Biomechanical model for evaluation of pediatric upper extremity joint dynamics during wheelchair mobility
Biomechanical model for evaluation of pediatric upper extremity joint dynamics during wheelchair mobility
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DOI：
10.1016/j.jbiomech.2013.11.014
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发表时间：
2014-01-03
影响因子：
2.4
通讯作者：
Harris, Gerald E.
中科院分区：
文献类型：
--
作者：
Schnorenberg, Alyssa J.;Slavens, Brooke A.;Harris, Gerald E.
儿童手动轮椅使用者（MWU）在轮椅活动期间对上肢（UE）的关节要求很高，导致他们有发生疼痛和病理的风险。研究已经检查了成人轮椅活动期间的UE生物力学；然而，目前评估儿童MWU UE关节动力学的方法是有限的。提出了一个逆动力学模型来表征儿童轮椅移动过程中使用SmartWheel仪器化把手系统的三维UE关节运动学和动力学。双侧模型包括胸、锁骨、肩胛骨、上臂、前臂和手节段，包括胸锁关节、肩锁关节、肩关节、肘关节和腕关节。一位患有C7脊髓损伤（SCI）的17岁单身男性在推动轮椅通过15米人行道时进行了评估。受试者的手腕伸展角度可达60度，肘关节活动范围大，肩关节峰值力可达体重的10%。模型检测到腕、肘、盂肱关节和肩锁关节的不对称性有统计学意义。如上所述，定制的双侧UE儿童模型可以为UE关节动力学提供大量的定量洞察，以改善轮椅处方、训练、康复和骨科残疾儿童的长期护理。在更大的脊髓损伤儿童群体中，需要进一步的研究来评估儿童轮椅移动能力与疼痛、功能和成年过渡变化的关系。(C) 2013 Elsevier Ltd.版权所有。
Pediatric manual wheelchair users (MWU) require high joint demands on their upper extremity (UE) during wheelchair mobility, leading them to be at risk of developing pain and pathology. Studies have examined UE biomechanics during wheelchair mobility in the adult population; however, current methods for evaluating UE joint dynamics of pediatric MWU are limited. An inverse dynamics model is proposed to characterize three-dimensional UE joint kinematics and kinetics during pediatric wheelchair mobility using a SmartWheel instrumented handrim system. The bilateral model comprises thorax, clavicle, scapula, upper arm, forearm, and hand segments and includes the sternoclavicular, acromioclavicular, glenohumeral, elbow and wrist joints. A single 17 year-old male with a C7 spinal cord injury (SCI) was evaluated while propelling his wheelchair across a 15-meter walkway. The subject exhibited wrist extension angles up to 60, large elbow ranges of motion and peak glenohumeral joint forces up to 10% body weight. Statistically significant asymmetry of the wrist, elbow, glenohumeral and acromioclavicular joints was detected by the model. As demonstrated, the custom bilateral UE pediatric model may provide considerable quantitative insight into UE joint dynamics to improve wheelchair prescription, training, rehabilitation and long-term care of children with orthopedic disabilities. Further research is warranted to evaluate pediatric wheelchair mobility in a larger population of children with SCI to investigate correlations to pain, function and transitional changes to adulthood. (C) 2013 Elsevier Ltd. All rights reserved.