Shoulder Pain Prevention Program for Manual Wheelchair Users With Paraplegia: A Randomized Clinical Trial.

To compare prevalence of shoulder pain (SP) onset over 3 years for individuals with paraplegia from spinal cord injury who participate in one of two shoulder pain prevention program (SPPP) formats with that of a similar population without intervention, and to compare exercise adherence between two SPPP formats. The randomized clinical trial (compared to historical controls) included a volunteer sample of 100 individuals without SP at study entry. Eighty-seven participants returned for assessments at 18 and 36 months after study entry.

Effect of reverse manual wheelchair propulsion on shoulder kinematics, kinetics and muscular activity in persons with paraplegia.

Shoulder pain after spinal cord injury (SCI) is attributed to increased mobility demands on the arms and negatively impacts independence and quality of life. Repetitive superior and posterior shoulder joint forces produced during traditional wheelchair (WC) locomotion can result in subacromial impingement if unopposed, as with muscular fatigue or weakness. ROWHEELS (RW), geared rear wheels that produce forward WC movement with backward rim pulling, could alter these forces.

Objective and Self-Reported Physical Activity Measures and Their Association With Depression and Satisfaction With Life in Persons With Spinal Cord Injury.

Objective: To identify associations between objective and self-reported measures of physical activity (PA) and relationships with depression and satisfaction with life (SWL) in persons with spinal cord injury (SCI).

Design: Retrospective, cross-sectional study of objectively measured wheelchair propulsion (WCP) from 2 studies in which an odometer was attached to participants' wheelchairs to record daily speed and distance. Self-reported data were collected in a separate study examining dyspnea, PA, mood, and SWL.

Relationship Between Hand Contact Angle and Shoulder Loading During Manual Wheelchair Propulsion by Individuals with Paraplegia.

Background: Shoulder loading during manual wheelchair propulsion (WCP) contributes to the development of shoulder pain in individuals with spinal cord injury (SCI).

Objective: To use regression analysis to investigate the relationships between the hand contact angle (location of the hand on the pushrim at initial contact and release during the push phase of the WCP cycle) with propulsion characteristics, pushrim forces, and shoulder kinetics during WCP in individuals with paraplegia.

Methods: Biomechanical data were collected from 222 individuals (198 men and 24 women) with paraplegia from SCI during WCP on a stationary ergometer at a self-selected speed.

Car Transfer and Wheelchair Loading Techniques in Independent Drivers with Paraplegia.

Car transfers and wheelchair (WC) loading are crucial for independent community participation in persons with complete paraplegia from spinal cord injury, but are complex, physically demanding, and known to provoke shoulder pain. This study aimed to describe techniques and factors influencing car transfer and WC loading for individuals with paraplegia driving their own vehicles and using their personal WCs. Sedans were the most common vehicle driven (59%).

Impact of a stance phase microprocessor-controlled knee prosthesis on level walking in lower functioning individuals with a transfemoral amputation.

Background: For individuals with transfemoral amputation, walking with a prosthesis presents challenges to stability and increases the demand on the hip of the prosthetic limb. Increasing age or comorbidities magnify these challenges. Computerized prosthetic knee joints improve stability and efficiency of gait, but are seldom prescribed for less physically capable walkers who may benefit from them.

Gait parameters associated with responsiveness to treadmill training with body-weight support after stroke: an exploratory study.

Background: Task-specific training programs after stroke improve walking function, but it is not clear which biomechanical parameters of gait are most associated with improved walking speed.

Objective: The purpose of this study was to identify gait parameters associated with improved walking speed after a locomotor training program that included body-weight-supported treadmill training (BWSTT).

Design: A prospective, between-subjects design was used.

Comparison of shoulder muscle electromyographic activity during standard manual wheelchair and push-rim activated power assisted wheelchair propulsion in persons with complete tetraplegia.

Objectives: To compare spatio-temporal propulsion characteristics and shoulder muscle electromyographic activity in persons with cervical spinal cord injury propelling a standard pushrim wheelchair (WC) and a commercially available pushrim-activated power assisted wheelchair (PAPAW) design on a stationary ergometer.

Design: Repeated measures.

Setting: Motion analysis laboratory within a rehabilitation hospital.

Shoulder muscular demand during lever-activated vs pushrim wheelchair propulsion in persons with spinal cord injury.

Background/objective: The high demand on the upper limbs during manual wheelchair (WC) use contributes to a high prevalence of shoulder pathology in people with spinal cord injury (SCI). Lever-activated (LEVER) WCs have been presented as a less demanding alternative mode of manual WC propulsion. The objective of this study was to evaluate the shoulder muscle electromyographic activity and propulsion characteristics in manual WC users with SCI propelling a standard pushrim (ST) and LEVER WC design.

A comparison of shoulder joint forces during ambulation with crutches versus a walker in persons with incomplete spinal cord injury.

Objective: To compare 3-dimensional (3D) shoulder joint reaction forces and stride characteristics during bilateral forearm crutches and front-wheeled walker ambulation in persons with incomplete spinal cord injury (SCI).

Design: Cross-sectional cohort study.

Setting: Biomechanics laboratory.

Effect of fore-aft seat position on shoulder demands during wheelchair propulsion: part 2. An electromyographic analysis.

Background/objectives: Shoulder pain is common in persons with complete spinal cord injury. Adjustment of the wheelchair-user interface has been thought to reduce shoulder demands. The purpose of this study was to quantify the effect of seat fore-aft position on shoulder muscle activity during wheelchair propulsion.

Effect of fore-aft seat position on shoulder demands during wheelchair propulsion: part 1. A kinetic analysis.

Background/objective: The highly repetitive and weight-bearing nature of wheelchair (WC) propulsion has been associated with shoulder pain among persons with spinal cord injury (SCI). Manipulation of WC seat position is believed to reduce the overall demand of WC propulsion. The objective of this investigation was to document the effect of fore-aft seat position on shoulder joint kinetics.

Upper extremity kinetics during Lofstrand crutch-assisted gait.

A three-dimensional (3D) biomechanical model was developed to determine upper extremity kinematics and kinetics of persons walking with forearm crutches. Six-component load cells and strain gauges were installed in the crutches to determine crutch forces. A six-camera VICON motion system was used to acquire coordinate data from 24 reflective markers attached to the upper extremities and crutches.

The supine hip extensor manual muscle test: a reliability and validity study.

Objectives: To define the relative hip extensor muscle strengths values identified by the 4 grades obtained with a supine manual muscle test (MMT) and to compare these values with those indicated by the traditional prone test.

Design: Comparison of 4 manual supine strength grades with isometric hip extension joint torque; kappa statistic-determined interrater reliability, and analyses of variance identified between grade differences in torque.

Setting: Pathokinesiology laboratory.

Use of cluster analysis for gait pattern classification of patients in the early and late recovery phases following stroke.

The mixture of gait deviations seen in patients following a stroke is remarkably variable. An objective system for classification of gait patterns for this population could be used to guide treatment planning. Quantitated gait analysis was conducted for 47 individuals at admission to in-patient rehabilitation and again at 6 months post-stroke for 42 subjects.

Toe walking: muscular demands at the ankle and knee.

Objective: To compare the relationship between electromyographic activity and internal moment in heel-toe and toe walking.

Design: Simultaneous recording of stride characteristics and kinematic, kinetic, and intramuscular electromyographic data; paired t tests identified significant between-condition differences.

Setting: Gait laboratory.

The effect of level of spinal cord injury on shoulder joint kinetics during manual wheelchair propulsion.

Objective: The effects of spinal cord injury level on shoulder kinetics during manual wheelchair propulsion were studied.

Design: Single session data collection in a laboratory environment.

Methods: Male subjects were divided into four groups: low level paraplegia (n=17), high level paraplegia (n=19), C7 tetraplegia (C7, n=16) and C6 tetraplegia (C6, n=17).

Electromyographic and kinematic analysis of the shoulder during four activities of daily living in men with C6 tetraplegia.

The pattern of motor paralysis that commonly follows C6 tetraplegia creates an increased demand on upper limb function. The present investigation documented shoulder motion and muscular activity during planar motions and four activities of daily living (ADLs) in 15 men with spinal cord injuries (SCI) resulting in C6 tetraplegia. Three-dimensional (3-D) shoulder motion was recorded using a VICON motion system, and intramuscular electrodes recorded electromyographic (EMG) activity of 12 shoulder muscles.

Three dimensional upper extremity motion during manual wheelchair propulsion in men with different levels of spinal cord injury.

This investigation compared three dimensional upper extremity motion during wheelchair propulsion in persons with 4 levels of spinal cord injury: low paraplegia (n=17), high paraplegia (n=19), C7 tetraplegia (n=16), and C6 tetraplegia (n=17). Upper extremity motion was recorded as subjects manually propelled a wheelchair mounted on a stationary ergometer. For all motions measured, subjects with paraplegia had similar patterns suggesting that the wheelchair backrest adequately stabilizes the trunk in the absence of abdominal musculature.

Isolation of the vastus medialis oblique muscle during exercise.

The purpose of this study was to selectively challenge the vastus medialis oblique muscle in comparison with the vastus lateralis, the vastus intermedius, and the vastus medialis longus muscles by performing nine sets of strengthening exercises. These knee rehabilitation exercise included isometric knee extension with the hip at neutral, 30 degrees external, and 30 degrees internal rotation; isokinetic knee extension through full range; isokinetic knee extension in the terminal 30 degrees arc; sidelying ipsilateral and contralateral full knee extension; and stand and jump from full squat. Electrical activity of the vastus medialis oblique, the vastus lateralis, the vastus intermedius, and the vastus medialis longus muscles was measured in eight uninjured subjects.

Assessment of rearfoot motion: passive positioning, one-legged standing, gait.

Earlier studies that address assessment of the subtalar joint (STJ) by measuring rearfoot motion used a goniometer to evaluate intertester reliability. Few investigations have determined how positions of the rearfoot, assessed manually (passive range of motion) or statically in one-legged standing, compare with those occurring during walking. The purpose of this study was to determine the following: (1) the intertester reliability of positioning the STJ in neutral, maximum inversion, and maximum eversion; (2) the reliability of the rearfoot position during relaxed one-legged standing; and (3) how these positions compare to rearfoot motion during walking.

Shoulder joint kinetics during the push phase of wheelchair propulsion.

The purpose of this investigation was to quantify the forces and moments at the shoulder joint during free, level wheelchair propulsion and to document changes imposed by increased speed, inclined terrain, and 15 minutes of continuous propulsion. Data were collected using a six-camera VICON motion analysis system, a strain gauge instrumented wheel, and a wheelchair ergometer. Seventeen men with low level paraplegia participated in this study.

Segment velocities in normal and transtibial amputees: prosthetic design implications.

Dynamic elastic response foot and ankle prostheses (Seattle-Lite, Flex Foot, etc.) used by transtibial amputees feature substantial design improvements over conventional designs (SACH, Single Axis, etc.).

Tibialis anterior transfer for calcaneal deformity: a postoperative gait analysis.

We retrospectively evaluated seven children who had low-lumbar-level spina bifida and who had undergone bilateral transfer of tibialis anterior to the calcaneus. The mean age at the time of operation was 8 years (range, 3-12), and the patients were monitored for an average of 40 months (range, 24-60). All children underwent a postoperative gait analysis to assess the function of the transfer and the need for continued postoperative bracing.