Shoulder joint kinetics and pathology in manual wheelchair users
Shoulder joint kinetics and pathology in manual wheelchair users
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DOI：
10.1016/j.clinbiomech.2006.04.010
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发表时间：
2006-10-01
影响因子：
1.8
通讯作者：
Cooper, Rory
中科院分区：
文献类型：
--
作者：
Mercer, Jennifer L.;Boninger, Michael;Cooper, Rory
背景。手动轮椅使用者严重依赖上肢进行独立活动，这可能导致肩部疼痛和损伤的发生率很高。本研究的目的是检查轮椅推进过程中所经历的肩部力和力矩与肩部病理学之间的关系。方法。记录了 33 名截瘫受试者以两种速度（0.9 和 1.8 m/s）推动轮椅时的动力学和运动学数据。使用逆动态方法计算肩关节力和力矩，并使用体检和磁共振成像扫描评估肩部病理学。结果。在推进过程中经历较高后向力（比值比（OR）= 1.29，P = 0.03）、侧向力（OR = 1.35，P = 0.047）或伸展力矩（OR = 1.35，P = 0.09）的受试者更有可能表现出喙肩韧带水肿。表现出较大侧向力（OR = 4.35，P = 0.045）或外展力矩（OR = 1.58，P = 0.06）的个体更有可能出现喙肩韧带增厚。肩部较高的上力（OR = 1.05，P = 0.09）和内旋力矩（OR = 1.61 P = 0.02）与体检期间肩部病理迹象的增加有关。解释。具体的关节力和力矩与肩部病理学的测量有关。这可能表明需要减少推动轮椅所需的总力，以保持上肢的完整性。潜在的干预措施包括改变轮椅设置、推进训练或其他移动方式。 (c) 2006 Elsevier Ltd. 保留所有权利。
Background. Manual wheelchair users rely heavily on their upper limbs for independent mobility which likely leads to a high prevalence of shoulder pain and injury. The goal of this study was to examine the relationship between shoulder forces and moments experienced during wheelchair propulsion and shoulder pathology.Methods. Kinetic and kinematic data was recorded from 33 subjects with paraplegia as they propelled their wheelchairs at two speeds (0.9 and 1.8 m/s). Shoulder joint forces and moments were calculated using inverse dynamic methods and shoulder pathology was evaluated using a physical exam and magnetic resonance imaging scan.Findings. Subjects who experienced higher posterior force (Odds Ratio (OR) = 1.29, P = 0.03), lateral force (OR = 1.35, P = 0.047), or extension moment (OR = 1.35, P = 0.09) during propulsion were more likely to exhibit coracoacromial ligament edema. Individuals who displayed larger lateral forces (OR = 4.35, P = 0.045) or abduction moments (OR = 1.58, P = 0.06) were more likely to have coracoacromial ligament thickening. Higher superior forces (OR = 1.05, P = 0.09) and internal rotation moments (OR = 1.61 P = 0.02) at the shoulder were associated with increased signs of shoulder pathology during the physical exam.Interpretation. Specific joint forces and moments were related to measures of shoulder pathology. This may indicate a need to reduce the overall force required to propel a wheelchair in order to preserve upper limb integrity. Potential interventions include changes to wheelchair setup, propulsion training, or alternative means of mobility. (c) 2006 Elsevier Ltd. All rights reserved.