Ultrasonographic Median Nerve Changes After Repeated Wheelchair Transfers in Persons With Paraplegia: Relationship With Subject Characteristics and Transfer Skills
Ultrasonographic Median Nerve Changes After Repeated Wheelchair Transfers in Persons With Paraplegia: Relationship With Subject Characteristics and Transfer Skills
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DOI：
10.1016/j.pmrj.2015.08.001
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发表时间：
2016-04-01
期刊：
影响因子：
2.1
通讯作者：
Boninger, Michael L.
中科院分区：
文献类型：
--
作者：
Hogaboom, Nathan S.;Diehl, Jessica A.;Boninger, Michael L.
背景：有脊髓损伤的轮椅使用者因过度使用而易患周围神经病变，但尚未有研究确定正中神经病变与轮椅移位之间的关系。目的：评估脊髓损伤患者腕管综合征(CTS)超声标志物的重复转移对受试者特征和转移技巧的影响。设计：横断面重复测量。背景：研究实验室和国家轮椅体育赛事。参与者：通过研究登记和2013全国退伍军人轮椅运动会和2014年美国七叶树残障运动会招募30名轮椅使用者作为便利样本。参与者年龄在18岁以上，可以在30秒内独立完成转移，无需使用腿部肌肉。方法：完成CTS的人口统计学调查问卷和体检。定量超声技术被用来测量重复传输方案后正中神经的变化。主要测量指标：豆状面正中神经横截面积(PCSA)、肿胀率(SR)、移位质量、移位技巧。结果：多次移位后PCSA增加(P<；.025)。使用安全手位的参与者基线SR较低(Beta=-0.728；P<；0.01)。体重越高的参与者，如果他们进行更高质量的转移，他们的基线SR就会越低。在移位前坐到座位前面的参与者(TAI项目7；Beta=0.144；P<；0.05)和体重较重(Beta=0.142；P<；0.05)的参与者在移位后PCSA的增加更大。结论：反复轮椅移位后，豌豆状正中神经CSA急剧增加。根据TAI的说法，体重较高的人和没有正确执行某些转移技能的人的变化更大。这些因素有可能导致慢性损伤，也可能导致CTS。
Background: Wheelchair users with spinal cord injuries are susceptible to peripheral neuropathies from overuse, yet no studies have established a relationship between median neuropathy and wheelchair transfers. A more thorough understanding of how transfers and technique contribute to pathologic conditions may guide interventions that curtail its development.Objective: To evaluate the effects of repeated transfers on ultrasound markers for carpal tunnel syndrome (CTS) in people with spinal cord injuries and to relate changes to subject characteristics and transfer skills.Design: Cross-sectional, repeated measures.Setting: Research laboratory and national wheelchair sporting events.Participants: A convenience sample of 30 wheelchair users with nonprogressive paraplegia were recruited via research registries and at the 2013 National Veterans Wheelchair Games and 2014 Paralyzed Veterans of America Buckeye Games. Participants were older than 18 years and could complete transfers independently within 30 seconds without use of their leg muscles.Methods: Demographic questionnaires and physical examinations for CTS were completed. Quantitative ultrasound techniques were used to measure changes in the median nerve after a repeated-transfers protocol. The Transfer Assessment Instrument (TAI) was completed to quantify transfer ability.Main Outcome Measurements: Median nerve cross-sectional area at the level of the pisiform (PCSA) and swelling ratio (SR), transfer quality, and skills via the TAI.Results: PCSA increased after repeated transfers (P < .025). Participants who used safe hand positions had a lower baseline SR (beta = -0.728; P < .01). Participants with a higher body weight had a lower baseline SR provided they performed higher quality transfers. Participants who scooted to the front of the seat prior to transferring (TAI item 7; beta = 0.144; P < .05) and who weighed more (beta = 0.142; P < .05) exhibited greater increases in PCSA in response to transfers.Conclusions: An acute increase was observed in median nerve CSA at the pisiform after repeated wheelchair transfers. Changes were greater in persons with higher body weight and in persons who did not perform certain transfer skills correctly (according to the TAI). It is possible that these factors contribute to chronic injury and possibly CTS.