Modifications in Wheelchair Propulsion Technique with Speed.
Modifications in Wheelchair Propulsion Technique with Speed.
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DOI：
10.3389/fbioe.2015.00171
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发表时间：
2015
影响因子：
5.7
通讯作者：
McNitt-Gray JL
中科院分区：
文献类型：
--
作者：
Russell IM;Raina S;Requejo PS;Wilcox RR;Mulroy S;McNitt-Gray JL
在手动轮椅推进(WCP)过程中，上肢关节的重复负荷被认为是导致肩痛的一个因素，导致丧失独立性和生活质量下降。这项研究的目的是确定截瘫的个体手动厕所使用者如何修改推进机制，以适应在推环上产生的预期增加的反作用力(RF)，以及自我选择的WCP速度增加。对40名有经验的截瘫手推式厕所使用者在固定测功器上以自己选择的自由和快速推进速度推进时，进行了上肢运动学和推轮缘RFS的测量。比较受试者在不同推进速度下的上肢运动学和动力学。组间和受试者内的差异被确定(α = 0.05)。随着推进速度的提高，RF幅度(22/40，>；10 N)和肩关节净力矩(NJM，15/40，>；10 Nm)增加，推力接触持续时间减少。受试者内部比较表明，27%的参与者通过调节相对于上肢节段的射频方向来改变他们的WCP机制，提高了速度。RF相对于上肢节段的重新定向可以作为一种有效的策略来减轻在推进速度增加时施加在肩部的旋转需求(NJM)。确定个人可以用来有效地适应RFs增加的推进策略是保持肩部肌肉骨骼健康和提高与健康相关的生活质量的重要一步。
Repetitive loading of the upper limb joints during manual wheelchair (WC) propulsion (WCP) has been identified as a factor that contributes to shoulder pain, leading to loss of independence and decreased quality of life. The purpose of this study was to determine how individual manual WC users with paraplegia modify propulsion mechanics to accommodate expected increases in reaction forces (RFs) generated at the pushrim with self-selected increases in WCP speed. Upper extremity kinematics and pushrim RFs were measured for 40 experienced manual WC users with paraplegia while propelling on a stationary ergometer at self-selected free and fast propulsion speeds. Upper extremity kinematics and kinetics were compared within subject between propulsion speeds. Between group and within-subject differences were determined (α = 0.05). Increased propulsion speed was accompanied by increases in RF magnitude (22 of 40, >10 N) and shoulder net joint moment (NJM, 15 of 40, >10 Nm) and decreases in pushrim contact duration. Within-subject comparison indicated that 27% of participants modified their WCP mechanics with increases in speed by regulating RF orientation relative to the upper extremity segments. Reorientation of the RF relative to the upper extremity segments can be used as an effective strategy for mitigating rotational demands (NJM) imposed on the shoulder at increased propulsion speeds. Identification of propulsion strategies that individuals can use to effectively accommodate for increases in RFs is an important step toward preserving musculoskeletal health of the shoulder and improving health-related quality of life.