Glenohumeral Joint Biomechanics, Pain and Stroke Pattern Variability During Pediatric Manual Wheelchair Mobilty: A Longitudinal Evaluation
1Slavens B, 2Schlidt K, 1Schnorenberg A, 3Vogel L, 4Harris G
1University of Wisconsin-Milwaukee, Milwaukee, WI, USA; 2Medical College of Wisconsin, Milwaukee, WI, USA; 3Shriners Hospitals for Children, Chicago, WI, USA; 4Marquette University, Milwaukee, WI, USA
Objective: Due to limited research investigating the longitudinal biomechanical changes in pediatric manual wheelchair users and the high risk of shoulder pain and pathology development, there is a need to determine the most efficient method of propulsion that limits the risk of musculoskeletal injury and improves quality of life. This study investigated stroke patterns and glenohumeral joint forces to understand how pediatric manual wheelchair use changes over time. We hypothesized that pediatric manual wheelchair users will experience lower joint forces with time and that pediatric users will experience lower pain due to lower joint forces.
Design/Methods: Three subjects with spinal cord injury (SCI) with a mean age for the first and second visit: 14.8 years (±2.5 years) and 16.3 years (±2.7 years), respectively, were included in the study. Bony levels of SCI ranged from the sixth cervical to the ninth thoracic vertebra. Subjects underwent motion analysis while they propelled their wheelchair at a self-selected speed and propulsion pattern. Ten strokes per subject were analyzed and the upper extremity joint forces were computed with our custom inverse dynamics model. Stroke patterns were determined by plotting the sagittal plane trajectories of a marker on the hand. Pain was reported using the standardized Visual Analog Scale (VAS), where 0 represents no pain and 100 was the worst pain ever experienced.
Results: The average glenohumeral joint forces that increased with time were the superiorly directed force (6.8%BW to 8.5%BW) and the laterally directed force (5.7%BW to 7.7%BW), which previous studies have associated with shoulder pathology in adult manual wheelchair users. Stroke patterns were observed that are not typically represented by the four adult classifications. Additionally, there was significant variation in the stroke patterns, both within and between visits for all subjects. Two of the subjects with comparable weights, time since injury, SCI level, and age displayed different joint forces and stroke patterns. The average VAS pain score decreased from 6.7 (±9.4) to 3.3 (±4.7), with one subject reporting no change in pain.
Conclusion: The increased glenohumeral joint forces and varying stroke patterns demonstrate the variability between these pediatric users over time. The variation in joint forces potentially resulting from the varied stroke patterns may be an important factor in preventing overuse injuries and pain. This research may be applied for training pediatric and adult manual wheelchair users.
Further investigation of the relationship among pain, shoulder forces, and stroke patterns while evaluating anatomical changes in the developing shoulder is warranted in a larger population of pediatric manual wheelchair users to more definitively understand how variability in these metrics can impact rehabilitation and long-term quality of life.
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