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.

Use of Game Theory to model patient engagement after surgery: a qualitative analysis.

Background: Patient engagement is challenging to define and operationalize. Qualitative analysis allows us to explore patient perspectives on this topic and establish themes. A game theoretic signaling model also provides a framework through which to further explore engagement.

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.

Body mass index changes over 3 years and effect of obesity on community mobility for persons with chronic spinal cord injury.

Objective: To identify the prevalence of obesity in persons with chronic spinal cord injury (SCI), determine change in body mass index (BMI) over time, and identify impact of obesity on community mobility.

Design: Prospective three year longitudinal study.

Setting: Outpatient clinic of rehabilitation center.

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%).

Shoulder Strength and Physical Activity Predictors of Shoulder Pain in People With Paraplegia From Spinal Injury: Prospective Cohort Study.

Background: Shoulder joint pain is a frequent secondary complaint for people following spinal cord injury (SCI).

Objective: The purpose of this study was to determine predictors of shoulder joint pain in people with paraplegia.

Methods/design: A 3-year longitudinal study was conducted.

Surgeons as medical school educators: an untapped resource.

Despite extensive experience teaching residents, surgeons are an untapped resource for educating medical students. We hypothesized that by involving surgeons as teachers earlier in the medical school curriculum, medical students' interest in surgery will increase and their opinions of surgeons will improve. Five programs designed to involve surgeons as educators in the medical school curriculum were implemented.

Strengthening and optimal movements for painful shoulders (STOMPS) in chronic spinal cord injury: a randomized controlled trial.

Background: Shoulder pain is a common problem after spinal cord injury (SCI), with negative effects on daily activities and quality of life (QOL).

Objective: The purpose of this study was to determine the effect of an exercise program and instruction to optimize performance of upper-extremity tasks on shoulder pain in people with paraplegia from SCI.

Methods: Design Eighty individuals with paraplegia from SCI and shoulder pain were randomly assigned to receive either an exercise/movement optimization intervention or an attention control intervention.

Impact of Gender on Shoulder Torque and Manual Wheelchair Usage for Individuals with Paraplegia: A Preliminary Report.

BACKGROUND: The prevalence of women with spinal cord injury is increasing, and their unique attributes merit attention, specifically, shoulder strength and community wheelchair propulsion. RESULTS: Shoulder torques were 62%-96% greater in men than women, average daily distance traveled was greater for men, and average speeds were similar. CONCLUSIONS: Community wheelchair propulsion speed was similar between men and women but men were significantly stronger, therefore daily mobility requires a higher relative effort for women's shoulder muscles.

Surgical clinical correlates in anatomy: design and implementation of a first-year medical school program.

Medical students state the need for a clinically oriented anatomy class so to maximize their learning experience. We hypothesize that the first-year medical students, who take the Surgical Clinical Correlates in Anatomy program, will perform better than their peers in their anatomy course, their surgical clerkships and ultimately choose surgical residencies. We designed and recently implemented this program for first-year medical students.

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 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.