Propulsion Mechanics Variability and Shoulder Pain in Manual Wheelchair Users

描述（由申请人提供）：美国估计有150万手动轮椅使用者。约70%的手动轮椅使用者报告肩部疼痛，这与进一步的残疾直接相关，包括难以进行日常生活活动，体力活动减少和生活质量下降。总的来说，任何由于疼痛导致的上肢功能丧失都会对手动轮椅使用者的独立性和移动性产生不利影响。因此，必须了解有助于手动轮椅使用者上肢病理的机制，以便制定适当的干预措施，以防止或尽量减少疼痛对功能的影响，并降低长期上肢残疾的风险。运动的时空特征缺乏变异性已被认为是过度使用损伤发展的一个促成因素。虽然已经有相当多的研究肩痛和手动轮椅使用者，这些研究还没有探讨运动变异性。此外，导致肩痛的大多数因素（例如性别和受伤程度）是不可修改的;然而，初步数据表明，推进力的变化可能是可以通过训练修改的。因此，本提案的创新之处在于探索轮椅推进的可变性特征，以及它是否与手动轮椅使用者的肩部疼痛相关。该项目的目标是（1）量化轮椅推进的动力学、运动学和时间变异性的数量和随时间变化的结构，作为功能水平（截瘫与四肢瘫痪）的函数，以及（2）确定手动轮椅使用者的推进力学变异性与肩痛之间的关联。我们的目标将使用横截面设计，手动轮椅使用者（截瘫和四肢瘫痪，有和没有疼痛）将推动自己的轮椅，而他们的推进力学（运动学，动力学和时间的结果措施）被记录。我们将利用新的和标准的非线性动力学措施来测量它们的推进力学的数量和随时间变化的结构。将使用自我报告和功能检查评估肩痛。我们假设，将有显着更大的运动学，动力学和时间的变异性较高的功能（截瘫）的个人。我们还假设轮椅推进的运动学、动力学和时间变异性与肩痛呈负相关。从这个项目中获得的信息将提供重要的信息，支持未来的前瞻性调查，在更大的样本手动轮椅使用者，将解决运动变异性是否是一个预测应该疼痛。. 公共卫生相关性：这项建议具有相当大的重要性，为公众健康的结果将导致更好地了解相关的肩痛手动轮椅使用者通过采取新的方法，检查电动机的变化，在轮椅推进力学。该项目将引入新的工具和方法来研究轮椅推进和肩部疼痛。此外，结果可用于进一步确定手动轮椅使用者的运动变异性和肩痛之间的关联。

DESCRIPTION (provided by applicant): There are an estimated 1.5 million manual wheelchair users in the United States. ~70% of manual wheelchair users report shoulder pain, which is directly linked to further disability including difficulty performing activities of daily living, decreased physical activity, and reduced quality of life. Overall, any loss of upper limb function due to pain adversely impacts the independence and mobility of manual wheelchair users. Subsequently, it is imperative to understand the mechanisms that contribute to upper limb pathology in manual wheelchair users so that appropriate interventions can be developed to prevent or minimize the effect of pain on function and reduce the risk of long-term upper extremity disability. Lack of variability in spatiotemporal characteristics of movements has been suggested to be a contributing factor to the development of overuse injuries. Although there has been considerable research on shoulder pain and manual wheelchair users, those studies have not explored motor variability. Further, the majority of factors (e.g. gender and injury level) contributing to shoulder pain are not modifiable; however, preliminary data suggest that propulsion variability is potentially modifiable with training. Therefore, the innovation of this proposal is to explore the variability profile of wheelchair propulsion and whether or not it correlates with shoulder pain in manual wheelchair users. The goals of this project are (1) to quantify the amount and time-evolving structure of kinetic, kinematic and temporal variability in wheelchair propulsion as a function of functional level (paraplegia vs. tetraplegia), and (2) to determine existence of an association between variability in propulsion mechanics and shoulder pain in manual wheelchair users. Our aims will be addressed using a cross-sectional design whereby manual wheelchair users (paraplegics and tetraplegics, with and without pain) will propel their own wheelchair while their propulsion mechanics (kinematic, kinetic, and temporal outcome measures) are recorded. We will measure the amount and time-evolving structure of their propulsion mechanics utilizing novel and standard non-linear dynamical measures. Shoulder pain will be assessed using self-report and functional examination. We hypothesize that there will be significantly greater kinematic, kinetic and temporal variability in higher functioning (paraplegic) individuals. We additionally hypothesize that kinematic, kinetic and temporal variability in wheelchair propulsion will be negatively associated with shoulder pain. The information gained from this project will provide vital information supporting a future prospective investigation in a larger sample of manual wheelchair users that would address whether motor variability is a predictor of should pain. . PUBLIC HEALTH RELEVANCE: This proposal has considerable importance for public health as the results will lead to a better understanding of correlates of shoulder pain in manual wheelchair users by taking the novel approach of examining motor variability in wheelchair propulsion mechanics. The project will introduce new tools and methodologies to the study of wheelchair propulsion and shoulder pain. Further, the results may be used to further determine the association between motor variability and shoulder pain in manual wheelchair users.