Gagnon Dany, Nadeau Sylvie, Gravel Denis, Noreau Luc, Larivière Christian, Gagnon Denis
Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain--Site Institut de réadaptation de Montréal, Montréal, Que., Canada.
Clin Biomech (Bristol). 2003 May;18(4):319-31. doi: 10.1016/s0268-0033(03)00016-0.
The purpose of this study was to determine the movement patterns and the muscular demand during a posterior transfer maneuver on a level surface in individuals with spinal cord injuries.
Six participants with high-level spinal cord injury (C7 to T6) were compared to five participants with low-level spinal cord injury (T11 to L2) with partial or complete control of abdominal musculature.
Developing an optimal level of independence for transfer activities figures among the rehabilitation goals of individuals with spinal cord injury. There has been no biomechanical study which specifically describes the posterior transfer maneuver.
Tridimensional kinematics at the elbow, shoulder, head and trunk, as well as surface electromyographic data of the biceps, triceps, anterior deltoid, posterior deltoid, pectoralis major, latissimus dorsi, trapezius and rectus abdominus muscles were recorded during the posterior transfer. To quantify the muscular demand, the electromyographic data were amplitude normalized to the peak value obtained from maximum voluntary contractions. The transfer was divided into pre-lift, lift, and post-lift phases for analysis.
The duration of the lift phase was significantly shorter (P<0.05) for the high-level spinal cord injury (1.24; SD, 0.37 s) when compared to the low-level spinal cord injury (1.74; SD, 0.39 s). The patterns and magnitudes of the angular displacements were found similar between groups (P values: 0.45-0.98). However, the high-level spinal cord injury initiated the task from a forward flexed posture, whereas the low-level spinal cord injury adopted an almost upright alignment of the trunk. Higher muscular demands were calculated for all muscles among high-level spinal cord injury participants during the transfer when compared to the low-level spinal cord injury. However, only the anterior deltoid (high level=92.4%; low level=34.2%) and the pectoralis major (high level=109.8%; low level=25.6%) reached statistical significance during the lift phase.Conclusions. Participants with high-level spinal cord injury presented different movement characteristics and higher muscular demands during the posterior transfer than low-level spinal cord injury ones. This is probably to compensate for the additional trunk and upper limb musculature impairment.
The findings of this study may help to develop guidelines of specific strengthening programs for the thoracohumeral, scapulothoracic and shoulder muscles designed to restore optimal transfer capacity in individuals with spinal cord injury. Furthermore, innovative rehabilitation programs targeting the ability to control the trunk could be beneficial for these individuals.
本研究旨在确定脊髓损伤患者在水平面上进行后向转移动作时的运动模式和肌肉需求。
将6名高位脊髓损伤（C7至T6）参与者与5名低位脊髓损伤（T11至L2）且腹部肌肉有部分或完全控制能力的参与者进行比较。
为转移活动培养最佳独立水平是脊髓损伤患者康复目标之一。目前尚无专门描述后向转移动作的生物力学研究。
在进行后向转移时，记录肘部、肩部、头部和躯干的三维运动学数据，以及肱二头肌、肱三头肌、三角肌前束、三角肌后束、胸大肌、背阔肌、斜方肌和腹直肌的表面肌电图数据。为量化肌肉需求，将肌电图数据的幅度归一化为从最大自主收缩获得的峰值。转移过程分为抬升前、抬升和抬升后阶段进行分析。
与低位脊髓损伤（1.74；标准差，0.39秒）相比，高位脊髓损伤（1.24；标准差，0.37秒）的抬升阶段持续时间显著更短（P<0.05）。两组之间的角位移模式和幅度相似（P值：从0.45至0.98）。然而，高位脊髓损伤参与者从向前屈曲姿势开始任务，而低位脊髓损伤参与者采用几乎直立的躯干姿势。与低位脊髓损伤相比，高位脊髓损伤参与者在转移过程中所有肌肉的肌肉需求计算值更高。然而，仅在抬升阶段三角肌前束（高位=92.4%；低位=34.2%）和胸大肌（高位=109.8%；低位=25.6%）达到统计学显著性。
高位脊髓损伤参与者在进行后向转移时表现出与低位脊髓损伤参与者不同的运动特征和更高的肌肉需求。这可能是为了补偿额外的躯干和上肢肌肉损伤。
本研究结果可能有助于制定针对胸肱、肩胛胸壁和肩部肌肉的特定强化训练计划指南，以恢复脊髓损伤患者的最佳转移能力。此外，针对控制躯干能力的创新康复计划可能对这些患者有益。
