From the Shoulder Health & Mobility Group, Swiss Paraplegic Research, Nottwil, Switzerland (FMB, UA, WdV); Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland (FMB, UA, WdV); Department of Rehabilitation Sciences and Physiotherapy, University of Ghent, Gent, Belgium (AC); Department of Occupational and Physical Therapy and Institute of Sports Medicine, Bispebjerg Hospital, University of Copenhagen, København, Denmark (AC); Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Department of Veterans Affairs, Pittsburgh, Pennsylvania (SR, MLB); Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania (SR, MLB); Swiss Paraplegic Centre, Nottwil, Switzerland (IE-H); Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania (MLB); and Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania (MLB).
Am J Phys Med Rehabil. 2020 Feb;99(2):91-98. doi: 10.1097/PHM.0000000000001267.
The aims of the study were to examine whether fatigue-inducing wheelchair propulsion changes neuromuscular activation and propulsion biomechanics and to determine predictor variables for susceptibility to fatigue.
This study with a quasi-experimental, one-group, pretest-posttest design investigates a population-based sample of wheelchair users with a spinal cord injury (n = 34, age: 50.8 ± 9.7 yrs, 82% males). Neuromuscular activation and propulsion biomechanics during treadmill propulsion at 25 W and 45 W were assessed before and after a protocol designed to cause fatigue.
With the induced fatigue, wheelchair users propelled with increased neuromuscular activation in the pectoralis major pars sternalis, deltoideus pars acromialis and upper trapezius (45 W, P < 0.05), and a slightly reduced push angle (25 W: 75-74 degrees, P < 0.05, 45 W: 78-76 degrees, P < 0.05). Wheelchair users susceptible to fatigue (47%) were more likely to have a complete lesion, to be injured at an older age, and had less years since injury. This group propelled in general with shorter push angle and greater maximum resultant force, had a greater anaerobic capacity, and had less neuromuscular activation.
Compensation strategies in response to fatiguing propulsion could increase the risk for shoulder injury. Predictor variables for susceptibility to fatigue inform interventions preserving shoulder health and include lesion characteristics, propulsion technique, anaerobic capacity, and neuromuscular activation.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Explain a neuromuscular compensation strategy and the corresponding muscles in response to fatiguing wheelchair propulsion; (2) Recommend propulsion biomechanics associated to reduced susceptibly to fatiguing wheelchair propulsion; and (3) List examples of predictor variables of susceptibility to fatigue.
Advanced.
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
本研究旨在探讨疲劳诱导的轮椅推进是否会改变神经肌肉激活和推进生物力学，并确定易疲劳的预测变量。
本研究采用准实验、单组、前后测试设计，调查了一组基于人群的脊髓损伤轮椅使用者（n=34，年龄：50.8±9.7 岁，82%为男性）。在跑步机上以 25 W 和 45 W 推进之前和之后，评估了在设计用于引起疲劳的方案期间的神经肌肉激活和推进生物力学。
在诱导的疲劳下，轮椅使用者在胸大肌胸骨部、三角肌前束和上斜方肌中表现出增加的神经肌肉激活（45 W，P<0.05），并且推角略有减小（25 W：75-74 度，P<0.05，45 W：78-76 度，P<0.05）。易疲劳的轮椅使用者（47%）更有可能完全损伤、年龄较大受伤，且受伤后时间较短。该组通常以较小的推角和较大的最大合力进行推进，具有更大的无氧能力，并且神经肌肉激活较小。
疲劳推进的补偿策略可能会增加肩部受伤的风险。易疲劳的预测变量可告知预防肩部健康受损的干预措施，包括损伤特征、推进技术、无氧能力和神经肌肉激活。
要求 CME 学分：在 http://www.physiatry.org/JournalCME 上在线完成自我评估活动和评估。CME 目标：完成本文后，读者应能够：（1）解释疲劳诱导的轮椅推进中神经肌肉补偿策略和相应肌肉；（2）推荐与降低疲劳诱导的轮椅推进易感性相关的推进生物力学；（3）列出易疲劳的预测变量的例子。
高级。
学术物理治疗师协会由继续医学教育认证委员会认可，可为医生提供继续医学教育。学术物理治疗师协会将这个基于期刊的 CME 活动指定为最多 1.0 AMA PRA 类别 1 学分（™）。医生只能要求与他们参与活动的程度相符的学分。
