Handrim Wheelchair Propulsion Technique in Individuals With Spinal Cord Injury With and Without Shoulder Pain

Abstract

Objective The aim of this study was to compare handrim wheelchair propulsion technique between individuals with spinal cord injury with and without shoulder pain. Design A cross-sectional study including 38 experienced handrim wheelchair users with spinal cord injury was conducted. Participants were divided into the “shoulder pain” (n = 15) and “no-shoulder pain” (n = 23) groups using the Local Musculoskeletal Discomfort scale. Kinetic and spatiotemporal aspects of handrim wheelchair propulsion during submaximal exercise on a motor-driven treadmill were analyzed. Data were collected using a measurement wheel instrumented with three-dimensional force sensors. Results After correction for confounders (time since injury and body height), linear regression analyses showed that the pain group had a 0.30-sec (95% confidence interval, −0.5 to −0.1) shorter cycle time, 0.22-sec (95% confidence interval, −0.4 to −0.1) shorter recovery time, 15.6 degrees (95% confidence interval, −27.4 to −3.8) smaller contact angle, and 8% (95% confidence interval, −15 to 0) lower variability in work per push compared with the no-pain group. Other parameters did not differ between groups. Conclusions This study indicates that individuals with spinal cord injury who experience shoulder pain propel their handrim wheelchair kinematically differently from individuals with spinal cord injury without shoulder pain. This difference in propulsion technique might be a pain-avoiding mechanism aimed at decreasing shoulder range of motion.

Rehabilitation: Neurogenic Bone Loss after Spinal Cord Injury

“…Therapies with an increased musculoskeletal load have proven effective; however, this approach is limited in patients who are wheelchair-bound after SCI. Stand-up wheelchairs, standing frames, and suspended treadmills can provide useful alternatives [ 11 , 111 , 112 ]. Physical activity, which inherently stimulates the axial loading of the tibia, femur, and axial skeleton, may also promote bone density after SCI by improving bone vascularization and osteoblast activity [ 4 , 112 ].…”

“…Stand-up wheelchairs, standing frames, and suspended treadmills can provide useful alternatives [ 11 , 111 , 112 ]. Physical activity, which inherently stimulates the axial loading of the tibia, femur, and axial skeleton, may also promote bone density after SCI by improving bone vascularization and osteoblast activity [ 4 , 112 ].…”

What’s New in Orthopaedic Rehabilitation

“…Because of the strenuous nature of wheelchair sports with respect to the shoulder, shoulder pain is common among wheelchair athletes. Braaksma et al performed a cross-sectional study analyzing different wheelchair propulsion techniques among those with and without shoulder pain 35 . They found that individuals with a spinal cord injury who experience shoulder pain propel their wheelchairs kinematically differently from those who do not experience pain; the pain group had a shorter cycle time, shorter recovery time, smaller contact angle, and lower variability in work performed per push compared with the group that did not experience pain.…”