Advertisement

Muscle Strength Cutoff Points for Functional Independence and Wheelchair Ability in Men With Spinal Cord Injury

Published:February 11, 2020DOI:https://doi.org/10.1016/j.apmr.2020.01.010

      Abstract

      Objective

      Determine trunk and shoulder muscle strength cutoff points for functional independence and wheelchair skills, and verify the predictive capacity of relative and absolute peak torque in men with spinal cord injury (SCI).

      Design

      Cross-sectional study.

      Setting

      Rehabilitation hospital setting.

      Participants

      Men (N=54) with SCI were recruited and stratified into high and low paraplegia groups.

      Interventions

      All participants performed maximum strength tests for shoulder abduction or adduction (isokinetic) and trunk flexion or extension (isometric) to determine relative and absolute peak torque cutoff points for the Spinal Cord Independence Measure version III (SCIM-III) and Adapted Manual Wheelchair Circuit (AMWC).

      Main outcome measures

      The primary outcome measures were SCIM-III, AMWC-Brazil test, and strength variables (peak torques). Demographic characteristics obtained from participants’ electronic medical records were the secondary outcomes used as predictor variables of functional independence.

      Results

      The best predictive model for SCIM-III (R=0.78, P≤.05) used the sum of trunk flexion and extension relative peak torque values to determine the cutoff points (1.42 N·m/kg for a score of 70). Relative shoulder abduction peak torque was used in the predictive models for AMWC outcomes: performance score (R=0.77, P≤.05, cutoff points of 0.97 N·m/kg for 300.0m) and 3-minute overground wheeling (R=0.72, P≤.05, cutoff points of 0.96 N·m/kg for 18.5s).

      Conclusions

      Relative peak torque showed better predictive capacity compared to absolute peak torque. Cutoff points were established for relative muscle strength and could help health professionals set appropriate goals for individuals with SCI to achieve high functional independence and wheelchair ability.

      Keywords

      List of abbreviations:

      1RM (one-repetition maximum), AMWC (Adapted Manual Wheelchair Circuit), HP (high paraplegia), LP (low paraplegia), MVIC (maximum voluntary isometric contraction), SCI (spinal cord injury), SCIM-III (Spinal Cord Independence Measure version III)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Haisma J.A.
        • Post M.W.
        • van der Woude L.H.
        • et al.
        Functional independence and health-related functional status following spinal cord injury: a prospective study of the association with physical capacity.
        J Rehabil Med. 2008; 40: 812-818
        • Mulroy S.J.
        • Gronley J.K.
        • Newsam C.J.
        • Perry J.
        Electromyographic activity of shoulder muscles during wheelchair propulsion by paraplegic persons.
        Arch Phys Med Rehabil. 1996; 77: 187-193
        • Harvey L.A.
        Physiotherapy rehabilitation for people with spinal cord injuries.
        J Phys. 2016; 62: 4-11
        • Kilkens O.J.
        • Dallmeijer A.J.
        • De Witte L.P.
        • Van Der Woude L.H.
        • Post M.W.
        The Wheelchair Circuit: construct validity and responsiveness of a test to assess manual wheelchair mobility in persons with spinal cord injury.
        Arch Phys Med Rehabil. 2004; 85: 424-431
        • Pentland W.E.
        • Twomey L.T.
        Upper limb function in persons with long term paraplegia and implications for independence: part I.
        Paraplegia. 1994; 32: 211-218
        • Saboe L.A.
        • Darrah J.M.
        • Pain K.S.
        • Guthrie J.
        Early predictors of functional independence 2 years after spinal cord injury.
        Arch Phys Med Rehabil. 1997; 78: 644-650
        • Abdul-Sattar A.B.
        Predictors of functional outcome in patients with traumatic spinal cord injury after inpatient rehabilitation: in Saudi Arabia.
        NeuroRehabilitation. 2014; 35: 341-347
        • Ribeiro Neto F.
        • Guanais P.
        • Lopes G.H.
        • et al.
        Influence of relative strength on functional independence of patients with spinal cord injury.
        Arch Phys Med Rehabil. 2017; 98: 1104-1112
        • Warburton D.E.
        • Eng J.J.
        • Krassioukov A.
        • Sproule S.
        Cardiovascular health and exercise rehabilitation in spinal cord injury.
        Top Spinal Cord Inj Rehabil. 2007; 13: 98-122
        • Manini T.M.
        • Clark B.C.
        Dynapenia and aging: an update.
        J Gerontol A Biol Sci Med Sci. 2012; 67: 28-40
        • Dost G.
        • Dulgeroglu D.
        • Yildirim A.
        • Ozgirgin N.
        The effects of upper extremity progressive resistance and endurance exercises in patients with spinal cord injury.
        J Back Musculoskelet Rehabil. 2014; 27: 419-426
        • Turbanski S.
        • Schmidtbleicher D.
        Effects of heavy resistance training on strength and power in upper extremities in wheelchair athletes.
        J Strength Cond Res. 2010; 24: 8-16
        • Schwingel P.A.
        • Porto Y.C.
        • Dias M.C.
        • Moreira M.M.
        • Zoppi C.C.
        Predicting one repetition maximum equations accuracy in paralympic rowers with motor disabilities.
        J Strength Cond Res. 2009; 23: 1045-1050
        • Cadore E.
        • Pinto R.S.
        • Brentano M.A.
        • et al.
        Prediction of one repetition maximum load by total and lean body mass in trained and untrained men.
        Med Sport. 2012; 16: 111-117
        • Gagnon D.H.
        • Roy A.
        • Gabison S.
        • Duclos C.
        • Verrier M.C.
        • Nadeau S.
        Effects of seated postural stability and trunk and upper extremity strength on performance during manual wheelchair propulsion tests in individuals with spinal cord injury: an exploratory study.
        Rehabil Res Pract. 2016; 2016: 6842324
        • Saltan A.
        • Ankarali H.
        The role of trunk stabilization in functional classification levels.
        J Sport Rehabil. 2017; 26: 287-293
        • Prestes J.
        • Tibana R.A.
        Muscular static strength test performance and health: absolute or relative values?.
        Rev Assoc Med Bras. 2013; 59: 308-309
        • Akagi R.
        • Tohdoh Y.
        • Hirayama K.
        • Kobayashi Y.
        Relationship of pectoralis major muscle size with bench press and bench throw performances.
        J Strength Cond Res. 2014; 28: 1778-1782
        • Kirshblum S.C.
        • Burns S.P.
        • Biering-Sorensen F.
        • et al.
        International standards for neurological classification of spinal cord injury (revised 2011).
        J Spinal Cord Med. 2011; 34: 535-546
        • van der Woude L.H.
        • de Groot S.
        • Janssen T.W.
        Manual wheelchairs: research and innovation in rehabilitation, sports, daily life and health.
        Med Eng Phys. 2006; 28: 905-915
        • Rufino R.
        • Costa C.H.
        • Antão V.C.
        • Pinheiro G.A.
        • Jansen J.M.
        Relação envergadura/altura: um valor para estudos espirométricos em brasileiros.
        Pulmão/RJ. 1996; 7: 40-44
        • Bohannon R.W.
        • Smith M.B.
        Interrater reliability of a modified Ashworth scale of muscle spasticity.
        Phys Ther. 1987; 67: 206-207
        • Fekete C.
        • Eriks-Hoogland I.
        • Baumberger M.
        • et al.
        Development and validation of a self-report version of the Spinal Cord Independence Measure (SCIM III).
        Spinal Cord. 2013; 51: 40-47
        • Itzkovich M.
        • Tamir A.
        • Philo O.
        • et al.
        Reliability of the Catz-Itzkovich Spinal Cord Independence Measure assessment by interview and comparison with observation.
        Am J Phys Med Rehabil. 2003; 82: 267-272
        • Ribeiro Neto F.
        • Gomes Costa R.R.
        • Garcia Lopes A.C.
        • Carregaro R.L.
        Cross-cultural validation of a Brazilian version of the adapted manual wheelchair circuit (AMWC-Brazil).
        Phys Theor Pract. 2018; 16: 1-13
        • Ribeiro Neto F.
        • Costa R.R.
        • Cardoso J.R.
        • Brown L.
        • Bottaro M.
        • Carregaro R.L.
        Influence of familiarization on maximum strength testing in male individuals with spinal cord injury.
        Isok Exerc Sci. 2018; 26: 125-132
        • Bohannon R.
        Spearman correlations of .60 are not poor.
        Am J Occ Ther. 1992; 46: 472
        • Kannan K.S.
        • Manoj K.
        • Arumugam S.
        Labeling methods for identifying outliers.
        Int J Stat Sys. 2015; 10: 231-238
        • Powers C.M.
        • Newsam C.J.
        • Gronley J.K.
        • Fontaine C.A.
        • Perry J.
        Isometric shoulder torque in subjects with spinal cord injury.
        Arch Phys Med Rehabil. 1994; 75: 761-765
        • Kotajarvi B.R.
        • Basford J.R.
        • An K.N.
        Upper-extremity torque production in men with paraplegia who use wheelchairs.
        Arch Phys Med Rehabil. 2002; 83: 441-446
        • Souza A.L.
        • Boninger M.L.
        • Fitzgerald S.G.
        • Shimada S.D.
        • Cooper R.A.
        • Ambrosio F.
        Upper limb strength in individuals with spinal cord injury who use manual wheelchairs.
        J Spinal Cord Med. 2005; 28: 26-32
        • Catz A.
        • Itzkovich M.
        • Agranov E.
        • Ring H.
        • Tamir A.
        SCIM -Spinal Cord Independence Measure: a new disability scale for patients with spinal cord lesions.
        Spinal Cord. 1997; 35: 850-856
        • 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
        • Aidinoff E.
        • Front L.
        • Itzkovich M.
        • et al.
        Expected spinal cord independence measure, third version, scores for various neurological levels after complete spinal cord lesions.
        Spinal Cord. 2011; 49: 893-896
        • Kilkens O.J.
        • Post M.W.
        • van der Woude L.H.
        • Dallmeijer A.J.
        • van den Heuvel W.J.
        The Wheelchair Circuit: reliability of a test to assess mobility in persons with spinal cord injuries.
        Arch Phys Med Rehabil. 2002; 83: 1783-1788
        • Cowan R.E.
        • Nash M.S.
        • de Groot S.
        • van der Woude L.H.
        Adapted Manual Wheelchair Circuit: test-retest reliability and discriminative validity in persons with spinal cord injury.
        Arch Phys Med Rehabil. 2011; 92: 1270-1280
        • Slowik J.S.
        • McNitt-Gray J.L.
        • Requejo P.S.
        • Mulroy S.J.
        • Neptune R.R.
        Compensatory strategies during manual wheelchair propulsion in response to weakness in individual muscle groups: a simulation study.
        Clin Biomech. 2016; 33: 34-41
        • Burnham R.S.
        • May L.
        • Nelson E.
        • Steadward R.
        • Reid D.C.
        Shoulder pain in wheelchair athletes. The role of muscle imbalance.
        Am J Sports Med. 1993; 21: 238-242