Original articleRelationship Between Shoulder Pain and Kinetic and Temporal-Spatial Variability in Wheelchair Users
Section snippets
Participants
Twenty-six individuals (10 women, 16 men) from the Urbana-Champaign community volunteered and provided informed consent before participation in this study. All the participants were MWUs who used a wheelchair as their primary means of ambulation for more than 1 year and were between 18 and 64 years of age. People were excluded from participation if they had upper limb pain that prohibited them from propelling a manual wheelchair. The wheelchair users' diagnoses include spinal cord injury (T8
Participant demographics
The pain group had a higher total WUSPI score than the no-pain group (P=.006) (see table 1).
Velocity and perceived exertion
All participants maintained speeds very close to the targets provided in real time. Actual propulsion speed differences between groups (pain/no pain) were not significantly different (P>.05). Perceived exertion scores were low (20%–30% effort) for all speed conditions and not significantly different between groups (P>.05). On average, the magnitude of self-selected speeds fell in between the slow and
Discussion
We hypothesized that MWUs experiencing pain would propel with less variable kinetic and temporal-spatial propulsion outcome measures than those without pain. Consistent with our hypothesis, MWUs with pain displayed decreased CV in kinetic and temporal-spatial variables (see table 3). These results provide preliminary evidence that CV may serve as a unique marker of shoulder pain.
In the present study, persons reporting pain displayed reduced relative variability (CV) in both temporal-spatial and
Conclusions
The mean wheelchair propulsion values of peak force and push time were not different between pain groups. However, the variability of these biomechanical measures of wheelchair propulsion was lower in wheelchair users with shoulder pain. Future work is needed to determine whether relative variability analysis will offer an approach of earlier identification of MWUs at risk for developing shoulder pain and upper limb musculoskeletal disorders.
Suppliers
- a.
Three Rivers Holdings, LLC, 1826 W Broadway Rd, Ste 43, Mesa, AZ 85202.
- b.
The MathWorks, Inc, 3 Apple Hill Dr, Natick, MA 01760-2098.
- c.
SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.
Acknowledgments
We thank the staff of the Illinois Simulator Laboratory where data collection occurred, and Sa Shen, PhD, for biostatistical support.
References (35)
- et al.
Manual wheelchair pushrim biomechanics and axle position
Arch Phys Med Rehabil
(2000) - et al.
Wheelchair pushrim kinetics: body weight and median nerve function
Arch Phys Med Rehabil
(1999) - et al.
Shoulder biomechanics during the push phase of wheelchair propulsion: a multisite study of persons with paraplegia
Arch Phys Med Rehabil
(2008) - et al.
Shoulder joint pathology and kinetics in manual wheelchair users
Clin Biomech (Bristol, Avon)
(2006) - et al.
Shoulder MRI abnormalities, wheelchair propulsion, and gender
Arch Phys Med Rehabil
(2003) - et al.
Course of gross mechanical efficiency in handrim wheelchair propulsion during rehabilitation of people with spinal cord injury: a prospective cohort study
Arch Phys Med Rehabil
(2005) - et al.
Motor variability in occupational health and performance
Clin Biomech (Bristol, Avon)
(2012) - et al.
A dynamical systems approach to lower extremity running injuries
Clin Biomech (Bristol, Avon)
(1999) Diversity and variation in biomechanical exposure: what is it, and why would we like to know?
Appl Ergon
(2006)- et al.
Hand-wrist disorders among investment casting plant workers
J Hand Surg [Am]
(1987)
Effects of fatigue on inter-cycle variability in cross-country skiing
J Biomech
Upper extremity pain after spinal cord injury
Spinal Cord
Upper extremity pain in the postrehabilitation spinal cord injured patient
Arch Phys Med Rehabil
Pushrim biomechanics and injury prevention in spinal cord injury: recommendations based on CULP-SCI Investigations
J Rehabil Res Dev
Shoulder pain in chronic spinal cord injury, part I: epidemiology, etiology, and pathomechanics
J Spinal Cord Med
Factors associated with thoracic spinal cord injury, lesion level and rotator cuff disorders
Spinal Cord
Cited by (23)
Shoulder Pain in Persons With Tetraplegia and the Association With Force Application During Manual Wheelchair Propulsion
2024, Archives of Rehabilitation Research and Clinical TranslationThe longitudinal relationship between shoulder pain and altered wheelchair propulsion biomechanics of manual wheelchair users
2021, Journal of BiomechanicsCitation Excerpt :Therefore, understanding the interplay between shoulder pain and wheelchair propulsion biomechanics is of clinical importance but remains surprisingly unclear. Previous studies have identified an association between shoulder pain and wheelchair propulsion parameters such as greater peak magnitude, rate of rise and jerk of push rim forces and lower kinetic and scapular kinematic variability (Beirens et al., 2020; Briley et al., 2020b; Dysterheft et al., 2017; Rice et al., 2014). However, these findings are based on cross-sectional studies; as a result, the time-varying relationship between shoulder pain symptoms and wheelchair propulsion biomechanics is currently undetermined.
Shoulder Pain Is Associated With Rate of Rise and Jerk of the Applied Forces During Wheelchair Propulsion in Individuals With Paraplegic Spinal Cord Injury
2021, Archives of Physical Medicine and RehabilitationScapular kinematic variability during wheelchair propulsion is associated with shoulder pain in wheelchair users
2020, Journal of BiomechanicsCitation Excerpt :Current evidence for an association between shoulder pain and wheelchair propulsion biomechanics is unclear (Collinger et al., 2008; Moon et al., 2013). Biomechanical studies of wheelchair propulsion primarily employ mean spatio-temporal and kinetic measures; however, evidence suggests that these variables are comparable in manual wheelchair users with and without shoulder pain (Moon et al., 2013; Rice et al., 2014). Previous findings are currently limited by the reliance on small study sample sizes and categorising individuals into those with and those without shoulder pain.
Predictors of shoulder pain in manual wheelchair users
2019, Clinical BiomechanicsCitation Excerpt :In highly repetitive tasks such as wheelchair propulsion, analyzing intra-individual variability may be able to distinguish those who are at a higher risk of developing pain or injuries. Recent studies have shown that MWCU with shoulder pain have significantly lower cycle-to-cycle variability in peak total shoulder joint force (Moon et al., 2013), peak total handrim force and push time (Rice et al., 2014). Other work has found that kinematic spatial variability in the wrist motion is higher at the beginning of the recovery phase in those with shoulder pain than those without pain (Jayaraman et al., 2014).
Supported in part by the National Institutes of Health (grant no. 1R21HD066129-01A1).
No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.