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.

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.

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.