Propulsion Mechanics Variability and Shoulder Pain in Manual Wheelchair Users

描述(由申请人提供)：据估计，美国有150万手动轮椅用户。约70%的手动轮椅使用者报告肩痛，这与进一步的残疾直接相关，包括日常生活活动困难、体力活动减少和生活质量下降。总体而言，任何由于疼痛而导致的上肢功能丧失都会对手动轮椅使用者的独立性和灵活性造成不利影响。因此，必须了解导致手动轮椅使用者上肢病变的机制，以便制定适当的干预措施，以防止或最大限度地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可变性被认为是过度使用损伤的一个促成因素。虽然已经有相当多的关于肩痛和手动轮椅使用者的研究，但这些研究还没有探索运动的可变性。此外，导致肩痛的大多数因素(例如性别和受伤程度)是不可改变的；然而，初步数据表明，推进力的可变性可能会随着训练而改变。因此，本方案的创新之处在于探索轮椅推进的变异性特征以及它是否与手动轮椅使用者的肩痛相关。该项目的目标是(1)量化轮椅推进中作为功能水平(截瘫与四肢瘫痪)函数的运动学、运动学和时间变异性的数量和时间演变结构，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是否存在关联。我们的目标将通过横断面设计实现，手动轮椅使用者(截瘫和四肢瘫痪，有或没有疼痛)将推动他们自己的轮椅，同时记录他们的推进力学(运动学、运动学和时间结果测量)。我们将利用新的和标准的非线性动力学测量方法来测量它们的推进力学的数量和时间演化结构。肩部疼痛将通过自我报告和功能检查进行评估。我们假设，在高功能(截瘫)个体中，运动学、运动学和时间上的变异性将显著更大。我们还假设，轮椅推进中的运动学、运动学和时间变异性将与肩部疼痛负相关。从这个项目中获得的信息将提供重要的信息，支持未来对手动轮椅使用者进行更大样本的前瞻性调查，以解决运动可变性是否是应该疼痛的预测因素。。 公共健康相关性：这项建议对公共健康具有相当重要的意义，因为结果将通过采用新的方法来检查轮椅推进机械中的运动可变性，从而更好地了解手动轮椅使用者肩痛的相关性。该项目将引入新的工具和方法来研究轮椅推进和肩痛。此外，该结果可用于进一步确定手动轮椅使用者的运动可变性和肩部疼痛之间的关联。

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.