Stefan I Madansingh1, Emma Fortune2, Melissa M Morrow2, Kristin D Zhao1, Beth A Cloud-Biebl3. 1. Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA. 2. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA. 3. Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA; Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic, Rochester, MN 55905, USA. Electronic address: Cloud.Beth@mayo.edu.
Abstract
BACKGROUND: Repetitive glenohumeral joint movement during manual wheelchair propulsion has been associated with shoulder pain in individuals with spinal cord injury. Clinical guidelines for shoulder health maintenance encourage semi-circular over arc propulsion to reduce loading frequency. This study aimed to determine the difference in estimated supraspinatus to acromion compression risk, and shoulder, thorax kinematics between (1) arc and semi-circular propulsion; and (2) self-selected and coached strategies. METHODS: Shoulder and thorax kinematics were captured during wheelchair propulsion, noting individually self-selected styles. Participants were then coached to perform the other style(s) of interest, arc and/or semi-circular. CT bone models of the humerus and scapula were animated using glenohumeral kinematics to estimate the minimum distance between the supraspinatus humeral attachment and the acromion. Compression risk was defined as the proportion of each propulsion phase where the minimum distance fell below 5 mm. Comparisons were made between conditions evaluating compression risk, minimum distances and kinematics at events throughout propulsion. FINDINGS: Ten individuals with spinal cord injury (9 male) participated. Arc and semi-circular propulsion did not significantly differ in compression risk or minimum distance across propulsion phases. Self-selected styles yielded lower compression risk and larger proximity values compared to coached styles. Glenohumeral horizontal abduction and thorax flexion differed between arc and semi-circular propulsion. Multiple glenohumeral and humerothoracic differences emerged between self-selected and coached conditions. INTERPRETATION: Supraspinatus compression was observed during both arc and semi-circular propulsion, suggesting risk may be unavoidable in this task. Self-selected styles yield less risk, likely related to coached style unfamiliarity.
BACKGROUND:Repetitive glenohumeral joint movement during manual wheelchair propulsion has been associated with shoulder pain in individuals with spinal cord injury. Clinical guidelines for shoulder health maintenance encourage semi-circular over arc propulsion to reduce loading frequency. This study aimed to determine the difference in estimated supraspinatus to acromion compression risk, and shoulder, thorax kinematics between (1) arc and semi-circular propulsion; and (2) self-selected and coached strategies. METHODS: Shoulder and thorax kinematics were captured during wheelchair propulsion, noting individually self-selected styles. Participants were then coached to perform the other style(s) of interest, arc and/or semi-circular. CT bone models of the humerus and scapula were animated using glenohumeral kinematics to estimate the minimum distance between the supraspinatus humeral attachment and the acromion. Compression risk was defined as the proportion of each propulsion phase where the minimum distance fell below 5 mm. Comparisons were made between conditions evaluating compression risk, minimum distances and kinematics at events throughout propulsion. FINDINGS: Ten individuals with spinal cord injury (9 male) participated. Arc and semi-circular propulsion did not significantly differ in compression risk or minimum distance across propulsion phases. Self-selected styles yielded lower compression risk and larger proximity values compared to coached styles. Glenohumeral horizontal abduction and thorax flexion differed between arc and semi-circular propulsion. Multiple glenohumeral and humerothoracic differences emerged between self-selected and coached conditions. INTERPRETATION: Supraspinatus compression was observed during both arc and semi-circular propulsion, suggesting risk may be unavoidable in this task. Self-selected styles yield less risk, likely related to coached style unfamiliarity.
Authors: Brianna M Goodwin; Omid Jahanian; Meegan G Van Straaten; Emma Fortune; Stefan I Madansingh; Beth A Cloud-Biebl; Kristin D Zhao; Melissa M Morrow Journal: Sensors (Basel) Date: 2021-02-10 Impact factor: 3.576