Propulsion Mechanics Variability and Shoulder Pain in Manual Wheelchair Users

描述（由申请人提供）：在美国估计有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，包括日常生活活动困难、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行动能力产生不利影响。因此，有必要了解导致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，以预防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。运动时空特征缺乏可变性被认为是过度使用性损伤发展的一个促成因素。虽然已经有相当多的关于肩痛和手动轮椅使用者的研究，但这些研究并没有探讨运动变异性。此外，导致肩痛的大多数因素（如性别和损伤程度）是不可改变的；然而，初步数据表明，推进变异性可能会随着训练而改变。因此，本提案的创新之处在于探索轮椅推进的变异性，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)量化轮椅推进的动能、运动学和时间变异性的数量和随时间变化的结构，作为功能水平的函数（截瘫与四肢瘫痪），以及(2)确定推进力学变异性与手动轮椅使用者肩痛之间存在的关联。我们的目标将通过横截面设计来解决，即手动轮椅使用者（截瘫患者和四肢瘫痪患者，有或没有疼痛）将推动自己的轮椅，同时记录他们的推进力学（运动学，动力学和时间结果测量）。我们将利用新颖和标准的非线性动力学测量来测量它们的推进力学的数量和随时间变化的结构。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）个体中会有更大的运动学、动力学和时间变异性。此外，我们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。从该项目中获得的信息将为未来在更大样本的手动轮椅使用者中进行前瞻性调查提供重要信息，以解决运动变异性是否是疼痛的预测因素。

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.