subsequently, bilateral investigations of wheelchair propulsion remain scarce, with the majority having compared kinetic differences [14][15][16], whilst kinematic comparisons have often been limited to an assessment of propulsion patterns between sides [15,17]. Only Schnorenberg et al [18] and Soltau et al [19] have provided detailed analyses of bilateral upper body kinematics during wheelchair propulsion, although these were limited to single-subject case studies [18], paraplegic participants or independent analyses of dominant and nondominant limbs [19]. Despite this, preliminary data suggest that asymmetries exist during wheelchair propulsion [14,15,[17][18][19], hence the need for bilateral investigations where possible.…”

Evaluation of Pediatric Manual Wheelchair Mobility Using Advanced Biomechanical Methods

“…Upper limb pain and pathologies have been associated with increased loading at extremes of joint excursions [ 15 ]. Manual wheelchair use in adults has shown high shoulder joint loading with forces ranging from 7% to 12% of body weight, of which our prior study of a child with SCI agrees [ 6 , 16 , 17 ]. High joint forces during manual wheelchair use have been shown to directly correlate to the cause of joint pain and injury [ 6 ].…”

“…Subject specific measurements were obtained and twenty-seven passive reflective markers were placed on bony anatomical landmarks and technical locations of the subject, including the suprasternal notch, xiphoid process, spinal process C7, acromioclavicular joint, inferior angle, trigonum spinae, scapular spine, acromial angle, coracoid process, humerus technical marker, olecranon, radial and ulnar styloids, and the third and fifth metacarpals [ 17 ]. Based on validated methods by Šenk and Chèze, due to the subcutaneous motion of the scapula, the trigonum spinae and inferior angle markers were only used during a static trial with the subject in anatomical position.…”

Upper extremity biomechanics of children with spinal cord injury during wheelchair mobility

“…A custom, bilateral, pediatric UE model was applied to the data to determine 3D joint angles, forces and moments [13]. This biomechanical model comprises 11 segments, including: thorax, clavicles, scapulae, upper arms, forearms and hands.…”

“…This study aims to characterize three-dimensional (3D) joint dynamics during manual wheelchair propulsion of children with SCI, using a custom, pediatric, inverse dynamics model [13]. Additionally, the study will identify significant differences in average peak loading amongst the glenohumeral, elbow, and wrist joints.…”