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Increased Seat Dump Angle in a Manual Wheelchair Is Associated With Changes in Thoracolumbar Lordosis and Scapular Kinematics During Propulsion

Published:March 18, 2017DOI:https://doi.org/10.1016/j.apmr.2017.02.014

      Abstract

      Objective

      To quantify and compare spinal curvature and shoulder kinematics throughout the manual wheelchair (MWC) propulsion cycle for individuals with spinal cord injury (SCI) who were seated at 2 different seat dump angles.

      Design

      Single-group, repeated-measures study.

      Setting

      Academic medical center.

      Participants

      Individuals (N=28) with SCI or spinal cord disease who used MWCs completed a telephone screening, and 21 of them were eligible and completed the study.

      Interventions

      Participants' personal MWCs were modified to have seat dump angles of 0° or 14°, with a vertical backrest. Participants completed at least 3 propulsion cycles in each condition, during which spine and shoulder motion data were collected with fiberoptic and electromagnetic sensors, respectively.

      Main Outcome Measures

      Thoracolumbar spinal curvature, glenohumeral kinematics, and scapulothoracic kinematics at the start of push (SP), mid-push (MP), end of push (EP), and mid-recovery.

      Results

      Participants had significantly less lordosis in the 14° condition for all propulsion events. Median differences ranged from 2.0° to 4.6°. Lordosis differences were more pronounced in those with low SCI. Scapulothoracic internal rotation was increased in the 14° condition at SP and MP (mean differences, 2.5° and 2.7°, respectively). Relative downward rotation increased in the 14° condition at SP and MP (mean differences, 2.4° and 2.1°, respectively). Scapulothoracic differences were more pronounced in those with high SCI. No glenohumeral rotations were significantly different between the conditions.

      Conclusions

      Scapulothoracic kinematics and spinal curvature differences during propulsion may be associated with the position of other body segments or postural stability. Because no differences were observed at the glenohumeral joint, the risk of subacromial impingement may not be affected by this seat angle change.

      Keywords

      List of abbreviations:

      EP (end of push), MP (mid-push), MWC (manual wheelchair), SCI (spinal cord injury), SP (start of push), WUSPI (Wheelchair User's Shoulder Pain Index)
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      References

        • Akbar M.
        • Balean G.
        • Brunner M.
        • et al.
        Prevalence of rotator cuff tear in paraplegic patients compared with controls.
        J Bone Joint Surg Am. 2010; 92: 23-30
        • Morrow M.M.
        • Van Straaten M.G.
        • Murthy N.S.
        • Braman J.P.
        • Zanella E.
        • Zhao K.D.
        Detailed shoulder MRI findings in manual wheelchair users with shoulder pain.
        Biomed Res Int. 2014; 2014: 769649
        • Sinnott K.A.
        • Milburn P.
        • McNaughton H.
        Factors associated with thoracic spinal cord injury, lesion level and rotator cuff disorders.
        Spinal Cord. 2000; 38: 748-753
        • Boninger M.L.
        • Baldwin M.
        • Cooper R.A.
        • Koontz A.
        • Chan L.
        Manual wheelchair pushrim biomechanics and axle position.
        Arch Phys Med Rehabil. 2000; 81: 608-613
        • Hughes C.J.
        • Weimar W.H.
        • Sheth P.N.
        • Brubaker C.E.
        Biomechanics of wheelchair propulsion as a function of seat position and user-to-chair interface.
        Arch Phys Med Rehabil. 1992; 73: 263-269
        • van der Woude L.H.
        • Bouw A.
        • van Wegen J.
        • van As H.
        • Veeger D.
        • de Groot S.
        Seat height: effects on submaximal hand rim wheelchair performance during spinal cord injury rehabilitation.
        J Rehabil Med. 2009; 41: 143-149
        • Yang Y.S.
        • Koontz A.M.
        • Yeh S.J.
        • Chang J.J.
        Effect of backrest height on wheelchair propulsion biomechanics for level and uphill conditions.
        Arch Phys Med Rehabil. 2012; 93: 654-659
        • Paralyzed Veterans of America Consortium for Spinal Cord Medicine
        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
        • Bolin I.
        • Bodin P.
        • Kreuter M.
        Sitting position—posture and performance in C5-C6 tetraplegia.
        Spinal Cord. 2000; 38: 425-434
        • Hastings J.D.
        • Fanucchi E.R.
        • Burns S.P.
        Wheelchair configuration and postural alignment in persons with spinal cord injury.
        Arch Phys Med Rehabil. 2003; 84: 528-534
        • Janssen-Potten Y.J.
        • Seelen H.A.
        • Drukker J.
        • Huson T.
        • Drost M.R.
        The effect of seat tilting on pelvic position, balance control, and compensatory postural muscle use in paraplegic subjects.
        Arch Phys Med Rehabil. 2001; 82: 1393-1402
        • Rodgers M.M.
        • Keyser R.E.
        • Gardner E.R.
        • Russell P.J.
        • Gorman P.H.
        Influence of trunk flexion on biomechanics of wheelchair propulsion.
        J Rehabil Res Dev. 2000; 37: 283-295
        • Finley M.A.
        • Lee R.Y.
        Effect of sitting posture on 3-dimensional scapular kinematics measured by skin-mounted electromagnetic tracking sensors.
        Arch Phys Med Rehabil. 2003; 84: 563-568
        • Kebaetse M.
        • McClure P.
        • Pratt N.A.
        Thoracic position effect on shoulder range of motion, strength, and three-dimensional scapular kinematics.
        Arch Phys Med Rehabil. 1999; 80: 945-950
        • Curtis K.A.
        • Roach K.E.
        • Applegate E.B.
        • et al.
        Reliability and validity of the Wheelchair User's Shoulder Pain Index (WUSPI).
        Paraplegia. 1995; 33: 595-601
        • Curtis K.A.
        • Roach K.E.
        • Applegate E.B.
        • et al.
        Development of the Wheelchair User's Shoulder Pain Index (WUSPI).
        Paraplegia. 1995; 33: 290-293
        • Maurer C.L.
        • Sprigle S.
        Effect of seat inclination on seated pressures of individuals with spinal cord injury.
        Phys Ther. 2004; 84: 255-261
        • Cloud B.A.
        • Zhao K.D.
        • Breighner R.
        • Giambini H.
        • An K.N.
        Agreement between fiber optic and optoelectronic systems for quantifying sagittal plane spinal curvature in sitting.
        Gait Posture. 2014; 40: 369-374
        • Wu G.
        • van der Helm F.C.
        • Veeger H.E.
        • et al.
        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
        • Phadke V.
        • Braman J.P.
        • LaPrade R.F.
        • Ludewig P.M.
        Comparison of glenohumeral motion using different rotation sequences.
        J Biomech. 2011; 44: 700-705
        • Tully E.A.
        • Wagh P.
        • Galea M.P.
        Lumbofemoral rhythm during hip flexion in young adults and children.
        Spine (Phila Pa 1976). 2002; 27: E432-E440
        • Seelen H.A.
        • Potten Y.J.
        • Drukker J.
        • Reulen J.P.
        • Pons C.
        Development of new muscle synergies in postural control in spinal cord injured subjects.
        J Electromyogr Kinesiol. 1998; 8: 23-34
        • Finley M.A.
        • McQuade K.J.
        • Rodgers M.M.
        Scapular kinematics during transfers in manual wheelchair users with and without shoulder impingement.
        Clin Biomech (Bristol, Avon). 2005; 20: 32-40
        • Ludewig P.M.
        • Cook T.M.
        Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement.
        Phys Ther. 2000; 80: 276-291
        • Ludewig P.M.
        • Reynolds J.F.
        The association of scapular kinematics and glenohumeral joint pathologies.
        J Orthop Sports Phys Ther. 2009; 39: 90-104
        • Lukasiewicz A.C.
        • McClure P.
        • Michener L.
        • Pratt N.
        • Sennett B.
        Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement.
        J Orthop Sports Phys Ther. 1999; 29 (discussion 584-586): 574-583
        • Michener L.A.
        • McClure P.W.
        • Karduna A.R.
        Anatomical and biomechanical mechanisms of subacromial impingement syndrome.
        Clin Biomech (Bristol, Avon). 2003; 18: 369-379
        • Nawoczenski D.A.
        • Riek L.M.
        • Greco L.
        • Staiti K.
        • Ludewig P.M.
        Effect of shoulder pain on shoulder kinematics during weight-bearing tasks in persons with spinal cord injury.
        Arch Phys Med Rehabil. 2012; 93: 1421-1430