Volume 89, Issue 4 , Pages 667-676, April 2008
Shoulder Biomechanics During the Push Phase of Wheelchair Propulsion: A Multisite Study of Persons With Paraplegia
Abstract
Collinger JL, Boninger ML, Koontz AM, Price R, Sisto SA, Tolerico ML, Cooper RA. Shoulder biomechanics during the push phase of wheelchair propulsion: a multisite study of persons with paraplegia.
Objectives
To present a descriptive analysis and comparison of shoulder kinetics and kinematics during wheelchair propulsion at multiple speeds (self-selected and steady-state target speeds) for a large group of manual wheelchair users with paraplegia while also investigating the effect of pain and subject demographics on propulsion.
Design
Case series.
Setting
Three biomechanics laboratories at research institutions.
Participants
Volunteer sample of 61 persons with paraplegia who use a manual wheelchair for mobility.
Intervention
Subjects propelled their own wheelchairs on a dynamometer at 3 speeds (self-selected, 0.9m/s, 1.8m/s) while kinetic and kinematic data were recorded.
Main Outcome Measures
Differences in demographics between sites, correlations between subject characteristics, comparison of demographics and biomechanics between persons with and without pain, linear regression using subject characteristics to predict shoulder biomechanics, comparison of biomechanics between speed conditions.
Results
Significant increases in shoulder joint loading with increased propulsion velocity were observed. Resultant force increased from 54.4±13.5N during the 0.9m/s trial to 75.7±20.7N at 1.8m/s (P<.001). Body weight was the primary demographic variable that affected shoulder forces, whereas pain did not affect biomechanics. Peak shoulder joint loading occurs when the arm is extended and internally rotated, which may leave the shoulder at risk for injury.
Conclusions
Body-weight maintenance, as well as other interventions designed to reduce the force required to propel a wheelchair, should be implemented to reduce the prevalence of shoulder pain and injury among manual wheelchair users.
Key Words: Biomechanics, Rehabilitation, Shoulder, Spinal cord injuries, Wheelchairs
Supported by the National Institute on Disability and Rehabilitation Research (grant no. H133A011107), Veterans Affairs Rehabilitation Research and Development Service, U.S. Department of VA Affairs (grant no. B3057R), University of Pittsburgh Model Center on Spinal Cord Injury (grant no. H133N000019), and a National Science Foundation Graduate Research Fellowship.
A commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit upon the author or 1 or more of the authors. Boninger and Cooper have a nonfinancial affiliation with Three Rivers Holdings in the form of subcontracted grants. In addition, Three Rivers Holdings licenses patents unrelated to this publication from the University of Pittsburgh. Boninger and Cooper receive royalties through the University of Pittsburgh from the sales of these licensed inventions.
PII: S0003-9993(08)00031-2
doi:10.1016/j.apmr.2007.09.052
© 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Volume 89, Issue 4 , Pages 667-676, April 2008
