Abstract
Objective
To evaluate the immediate effects of transfer training based on the Transfer Assessment
Instrument (TAI) on the upper limb biomechanics during transfers.
Design
Pre-post intervention.
Setting
Biomechanics laboratory.
Participants
Full-time manual wheelchair users (N=24) performed 5 transfers to a level height bench,
while their natural transfer skills were scored using the TAI, and their biomechanical
data were recorded.
Intervention
Participants with 2 or more component skill deficits were invited to return to receive
personalized transfer training.
Main Outcome Measures
TAI part 1 summary scores and biomechanical variables calculated at the shoulder,
elbow, and wrist joints were compared before and immediately after transfer training.
Results
Sixteen of the 24 manual wheelchair users met the criteria for training, and 11 manual
wheelchair users came back for the revisit. Their TAI part 1 summary scores improved
from 6.31±.98 to 9.92±.25. They had significantly smaller elbow range of motion, shoulder
resultant moment, and rates of rise of elbow and wrist resultant forces on their trailing
side during transfers after training (P<.05). On the leading side, shoulder maximum internal rotation and elevation angles,
and shoulder resultant moments and rates of rise of shoulder resultant force and moment
decreased after training (P<.04).
Conclusions
The TAI-based training showed short-term beneficial biomechanical effects on wheelchair
users' upper limbs, such as better shoulder positioning and lower joint loadings.
If the skills are practiced longer-term, they may help protect the upper limbs from
developing pain and injuries.
Keywords
List of abbreviations:
ROM (range of motion), TAI (Transfer Assessment Instrument)To read this article in full you will need to make a payment
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References
- Most essential wheeled mobility skills for daily life: an international survey among paralympic wheelchair athletes with spinal cord injury.Arch Phys Med Rehabil. 2012; 93: 629-635
- Scapular kinematics during transfers in manual wheelchair users with and without shoulder impingement.Clin Biomech (Bristol, Avon). 2005; 20: 32-40
- Comparison of peak shoulder and elbow mechanical loads during weight-relief lifts and sitting pivot transfers among manual wheelchair users with spinal cord injury.J Rehabil Res Dev. 2008; 45: 863-873
- Load on the shoulder complex during wheelchair propulsion and weight relief lifting.Clin Biomech (Bristol, Avon). 2011; 26: 452-457
- Upper extremity pain after spinal cord injury.Spinal Cord. 1999; 37: 191-195
- Development of the wheelchair user's shoulder pain index (WUSPI).Paraplegia. 1995; 33: 290-293
- Upper limb kinetic analysis of three sitting pivot wheelchair transfer techniques.Clin Biomech (Bristol, Avon). 2011; 26: 923-929
- Late complications of the weight-bearing upper extremity in the paraplegic patient.Clin Orthop Relat Res. 1988; : 132-135
- MR imaging of rotator cuff tears in individuals with paraplegia.AJR Am J Roentgenol. 1997; 168: 919-923
- Biomechanics of sitting pivot transfers among individuals with a spinal cord injury: a review of the current knowledge.Top Spinal Cord Inj Rehabil. 2009; 15: 33-58
- Upper extremity peripheral nerve entrapments among wheelchair athletes: prevalence, location, and risk factors.Arch Phys Med Rehabil. 1994; 75: 519-524
- Upper limb nerve entrapment syndromes in veterans with lower limb amputations.PMR. 2010; 2: 14-22
- Association between mobility, participation, and wheelchair-related factors in long-term care residents who use wheelchairs as their primary means of mobility.J Am Geriatr Soc. 2012; 60: 1310-1315
- Upper limb function in persons with long term paraplegia and implications for independence: part I.Paraplegia. 1994; 32: 211-218
- Reliability and validity analysis of the Transfer Assessment Instrument.Arch Phys Med Rehabil. 2011; 92: 499-508
- The relationship between independent transfer skills and upper limb kinetics in wheelchair users.Biomed Res Int. 2014; 2014: 984526
- Impact of the clinical practice guideline for preservation of upper limb function on transfer skills of persons with acute spinal cord injury.Arch Phys Med Rehabil. 2013; 94: 1230-1246
- Development of custom measurement system for biomechanical evaluation of independent wheelchair transfers.J Rehabil Res Dev. 2011; 48: 1015-1028
- ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion—part II: shoulder, elbow, wrist and hand.J Biomech. 2005; 38: 981-992
- Basic psychometric properties of the Transfer Assessment Instrument (version 3.0).Arch Phys Med Rehabil. 2013; 94: 2456-2464
- Modeling considerations in motor skill acquisition and performance: an integrated approach.Exerc Sport Sci Rev. 1989; 17: 475-513
- Hand rim wheelchair propulsion training using biomechanical real-time visual feedback based on motor learning theory principles.J Spinal Cord Med. 2010; 33: 33-42
Kankipati P, Vega A, Koontz A, Lin Y. Phase identification of sitting pivot wheelchair transfers. In: Proceedings of the American Society of Biomechanics annual meeting; 2011 Aug 10-13; Long Beach, CA. American Society of Biomechanics; 2011.
- A mathematical model of the human body.AMRL TR. 1964; : 1-149
- Glenohumeral joint kinematics and kinetics for three coordinate system representations during wheelchair propulsion.Am J Phys Med Rehabil. 1999; 78: 435-446
- Effects of sensorimotor trunk impairments on trunk and upper limb joint kinematics and kinetics during sitting pivot transfers in individuals with a spinal cord injury.Clin Biomech (Bristol, Avon). 2013; 28: 1-9
- Relationship between shoulder pain and kinetic and temporal-spatial variability in wheelchair users.Arch Phys Med Rehabil. 2014; 95: 699-704
- A biomechanical model correlating shoulder kinetics to pain in young baseball pitchers.J Hum Kinet. 2012; 34: 15-20
- Shoulder joint kinetics and pathology in manual wheelchair users.Clin Biomech (Bristol, Avon). 2006; 21: 781-789
- Persistent shoulder pain: epidemiology, pathophysiology, and diagnosis.Am J Orthop (Belle Mead NJ). 2005; 34: 5-9
- Prevalence and identification of shoulder pathology in athletic and nonathletic wheelchair users with shoulder pain: a pilot study.J Rehabil Res Dev. 2004; 41: 395-402
- Pushrim biomechanics and injury prevention in spinal cord injury: recommendations based on CULP-SCI investigations.J Rehabil Res Dev. 2005; 42: 9-19
- Glenohumeral rotational motion and strength and baseball pitching biomechanics.J Athl Train. 2012; 47: 247-256
- Trunk and upper extremity kinematics during sitting pivot transfers performed by individuals with spinal cord injury.Clin Biomech (Bristol, Avon). 2008; 23: 279-290
- Transfer movement strategies of individuals with spinal cord injuries.Disabil Rehabil. 1996; 18: 35-41
- Wheelchair pushrim kinetics: body weight and median nerve function.Arch Phys Med Rehabil. 1999; 80: 910-915
- power primer.Psychol Bull. 1992; 112: 155-159
- Postural control and fear of falling in persons with low-level paraplegia.J Rehabil Res Dev. 2010; 47: 497-502
- Transfer component skill deficit rates among veterans who use wheelchairs.J Rehabil Res Dev. 2016; 53: 279-293
- Transfer from table to wheelchair in men and women with spinal cord injury: coordination of body movement and arm forces.Spinal Cord. 2007; 45: 41-48
- Quantification of reaction forces during sitting pivot transfers performed by individuals with spinal cord injury.J Rehabil Med. 2008; 40: 468-476
- Preservation of upper limb function following spinal cord injury: a clinical practice guideline for health-care professionals.J Spinal Cord Med. 2005; 28: 434-470
- In vivo measurements of subacromial impingement: substantial compression develops in abduction with large internal rotation.Clin Biomech (Bristol, Avon). 2006; 21: 692-700
- Shoulder biomechanics and muscle plasticity: implications in spinal cord injury.Clin Orthop Relat Res. 2002; : S26-S36
- Upper limb nerve entrapments in elite wheelchair racers.Am J Phys Med Rehabil. 1996; 75: 170-176
- Elbow extension using anterior deltoids and upper pectorals in spinal cord-injured subjects.Arch Phys Med Rehabil. 1995; 76: 426-432
- Upper extremity pain in the postrehabilitation spinal cord injured patient.Arch Phys Med Rehabil. 1992; 73: 44-48
- The effects of tendon load and posture on carpal tunnel pressure.J Hand Surg [Am]. 1997; 22: 628-634
Article info
Publication history
Published online: April 12, 2016
Footnotes
Supported by the Department of Veterans Affairs (grant no. B7149I).
The contents of this publication were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90SI5008). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this paper do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.
Clinical Trial Registration No.: VA02974.
Disclosures: R.A.C. reports financial relationships with Accessible Design and Three Rivers Holdings, outside the submitted work. The other authors have nothing to disclose.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
