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Abstract-The purpose of the study was to determine whether wheelchair-based circuit resistance training (CRT) exercises place the shoulder at risk for mechanical impingement. Using a novel approach, we created a mechanical impingement risk score for each exercise by combining scapular and glenohumeral kinematic and exposure data. In a case series design, 18 individuals (25-76 yr old) with paraplegia and without substantial shoulder pain participated. The mean mechanical impingement risk scores at 45-60 degrees humerothoracic elevation were rank-ordered from lowest to highest risk as per subacromial mechanical impingement risk: overhead press (0.6 +/-0.5 points), lat pulldown (1.2 +/-0.5 points), chest press (2.4 +/-2.8 points), row (2.7 +/-1.6 points), and rickshaw (3.4 +/-2.3 points). The mean mechanical impingement risk scores at 105-120 degrees humerothoracic elevation were rank-ordered from lowest to highest risk as per internal mechanical impingement risk: lat pulldown (1.2 +/-0.5 points) and overhead press (1.3 +/-0.5 points). In conclusion, mechanical impingement risk scores provided a mechanism to capture risk associated with CRT. The rickshaw had the highest subacromial mechanical risk, whereas the overhead press and lat pulldown had the highest internal mechanical impingement risk. The rickshaw was highlighted as the most concerning exercise because it had the greatest combination of magnitude and exposure corresponding with increased subacromial mechanical impingement risk.

<b><i>Background:</i></b> Prior studies suggest that participation in rehabilitation exercises improves motor function poststroke; however, studies on optimal exercise dose and timing have been limited by the technical challenge of quantifying exercise activities over multiple days. <b><i>Objectives:</i></b> The objectives of this study were to assess the feasibility of using body-worn sensors to track rehabilitation exercises in the inpatient setting and investigate which recording parameters and data analysis strategies are sufficient for accurately identifying and counting exercise repetitions. <b><i>Methods:</i></b> MC10 BioStampRC® sensors were used to measure accelerometer and gyroscope data from upper extremities of healthy controls (<i>n</i> = 13) and individuals with upper extremity weakness due to recent stroke (<i>n</i> = 13) while the subjects performed 3 preselected arm exercises. Sensor data were then labeled by exercise type and this labeled data set was used to train a machine learning classification algorithm for identifying exercise type. The machine learning algorithm and a peak-finding algorithm were used to count exercise repetitions in non-labeled data sets. <b><i>Results:</i></b> We achieved a repetition counting accuracy of 95.6% overall, and 95.0% in patients with upper extremity weakness due to stroke when using both accelerometer and gyroscope data. Accuracy was decreased when using fewer sensors or using accelerometer data alone. <b><i>Conclusions:</i></b> Our exploratory study suggests that body-worn sensor systems are technically feasible, well tolerated in subjects with recent stroke, and may ultimately be useful for developing a system to measure total exercise “dose” in poststroke patients during clinical rehabilitation or clinical trials.

Hand position alters kinematics during CRT and should be selected to emphasize healthy shoulder mechanics.