Shoulder Pain in Persons With Tetraplegia and the Association With Force Application During Manual Wheelchair Propulsion

Archives of Rehabilitation Research and Clinical Translation, 2024 · DOI: https://doi.org/10.1016/j.arrct.2023.100310 · Published: January 1, 2024

Spinal Cord Injury Orthopedics Rehabilitation

Simple Explanation

Manual wheelchair users rely on their upper body strength for daily tasks, making them susceptible to shoulder pain, which can reduce their independence and quality of life. This study found that wheelchair users with tetraplegia and high levels of shoulder pain actually propel their wheelchairs more optimally, using force more effectively and shortening recovery time, contrary to what's seen in paraplegia. These results suggest that risk factors for shoulder pain and propulsion biomechanics differ between individuals with tetraplegia and paraplegia, highlighting the need for tailored interventions.

Study Duration

Not specified

Participants

16 community dwelling, wheelchair dependent persons with a chronic tetraplegia between C4 and C7

Evidence Level

Cross-sectional, observational study

Key Findings

1
Wheelchair users with high levels of shoulder pain applied propulsion force more effectively and with a lower medial component compared to those with low or moderate pain.
2
Individuals with high shoulder pain shortened their recovery time during wheelchair propulsion compared to those with low shoulder pain.
3
The study found that persons with high levels of shoulder pain applied the force over a larger push angle, which is considered more optimal for reducing peak forces and push frequency.

Research Summary

This study investigated the relationship between shoulder pain and wheelchair propulsion in individuals with tetraplegia, finding that those with high pain levels propel their wheelchairs more optimally. Contrary to expectations based on studies of paraplegic wheelchair users, the tetraplegic participants with higher shoulder pain demonstrated more effective force application and shorter recovery times. The findings suggest a different interaction between shoulder pain and propulsion biomechanics in tetraplegia, necessitating tailored analyses and interventions for this population.

Practical Implications

Tailored Interventions

Rehabilitation programs should consider the unique propulsion biomechanics of individuals with tetraplegia when addressing shoulder pain.

Further Research Needed

Longitudinal studies are required to understand the causal relationship between shoulder pain and wheelchair propulsion in tetraplegia.

Clinical Practice

Healthcare professionals should recognize that recommendations based on paraplegia studies may not be directly applicable to individuals with tetraplegia.

Study Limitations

1
The cross-sectional design limits the ability to determine causality.
2
The small sample size may not fully represent the variability within pain groups.
3
The study was conducted in a lab setting, which may not reflect real-life wheelchair propulsion.

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