Duration Of Wheelchair Use Research Articles

Progression of rotator cuff tendon pathology in manual wheelchair users with spinal cord injury: A 1-year longitudinal study

Objective To investigate the progression of rotator cuff tendon pathology across one year in manual wheelchair (MWC) users with spinal cord injury (SCI) and matched able-bodied individuals, and to explore the association between pain, age, and duration of wheelchair use with the progression of rotator cuff pathology. Design Longitudinal cohort study, 1-year follow-up. Setting Outpatient clinic at a tertiary medical center. Participants Twenty-four adult MWC users with SCI (20 men) with an average age (SD) of 37(12) years and 24 age and sex-matched able-bodied individuals. Interventions Not applicable. Main outcome measure(s) Presence of shoulder pain was collected. Magnetic resonance imaging (MRI) abnormalities of rotator cuff tendons including tendinopathy and tendon tears at baseline and 1-year follow-up visits were graded by a board-certified musculoskeletal radiologist, and three categories of tendon pathology scores including individual tendon scores, unilateral cuff scores, and bilateral cuff scores were calculated for each participant. Results Fifty-four percent of the MWC users reported shoulder pain at both time points which was significantly higher than able-bodied cohort at baseline (17%, P = 0.012) and year 1 (21%, P = 0.021). Rotator cuff tendon pathology was detected as mainly mild tendinopathies and low-grade partial-thickness tears in both cohorts at both time points but was more common in MWC users. The results for the bilateral cuff scores indicated a significant (P < 0.008) progression of rotator cuff tendon pathology in the MWC users over one year. MRI findings did not change significantly for the able-bodied cohort across time. There was no association of pain, age, or duration of MWC use with progression of rotator cuff pathology in MWC user cohort. Conclusion MWC users had a higher prevalence of pain than matched able-bodied cohort, but pain was minimal and not function-limiting. Bilateral cuff TOTAL scores showed pathology progression in MWC users, but MRI findings remained stable in the able-bodied cohort. MWC users were 3.4 times more likely to experience pathology progression than the able-bodied cohort.

Musculoskeletal Pain Due to Wheelchair Use: A Systematic Review and Meta-Analysis.

IntroductionWheelchair users are at a high risk of experiencing non-neuropathic pain of musculoskeletal origin as a result of being wheelchair-bound. The aim of this systematic review was to establish the prevalence of musculoskeletal pain in wheelchair users that is attributable to wheelchair use, and to describe the different pain syndromes and discuss risk factors and management options.MethodsAfter a systematic MEDLINE search, we identified 40 papers eligible for inclusion.ResultsThe pooled prevalence of musculoskeletal pain at any location was 50% (95% CI 33–67%). The most common pain syndrome was shoulder pain (pooled prevalence 44%, 95% CI 36–52%). Wheelchair users were 5.8 times as likely to suffer from shoulder pain as controls (95% CI 2.7–12.2, p < 0.0001). Other pain syndromes included neck, elbow, wrist, hand and low back pain.Older age and increased duration of wheelchair use were the most significant determinants of pain in wheelchair users.ConclusionsMusculoskeletal pain as a result of wheelchair use is very common amongst wheelchair users. Management of pain should follow national and international guidelines. Optimal adjustment of seating position may prevent pain, and is important to be taken into consideration.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-021-00294-5.

Manual ability and upper limb performance in nonambulatory stage of Duchenne muscular dystrophy

PurposeThe functional use of the upper extremities in daily living activities has become important in the later ages with the increasing life expectancy of patients with Duchenne muscular dystrophy (DMD). This study aimed to assess manual ability and upper limb performance of nonambulatory children with DMD, and to determine their relationship with factors that might affect ability and performance. MethodsManual ability was determined via the ABILHAND-Kids questionnaire and upper limb performance was assessed with the Performance of Upper Limb (PUL) test. Possible related factors such as functional level, steroid usage, upper limb range of motion (ROM), thumb opposition, upper limb muscular strength, and grip strength were evaluated. Correlations of related factors with manual ability and upper limb performance were analyzed. ResultsThe mean age of 23 nonambulatory DMD children was 13.04±1.39 years. Moderate impairments were determined according to the ABILHAND-Kids and PUL, with scores of 26.30±10.74 and 46.22±15.02, respectively. The functional level, steroid usage, duration of wheelchair use, upper extremity ROM, and global upper limb muscle strength of children were weak-to-strongly correlated with at least one score of ABILHAND-Kids and PUL (P<0.05). ConclusionChildren with DMD may already have severe proximal and mid-level upper extremity involvement, even reflected in distal functions, at the time when they progress to the nonambulatory stage. Besides muscular strength, many related factors should be taken into account for therapists to assess and treat upper limb performance at later stages of DMD.

Challenges of Developing a Natural Language Processing Method With Electronic Health Records to Identify Persons With Chronic Mobility Disability

ObjectiveTo assess the utility of applying natural language processing (NLP) to electronic health records (EHRs) to identify individuals with chronic mobility disability. DesignWe used EHRs from the Research Patient Data Repository, which contains EHRs from a large Massachusetts health care delivery system. This analysis was part of a larger study assessing the effects of disability on diagnosis of colorectal cancer. We applied NLP text extraction software to longitudinal EHRs of colorectal cancer patients to identify persons who use a wheelchair (our indicator of mobility disability for this analysis). We manually reviewed the clinical notes identified by NLP using directed content analysis to identify true cases using wheelchairs, duration or chronicity of use, and documentation quality. SettingEHRs from large health care delivery system ParticipantsPatients (N=14,877) 21-75 years old who were newly diagnosed with colorectal cancer between 2005 and 2017. InterventionsNot applicable. Main Outcome MeasuresConfirmation of patients’ chronic wheelchair use in NLP-flagged notes; quality of disability documentation. ResultsWe identified 14,877 patients with colorectal cancer with 303,182 associated clinical notes. NLP screening identified 1482 (0.5%) notes that contained 1+ wheelchair-associated keyword. These notes were associated with 420 patients (2.8% of colorectal cancer population). Of the 1482 notes, 286 (19.3%, representing 105 patients, 0.7% of the total) contained documentation of reason for wheelchair use and duration. Directed content analysis identified 3 themes concerning disability documentation: (1) wheelchair keywords used in specific EHR contexts; (2) reason for wheelchair not clearly stated; and (3) duration of wheelchair use not consistently documented. ConclusionsNLP offers an option to screen for patients with chronic mobility disability in much less time than required by manual chart review. Nonetheless, manual chart review must confirm that flagged patients have chronic mobility disability (are not false positives). Notes, however, often have inadequate disability documentation.

A cross-sectional study to evaluate the manual wheelchair-related factors associated with median nerve compression by ultrasonography

OBJECTIVES: The objective is to know the prevalence of median nerve compression and determine the relationship of median nerve compression with wheelchair (WC)-associated parameters. MATERIALS AND METHODS: A cross-sectional study was carried out from December 2016 to September 2018, where a total of 50 patients of either sex, aged 20–70 years, with spinal cord injury (D2 or below) who were independent manual WC ambulators (for >6 months) were included. The detailed demography, clinical details, and the wheel ergonomics (height of the shoulder from the axle of WC, weight of the WC) were noted. Ultrasonography of the bilateral median nerve was done at three levels to determine the median nerve thickness. The data were entered into the MS EXCEL spreadsheet, and analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 21.0. A value of P RESULTS: Median nerve compression was present in 12 (24%) patients who had significantly more weight of WC (kg) (19.42 ± 2.02 vs. 18.74 ± 7.38, P = 0.023); comparable mean duration of WC use (months) (31 ± 21.78 vs. 20.9 ± 20.02, P = 0.114); and comparable height between shoulder and axle of WC (inches) (28.17 ± 2.86 vs. 27.16 ± 2.32, P = 0.188). A significant positive correlation was seen between height from the shoulder to axle of WC (inches) and cross-sectional area (CS) of median nerve at carpal tunnel inlet (r = 0.517, P = 0.0001). CONCLUSION: The height of the axle with respect to the shoulder is important to limit the stress on the wrist to the minimum, thus preventing the median nerve compression.

Ultrasonographic comparison of the lateral epicondyle in wheelchair-user (and able-bodied) tennis players: A pilot study

Objective: To evaluate whether manual wheelchair use and wheelchair tennis are associated with increased risk of lateral epicondylosis (LE). We hypothesized that the prevalence of LE would be highest in WC tennis players, followed by tennis players, WC users, and able-bodied subjects. Study design: Prospective cross-sectional pilot study. Setting: Milwaukee VAMC (clinic), National Veterans Wheelchair Games 2016 (medical event coverage). Participants: Wheelchair users, able-bodied controls, tennis players, non-tennis players. Interventions: Subjects meeting inclusion criteria underwent ultrasound examination of the dominant elbow evaluating for characteristics of LE (n = 83). Outcome measurements: Prevalence of LE between groups. Statistical analysis included odds ratios (OR), univariate and multivariate logistic regression. Results: There was no significant difference in diagnosis of LE between groups when comparing prevalence, unadjusted odds ratios, and predicted probabilities. When adjusted for age, able-bodied controls and tennis players had a similar increase in probability of LE with age; this effect was not seen for wheelchair users. Wheelchair users diagnosed with LE on US had spent significantly more time in a wheelchair (23 vs 13 years) than those with a negative diagnosis. Conclusions: Tennis playing in able bodied controls did not increase risk of LE. In wheelchair users, tennis playing does not appear to be associated with LE, though duration of wheelchair use appears to be a significant predictor of LE. Level of evidence: Level II.

The manual wheelchair tilt-rest skill: A cross-sectional survey of awareness and capacity among wheelchair users

The tilt-rest skill consists of tipping the wheelchair back and allowing it to rest against a solid object with the wheel locks applied (e.g. for pressure redistribution, neck comfort or hands-free activities). The objective of this study was to test the hypotheses that many wheelchair users are unaware of the skill and even fewer can perform it. We conducted a cross-sectional survey following STROBE guidelines on 49 manual wheelchair users with a variety of diagnoses. The main outcome measures were a questionnaire regarding demographic, clinical, wheelchair and tilt-rest data, as well as skill demonstration by those who reported that they were capable of doing so. Participants’ mean (SD) age was 55.1 (18.2) years, 38 (77.6%) were male, their mean (SD) duration of wheelchair use was 7.0 (10.4) years and their mean (SD) daily time spent in the wheelchair was 9.5 (4.6) hours. Twenty-seven (55.1%) of participants were aware of the skill, 20 (40.8%) reported being able to perform the skill and 16 (33.3%) could demonstrate it. Just over half of manual wheelchair users are aware of the tilt-rest skill and one-third of them can perform it. Older people are less likely to report being able to complete the skill. These findings have implications for wheelchair skills training.

Manual wheelchair tilt-rest skill: a cross-sectional survey of awareness and capacity among wheelchair users

Purpose: The tilt-rest skill consists of tipping the wheelchair back and allowing it to rest against a solid object with the wheel locks applied (e.g., for pressure redistribution, neck comfort or hands-free activities). The objective of this study was to determine the proportion of experienced manual wheelchair users who are aware of this skill and who can perform it.Materials and methods: We conducted a cross-sectional survey of 49 manual wheelchair users using a questionnaire developed for the purpose. The tilt-rest skill was attempted by those who reported that they were capable of performing it.Results: Participants’ mean (SD) age was 55.1 (18.2) years, 38 (77.6%) were male, their median (IQR) duration of wheelchair use was 2 (7.2) years and their mean (SD) daily time spent in the wheelchair was 9.5 (4.6) hours. Twenty-seven (55.1%) participants were aware of the skill, 19 (38.8%) reported being able to perform the skill and 16 of 47 (34.0%) were able to demonstrate the skill. Multivariate modelling with the question “Can you complete the tilt-rest skill?” as the dependent measure revealed an inverse relationship with age – Odds Ratio (95% Confidence Interval) of 0.476 (0.293, 0.774) (p = .0028) for each 10 year increase in age.Conclusions: Only just over half of manual wheelchair users are aware of the tilt-rest skill and one-third of users can perform it. Older people are less likely to report being able to complete the skill. These findings have implications for wheelchair skills training during the wheelchair-provision process.Implications for RehabilitationOnly just over half of manual wheelchair users are aware of the tilt-rest skill and only about one-third of users can perform it.Older people are less likely to report being able to complete the skill.These findings have clinical implications for wheelchair skills training during the, specifically that clinicians responsible for manual wheelchair-provision process should ensure that appropriate wheelchair users have the opportunity to learn this skill.

Falls among full-time wheelchair users with spinal cord injury and multiple sclerosis: a comparison of characteristics of fallers and circumstances of falls

Purpose: The purpose of this study is to (1) explore and (2) compare circumstances of falls among full-time wheelchair users with spinal cord injury (SCI) and multiple sclerosis (MS).Methods: A mixed method approach was used to explore and compare the circumstances of falls of 41 full-time wheelchair users with SCI (n = 23) and MS (n = 18). In addition to collecting participants’ demographic information (age, gender, type of wheelchair used, duration of wheelchair use, and duration of disability), self-reported fall frequency in the past 6 months, self-reported restriction in activity due to fear of falling and the Spinal Cord Injury-Fall Concerns Scale (SCI-FCS) was collected. Qualitative data in the form of participants’ responses to an open-ended question yielding information regarding the circumstances of the most recent fall were also collected. To examine differences in survey outcomes and demographic characteristics between participants with SCI and MS, independent t-tests and Pearson’s Chi-square tests were used. Qualitative data were analyzed with a thematic analysis.Results: Statistical analysis revealed that individuals with MS (mean =3.3) had significantly higher average SCI-FCS than individuals with SCI (mean =2.4). The analysis of the participants’ descriptions of the circumstances of their most recent falls resulted in three main categories: action-related fall contributors (e.g., transfer), (2) location of falls (e.g., bathroom), and (3) fall attributions (e.g., surface condition).Conclusions: The results from this study helped to understand fall circumstances among full-time wheelchair users with MS and SCI. Findings from this study can inform the development of evidenced-based interventions to improve the effectiveness of clinically based treatment protocols.Implications for rehabilitationFalls are a common health concern in full-time wheelchair users living with multiple sclerosis and spinal cord injury.The circumstances surrounding falls reported by full-time wheelchair users living with multiple sclerosis and spinal cord injuries were found to be multifactorial. The complex nature of falls must be taken into consideration in the development of fall prevention programs.Findings from this study can inform the development of comprehensive evidence-based, population-specific interventions to manage falls among full-time wheelchair users living with multiple sclerosis and spinal cord injury.

Perspectives of basic wheelchair users on improving their access to wheelchair services in Kenya and Philippines: a qualitative study

BackgroundThe United Nations has called for countries to improve access to mobility devices when needed. The World Health Organization has published guidelines on the provision of manual wheelchairs in less-resourced settings. Yet little is known about the extent to which appropriate wheelchairs are available and provided according to international guidelines. This study’s purpose was to describe wheelchair users’ experiences receiving services and acquiring wheelchair skills in urban and peri-urban areas of Kenya and the Philippines.MethodsLocal researchers in Nairobi and Manila interviewed 48 adult basic wheelchair users, with even distribution of those who had and had not received wheelchair services along with their wheelchair. Recordings were transcribed in the local language and translated into English. The study team coded transcripts for predetermined and emergent themes, using Atlas-ti software. A qualitative content analysis approach was taken with the WHO service delivery process as an organizing framework.ResultsWheelchair users frequently described past experiences with ill-fitting wheelchairs and little formal training to use wheelchairs effectively. Through exposure to multiple wheelchairs and self-advocacy, they learned to select wheelchairs suitable for their needs. Maintenance and repair services were often in short supply. Participants attributed shorter duration of wheelchair use to lack of repair. Peer support networks emerged as an important source of knowledge, resources and emotional support. Most participants acknowledged that they received wheelchairs that would have been difficult or impossible for them to pay for, and despite challenges, they were grateful to have some means of mobility. Four themes emerged as critical for understanding the implementation of wheelchair services: barriers in the physical environment, the need for having multiple chairs to improve access, perceived social stigma, and the importance of peer support.ConclusionsInterventions are needed to provide wheelchairs services efficiently, at scale, in an environment facilitating physical access and peer support, and reduced social stigma.Trial registrationNot applicable since this was a descriptive study.

Association of Pectoralis Minor Muscle Extensibility, Shoulder Mobility, and Duration of Manual Wheelchair Use

ObjectiveTo assess the relation of pectoralis minor muscle (PMm) length and extensibility to shoulder pain, shoulder girdle motion, and duration of manual wheelchair (MWC) use, and to compare differences in muscle length, muscle extensibility, peak humeral elevation, and pain among groups based on duration of wheelchair use. DesignCross-sectional cohort study. SettingLaboratory setting. ParticipantsIndividuals with spinal cord injury (SCI) who used an MWC for daily community and home mobility (N=22; 18 men; mean age, 41.7y; duration wheelchair use, 14.6y). Participants were stratified into groups based on duration of wheelchair use: <5 years (n=6), 5 to 15 years (n=8), and >15 years (n=8). InterventionsNot applicable. Main Outcome MeasuresClinical measures of PMm length and extensibility, shoulder girdle motion, and shoulder pain (Wheelchair User's Shoulder Pain Index). ResultsSignificant high correlations were found among duration of wheelchair use, passive PMm length, passive PMm extensibility, and peak humerothoracic elevation. Moderate correlation of peak humerothoracic elevation to pain was found. Individuals with >15 years wheelchair use had reduced PMm extensibility and reduced peak humerothoracic elevation than those with <5 years duration of use. ConclusionsTo our knowledge, this is the first investigation to identify the association of reduced PMm extensibility with reduced shoulder girdle mobility, pain, and duration of wheelchair use in individuals with SCI.

The prevalence of carpal tunnel syndrome among long-term manual wheelchair users with spinal cord injury: A cross-sectional study

Context: Use of a handrim wheelchair could force the wrist into extreme excursions and encroachment of the median nerve.Objective: We performed a study of the prevalence of carpal tunnel syndrome in prolonged wheelchair users.Design and setting: A cross-sectional study was conducted for one year in an outpatient clinic of spinal cord injury.Participants: Patients had traumatic injury at the first thoracic level and below, with time since injury of at least 5 years.Outcome measure: The prevalence of carpal tunnel syndrome by history taking, clinical examinations and motor and sensory nerve conduction studies of median nerve performed for both hands.Results: Participants (N = 297) were all male. Mean (SD) age and duration since injury were 48 (8.5) and 23 (6.6) years, respectively. A significant difference in median duration of injury based on the severity of the syndrome (P < 0.001), and a significant trend in time since injury for the severity (P (one tailed) < 0.001) were seen. There was a significant difference in the median age among the groups (P = 0.009), and the median increased with the severity (P (one tailed) = 0.001).Conclusions: Carpal tunnel syndrome is a common side effect of the long time use of wheelchair, and its severity is associated with duration of wheelchair use and age. Alternative methods for wheelchair propulsion should be developed to diminish the likelihood of the syndrome.

Evaluation of pediatric manual wheelchair mobility using advanced biomechanical methods.

There is minimal research of upper extremity joint dynamics during pediatric wheelchair mobility despite the large number of children using manual wheelchairs. Special concern arises with the pediatric population, particularly in regard to the longer duration of wheelchair use, joint integrity, participation and community integration, and transitional care into adulthood. This study seeks to provide evaluation methods for characterizing the biomechanics of wheelchair use by children with spinal cord injury (SCI). Twelve subjects with SCI underwent motion analysis while they propelled their wheelchair at a self-selected speed and propulsion pattern. Upper extremity joint kinematics, forces, and moments were computed using inverse dynamics methods with our custom model. The glenohumeral joint displayed the largest average range of motion (ROM) at 47.1° in the sagittal plane and the largest average superiorly and anteriorly directed joint forces of 6.1% BW and 6.5% BW, respectively. The largest joint moments were 1.4% body weight times height (BW × H) of elbow flexion and 1.2% BW × H of glenohumeral joint extension. Pediatric manual wheelchair users demonstrating these high joint demands may be at risk for pain and upper limb injuries. These evaluation methods may be a useful tool for clinicians and therapists for pediatric wheelchair prescription and training.

Wheelchair appropriateness in patients with spinal cord injury: a Turkish experience.

Descriptive. To determine the wheelchair appropriateness in patients with spinal cord injury (SCI). National Rehabilitation Center in Ankara, Turkey. Twenty-seven (25 male, 2 female) SCI patients were included. Demographic and clinical characteristics of the patients were noted. All wheelchairs were evaluated considering each part (seat length, seat depth, seat height, back height, armrest, headrest, wheels and seat belt) by a physiatrist who had attended the wheelchair-training course. The wheelchair was declared as inappropriate if at least three parts of wheelchair were not appropriate. The mean age of the patients was 32.9±9.3 years and mean duration of wheelchair use was 19.63±23.02 months. Among the patients, 21 (77.8%) were American Spinal Injury Association Impairment Scale (AIS) A, 4 (3.7%) AIS B, 1 (3.7%) AIS C and 1 (3.7%) AIS D. Five (18.5%) wheelchairs were motorized and 22 (81.5%) were manual. Overall, 15 (55.6%) wheelchairs were inappropriate. Seat height, cushion and back height were the most common inappropriate parts. In light of our first and preliminary results, we can argue that 55% of the patients with SCI use inappropriate wheelchairs. In order to achieve better mobility; personally designed wheelchairs should be prescribed by the clinicians.

Wheelchair Propulsion Test: Development and Measurement Properties of a New Test for Manual Wheelchair Users

ObjectiveTo develop and assess some of the measurement properties of a simple and inexpensive test that can be used to evaluate the wheelchair mobility of manual wheelchair users. DesignThe initial phase of the study was developmental and descriptive. For the assessment of reliability and validity, correlations and comparisons were carried out using within-participant and subgroup comparisons. SettingRehabilitation center. ParticipantsManual wheelchair users (N=58), a sample of convenience. InterventionThe Wheelchair Propulsion Test (WPT) consists of wheeling 10m while time is recorded with a stopwatch, and the number of cycles and propulsion methods are recorded by observation. The WPT was administered once to each participant. Participants in subgroups involved in the assessment of reliability, construct, and concurrent validity had an additional WPT on the same occasion. Main Outcome MeasuresDerived measures—speed (m/s), push frequency (cycles per second) and effectiveness (meters per cycle)—from the WPT and, for concurrent validity, an instrumented rear wheel. ResultsRegarding intra- and interrater reliability, intraclass correlation coefficients ranged from .72 to .96. Content validity was qualitatively good. For construct validity, on univariate or multivariate analyses, we found statistically significant relations between WPT measures and age, sex, duration of wheelchair use, type of wheelchair frame, and rolling surface. For concurrent validity, the WPT and instrumented wheel variables were highly correlated (r range, .92–.99), and there were no clinically significant differences between them. ConclusionsThe WPT appears to be a simple and inexpensive test with good measurement properties that can be used for people who use hand and/or foot propulsion. However, further study is needed before widespread implementation can be recommended.

Assistive technology use and human rights enjoyment: a cross-sectional study in Bangladesh.

BackgroundAbout half a billion people with disabilities in developing countries have limited access to assistive technology. The Convention on the Rights of persons with Disabilities requires governments to take measures to ensure provision of such technologies. To guide implementation of these measures there is a need for understanding health outcomes from a human rights perspective. The objective of this study was therefore to explore the relation between assistive technology use and enjoyment of human rights in a low-income country.MethodsData was collected in eight districts of Bangladesh through interviews of people with hearing impairments using and not using hearings aids, and people with ambulatory impairments using and not using manual wheelchairs (N = 583). Using logistic regression, self-reported outcomes on standard of living, health, education, work, receiving information and movement were analyzed.ResultsThe adjusted likelihood of reporting greater enjoyment of human rights was significantly higher among people using hearing aids compared to non-users for all outcomes except working status. Compared to non-users, users of wheelchairs reported a significantly higher adjusted likelihood of good ambulatory performance and a significantly lower adjusted likelihood of reporting a positive working status. Further analyses indicated that physical accessibility to working places and duration of wheelchair use had a statistically significant impact on the likelihood of reporting positive work outcomes.ConclusionsThe findings support the notion that assistive technology use increases the likelihood of human rights enjoyment, particularly hearing aid use. Physical accessibility should always be addressed in wheelchair provision.

Effect of an Intense Wheelchair Propulsion Task on Quantitative Ultrasound of Shoulder Tendons

To investigate acute ultrasound changes of biceps and supraspinatus tendon appearance after an intense wheelchair propulsion task, and how these changes relate to demographic and biomechanical risk factors. A survey. Research laboratory and research space at the National Veterans Wheelchair Games. A convenience sample of 60 manual wheelchair users were recruited through research registries and rehabilitation clinics as well as from participants at the 2007 and 2008 National Veterans Wheelchair Games. The subjects were between 18 and 65 years of age at least 1 year after injury and did not have progressive disabilities. Quantitative ultrasound (QUS) measures of biceps and supraspinatus tendon appearance, stroke frequency, resultant force, tendinopathy score, and duration of wheelchair use. Biceps tendon appearance after an intense propulsion task was significantly related to chronic biceps tendinopathy, duration of wheelchair use, stroke frequency, and resultant force. The subjects with a higher stroke frequency or resultant force tended to have a brighter, more organized tendon appearance compared with the prepropulsion imaging session (baseline). The subjects with tendinopathy or a longer duration of wheelchair use were more likely to have a darker, diffuse tendon appearance immediately after the propulsion task. Supraspinatus tendon appearance after propulsion was only significantly predicted by baseline QUS measures. QUS has proven to be sensitive to risk factors for tendon pathology. Future studies can apply grayscale-based QUS to study the development and prevention of repetitive strain injuries, particularly on an individual basis.

Validation of grayscale-based quantitative ultrasound in manual wheelchair users: relationship to established clinical measures of shoulder pathology.

The primary aim of this study is to establish the validity of grayscale-based quantitative ultrasound (QUS) measures of the biceps and supraspinatus tendons. Nine QUS measures of the biceps and supraspinatus tendons were computed from ultrasound images collected from 67 manual wheelchair users. Shoulder pathology was measured using questionnaires, physical examination maneuvers, and a clinical ultrasound grading scale. Increased age, duration of wheelchair use, and body mass correlated with a darker and more homogenous tendon appearance. Subjects with pain during physical examination tests for biceps tenderness and acromioclavicular joint tenderness exhibited significantly different supraspinatus QUS values. Even when controlling for tendon depth, QUS measures of the biceps tendon differed significantly between subjects with healthy tendons, mild tendinosis, and severe tendinosis. Clinical grading of supraspinatus tendon health was correlated with QUS measures of the supraspinatus tendon. QUS is valid method to quantify tendinopathy and may allow for early detection of tendinosis. Manual wheelchair users are at a high risk for developing shoulder tendon pathology and may benefit from QUS-based research that focuses on identifying interventions designed to reduce this risk.

Ultrasonographic Median Nerve Changes After a Wheelchair Sporting Event

Impink BG, Boninger ML, Walker H, Collinger JL, Niyonkuru C. Ultrasonographic median nerve changes after a wheelchair sporting event. Objectives To investigate the acute median nerve response to intense wheelchair propulsion by using ultrasonography and to examine the relationship between carpal tunnel syndrome (CTS) signs and symptoms and the acute median nerve response. Design Case series. Setting Research room at the National Veterans Wheelchair Games. Participants Manual wheelchair users (N=28) competing in wheelchair basketball. Intervention Ultrasound images collected before and after a wheelchair basketball game. Main Outcome Measures Median nerve cross-sectional area, flattening ratio, and swelling ratio and changes in these after activity. Comparison of median nerve characteristics and patient characteristics between participants with and without positive physical examination findings and with and without symptoms of CTS. Results Significant changes in median nerve ultrasound characteristics were noted after activity. The group as a whole showed a significant decrease in cross-sectional area at the radius of 4.05% ( P=.023). Participants with positive physical examinations showed significantly different ( P=.029) and opposite changes in swelling ratio compared with the normal group. Subjects with CTS symptoms had a significantly ( P=.022) greater duration of wheelchair use (17.1y) compared with the asymptomatic participants (9y). Conclusions Manual wheelchair propulsion induces acute changes in median nerve characteristics that can be visualized by using ultrasound. Studying the acute median nerve response may be useful for optimizing various interventions, such as wheelchair set up or propulsion training, to decrease both acute and chronic median nerve damage and the likelihood of developing CTS.

Factors Affecting Shoulder Pain in Adolescents and Young Adults with Spina Bifida

This study was designed to determine whether factors affecting shoulder pain in adults with spinal cord injury also affected adolescent and young adult manual wheelchair users with spina bifida. Forty-one participants with spina bifida rated their pain using the Wheelchair User's Shoulder Pain Index. Results showed no significant relationship between shoulder pain and age or duration of wheelchair use but significant differences in pain between age groups. Participation in a sports program and level of lesion were not factors in pain intensity. Propelling up an incline was the activity for which the highest intensity of pain was reported. Shoulder pain in adolescents and young adults with spina bifida is not as great as previously reported in adults with spinal cord injuries but older subjects had greater pain than younger subjects.