Effect of Fatiguing Wheelchair Propulsion and Weight Relief Lifts on Subacromial Space in Wheelchair Users

Abstract

ObjectiveThis study aimed to identify targets of intervention for reducing shoulder pain in wheelchair users with spinal cord injury (SCI) by (1) examining changes in subacromial space [acromiohumeral distance (AHD) and occupation ratio (OccRatio)] with fatiguing wheelchair propulsion, and different loading conditions [unloaded position vs. weight relief lifts (WRL)]; (2) associating these changes with wheelchair user capacity, as well as (3) identifying subject characteristics associated with subacromial space, such as sex, lesion level, time since injury, body mass index and impaired shoulder range of motion.MethodsFifty manual wheelchair users with SCI [11 females, age = 50.5 (9.7) years, time since injury = 26.2 (11.4) years] participated in this quasi-experimental one-group pretest-posttest study. Ultrasound images were used to define AHD during an unloaded position, and during personal and instructed WRL before and after fatiguing wheelchair propulsion. Furthermore, supraspinatus and biceps thickness defined from ultrasound images were used to calculate OccRatios. Wheelchair user capacity was quantified as functional strength (maximum resultant force reached during maximum isometric forward push) and anaerobic work capacity (highest power output reached during 15-m sprint test). Multilevel mixed-effects linear regression analyses controlling for between subject variability and covariables were performed to address the research questions.ResultsAHD was significantly smaller during personal WRL (p < 0.001) and instructed WRL (p = 0.009, AHD both 11.5 mm) compared to the unloaded position (11.9 mm). A higher wheelchair user capacity (higher anaerobic work capacity) reduced the impact of WRL on AHD decrease. The fatiguing wheelchair propulsion had no effect on AHD (p = 0.570) and on OccRatio of supraspinatus (p = 0.404) and biceps (p = 0.448). Subject characteristics related to a larger subacromial space were lower lesion level, shorter time since injury, impaired external rotation, a lower body mass index and a higher anaerobic work capacity.ConclusionThis study showed a significant reduction in AHD during WRL with no effect of fatiguing wheelchair propulsion on the subacromial space in wheelchair users with SCI. A higher anaerobic work capacity was beneficial in stabilizing the shoulder during WRL. Our findings may assist clinicians in designing a shoulder injury prevention program.

Computer-aided quantitative ultrasound algorithm of acromiohumeral distance among individuals with spinal cord injury

“…The use of ultrasound to measure AHD has been widely described in SCI populations [7,17,20,28]. Since this is a safe procedure easily to maneuver in the clinics, the US is wellknown and regarded as the optimal point-of-care modality to image the shoulders.…”

Changes in neuromuscular activation, heart rate and rate of perceived exertion over the course of a wheelchair propulsion fatigue protocol

“…This study, with a quasi-experimental one-group pretest-posttest design, was part of a larger project registered at ClinicalTrials.gov (Identifier: NCT03153033; Registration date: 15 May 2017) ( Bossuyt et al, 2020a ; Bossuyt et al, 2020c ; Bossuyt et al, 2020d ; Arnet et al, 2022a ). Ethical approval was granted by the Ethikkommision Nordwest-und Zentralschweiz (Project-ID: 2017-00355).…”

“…The standardized procedures prior to the F8F lasted for about 3 h and included preparations for EMG and kinematic measurements, completion of questionnaires, wheelchair propulsion (15 m sprint and propulsion on a treadmill) and ultrasound examination of the shoulder. For further details on these assessments, which will not be part of the analysis in the current study, please consider the following publications: Bossuyt et al (2020a) ; Bossuyt et al (2020b) ; Bossuyt et al (2020d) ; Arnet et al (2022a) . These previous studies published results from this dataset including changes in treadmill propulsion biomechanics and ultrasound measures of shoulder tendons and acromiohumeral distance before and after the F8F.…”

“… Adapted from Arnet et al (2022a) , licensed under CC BY 4.0 : Illustration of one lap of the figure-8 protocol. …”

Shoulder Pain in Persons With Tetraplegia and the Association With Force Application During Manual Wheelchair Propulsion

“…Several wheelchair related tasks have been associated with a higher risk for shoulder problems: daily wheelchair propulsion, 4 transfers in and out of the wheelchair, 5 and pressure relief lifts for pressure injury prevention. 6 Wheelchair propulsion is a predominant activity in manual wheelchair users and approximately 1400 pushes are done throughout a day. 7 The repetitiveness may predispose tissue degeneration over time demonstrating the need to optimize the load on the shoulder.…”