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Shoulder Magnetic Resonance Imaging Abnormalities, Wheelchair Propulsion, and Gender

Boninger, ML and Dicianno, BE and Cooper, RA and Towers, JD and Koontz, AM and Souza, AL (2003) Shoulder Magnetic Resonance Imaging Abnormalities, Wheelchair Propulsion, and Gender. Archives of Physical Medicine and Rehabilitation, 84 (11). 1615 - 1620. ISSN 0003-9993

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Abstract

Objective: To investigate the relationship between pushrim forces and the progression of shoulder injuries in manual wheelchair users. Design: Longitudinal case series. Setting: Biomechanics laboratory and magnetic resonance imaging (MRI) facility at a Veterans Health Administration medical center and university hospital, respectively. Participants: Fourteen individuals with spinal cord injury (8 men, 6 women) who used manual wheelchairs. Intervention: Subjects propelled their own wheelchairs on a dynamometer at 0.9 and 1.8m/s. Bilateral biomechanical data were obtained by using force and moment sensing pushrims at time 1. Bilateral shoulder MR images were also completed on 2 occasions, at time 1 and, approximately 2 years later, at time 2. Main Outcome Measures: The peak pushrim forces in a pushrim coordinate system were calculated, weight normalized and averaged over 5 strokes (presented as % body weight). MRI abnormalities were graded by using a summated scale. Differences between scores between times 1 and 2 were calculated. Results: Subjects were divided into 2 groups based on change in MRI score. Seven subjects were in the group with worsening scores (MRI+; mean, 8.14 points; range, 5-16), and 7 were in the group with improving or unchanging scores (MRI-; mean, -1.00 point; range, -5 to 1). There was no significant difference between groups with respect to age, body mass index, or years from injury. There were significantly more women in the MRI+ group (6 women, 1 man) than in the MRI- group (7 men) (P=.001). The MRI+ group used significantly greater weight- normalized radial force, or force directed toward the axle at time 1, to propel their wheelchairs at each speed (P<.01): MRI+ at 0.9m/s (mean radial force ± standard deviation, 5.2%±1.0%) and MRI- at 0.9m/s (mean radial force, 3.2%±1.7%) (P=.028); and MRI+ at 1.8m/s (mean radial force, 6.6%±1.2%) (P=.023) and MRI- at 1.8m/s (mean radial force, 4.1%±2.2%). In a separate analysis, women were found to propel with a significantly higher radial force. A logistic regression found a significant relationship between radial force at time 1 and increased risk of progression of MRI findings over time. Conclusion: Individuals who propel with a greater percentage of force directed toward the axle were at increased risk of progression of MRI findings over time. Most people in this group were women. Clinicians should instruct wheelchair users in effective propulsion techniques and should pay particular attention to women who use wheelchairs. Reducing forces during wheelchair propulsion may minimize the likelihood of developing shoulder injuries.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Boninger, MLboninger@pitt.eduBONINGER
Dicianno, BEdicianno@pitt.eduDICIANNO0000-0003-0738-0192
Cooper, RARCOOPER@pitt.eduRCOOPER
Towers, JD
Koontz, AMakoontz@pitt.eduAKOONTZ
Souza, AL
Centers: Other Centers, Institutes, or Units > Human Engineering Research Laboratories
Date: 1 January 2003
Date Type: Publication
Journal or Publication Title: Archives of Physical Medicine and Rehabilitation
Volume: 84
Number: 11
Page Range: 1615 - 1620
DOI or Unique Handle: 10.1053/s0003-9993(03)00282-x
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science and Technology
Refereed: Yes
ISSN: 0003-9993
MeSH Headings: Adult; Biomechanics; Female; Humans; Logistic Models; Longitudinal Studies; Magnetic Resonance Imaging; Male; Sex Factors; Shoulder--abnormalities; Shoulder--radiography; Spinal Cord Injuries--rehabilitation; Wheelchairs
PubMed ID: 14639560
Date Deposited: 25 Sep 2012 14:24
Last Modified: 02 Feb 2019 16:56
URI: http://d-scholarship.pitt.edu/id/eprint/14421

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