Preserving transfer independence among individuals with spinal cord injury

Abstract

Study design: Literature review. Objectives: Upper extremity (UE) joint degeneration, particularly at the shoulder, detrimentally in¯uences functional independence, quality of life, cardiovascular disease risk, and life expectancy of individuals following spinal cord injury (SCI). This review (1) describes UE use for transfers among individuals with SCI; (2) describes contributing factors associated with UE joint degeneration and loss of transfer independence; (3) summarizes and identi®es gaps in existing research; and (4) provides suggestions for future research. Results: Investigations of wheelchair transfer related UE joint and function preservation among individuals with SCI should consider factors including age and length of time from SCI onset, interface between subject-wheelchair, pain, shoulder joint range of motion (ROM) and muscle strength de®ciencies or imbalances, exercise capacity and tolerance for the physical strain of activities of daily living (ADL), body mass and composition, previous UE injury or disease history, and transfer techniques. Existing studies of transfers among individuals with SCI have relied on small groups of either asymptomatic or non-impaired subjects, with minimal integration of kinematic, kinetic and electromyographic data. Descriptions of UE joint ROM, forces, and moments produced during transfers are lacking. Conclusions: Biomechanical measurement and computer modeling have provided increasingly accurate tools for acquiring the data needed to guide intervention planning to prevent UE joint degeneration and preserve function among individuals with SCI. The identi®cation of stressful sub-components during transfers will enable intervening clinicians and engineers who design and modify assistive and adaptive devices to better serve individuals with SCI. Spinal Cord (2000) 38, 649 ± 657

Glenohumeral Contact Forces and Muscle Forces Evaluated in Wheelchair-Related Activities of Daily Living in Able-Bodied Subjects Versus Subjects With Paraplegia and Tetraplegia

“…1 One factor that could contribute to the development of shoulder complaints is the relatively heavy and frequent loading of the upper extremity during wheelchair ADLs, such as transfers and weight-relief lifts. [2][3][4] The load on the shoulder has often been quantified as net joint moments, probably because net moments are fairly simple to determine.…”

Mechanical Load on the Upper Extremity During Wheelchair Activities

“…Pain is experienced during wheelchair-related activities of daily living (ADLs), such as wheelchair propulsion and performing transfers. Because these activities are essential for functional independence, quality of life, and even the life expectancy of people after an SCI, 3 evaluating the mechanical load on the shoulder is important to an understanding of the mechanisms that may cause upper-extremity joint degeneration. Factors that have been mentioned as contributors to the development of shoulder complaints are the relatively high load and high frequency of this load on the shoulder during wheelchair propulsion.…”

Explanatory power does not equal clinical importance: study of the use of the Brief ICF Core Sets for Spinal Cord Injury with a purely statistical approach

“…The clinical expertise, as well as the SCI literature, shows that they are fundamental aspects of functioning in SCI. 16 The Lasso set was developed on the basis of a regression technique in which the variability of both dependent and independent variables is fundamental. The selection leads by definition to a set of ICF categories that differentiates among different levels of the dependent variable, regardless of their clinical relevance.…”