Propulsion Mechanics Variability and Shoulder Pain in Manual Wheelchair Users

手动轮椅使用者的推进机制变异性和肩部疼痛

• 批准号: 8248306
• 负责人: Jacob J. Sosnoff
• 金额: $ 18.71万
• 依托单位: UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8248306
• 关键词: Activities of Daily Living; Address; Back; Cardiovascular Diseases; Characteristics; Cumulative Trauma Disorders; Data; Development; Early identification; Future; Gender; Goals; Health Care Costs; Human; Individual; Injury; Intervention; Investigation; Kinetics; Lead; Link; Manual wheelchair; Measures; Mechanics; Methodology; Morbidity - disease rate; Motor; Movement; Musculoskeletal; Musculoskeletal Development; Normal Range; Obesity; Outcome; Outcome Measure; Output; Pain; Paraplegia; Pathogenesis; Pathology; Patient Self-Report; Performance; Physical activity; Population; Public Health; Quadriplegia; Quality of life; Reporting; Research; Risk; Sampling; Shoulder; Shoulder Pain; Stroke; Structure; Time; Training; United States; Upper Extremity; Variant; Wheelchair propulsion; Wheelchairs; adverse outcome; design; disability; experience; high risk; innovation; intervention program; kinematics; neuromuscular system; novel; novel strategies; peer; prevent; prospective; public health relevance; skeletal injury; spatiotemporal; tool

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.

描述（由申请人提供）：美国估计有150万手动轮椅使用者。 〜70％的手动轮椅使用者报告的肩痛与进一步的残疾直接相关，包括难以进行日常生活的活动，减少体育锻炼和生活质量降低。总体而言，由于疼痛而导致的上肢功能的任何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。随后，必须了解有助于手动轮椅使用者上肢病理的机制，以便可以制定适当的干预措施，以防止或最大程度地减少疼痛对功能的影响并降低长期上肢残疾的风险。已经认为，运动的时空特征缺乏可变性，这被认为是导致过度使用伤害发展的一个因素。尽管对肩部疼痛和手动轮椅使用者进行了大量研究，但这些研究并未探索运动变异性。此外，大多数导致肩部疼痛的因素（例如性别和伤害水平）是无法改变的。但是，初步数据表明，推进变异性可能通过培训进行修改。因此，该提案的创新是探索轮椅推进的变异性概况，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）量化轮椅推进动力学，运动学和时间变化的数量和时间变化结构，作为功能水平的函数（二链球血和四边形）的函数，以及（2）确定手动轮椅使用方法中的变异性和肩部疼痛中变异性之间的关联之间存在。我们的目标将使用横截面设计来解决，其中手动轮椅使用者（截瘫和四边形，有或没有疼痛）将推动自己的轮椅推动自己的轮椅，而他们的推进力学（运动学，动力学，动力学和时间效果措施）则记录下来。我们将利用新颖和标准的非线性动力学措施来衡量其推进力学的数量和时间发展结构。将使用自我报告和功能检查评估肩部疼痛。我们假设在较高功能（截瘫）个体中，运动学，动力学和时间变化将显着更大。我们还假设轮椅推进的运动学，动力学和时间变化将与肩痛负相关。从该项目中获得的信息将提供重要的信息，以支持较大的手动轮椅使用者样本中未来的前瞻性调查，这些调查将解决运动变异性是否是应有的疼痛预测指标。 。 公共卫生相关性：该提案对公共卫生非常重要，因为结果将通过采用检查轮椅推进力学中的运动变异性的新方法来更好地了解手动轮椅使用者的肩部疼痛的相关性。该项目将向轮椅推进和肩痛的研究引入新的工具和方法。此外，结果可用于进一步确定手动轮椅使用者中电动机变异性和肩痛之间的关联。

项目成果

Relationship between shoulder pain and kinetic and temporal-spatial variability in wheelchair users.

• DOI: 10.1016/j.apmr.2013.11.005
• 发表时间: 2014-04
• 期刊: ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
• 影响因子: 4.3
• 作者: Rice, Ian M.;Jayaraman, Chandrasekaran;Hsiao-Wecksler, Elizabeth T.;Sosnoff, Jacob J.
• 通讯作者: Sosnoff, Jacob J.