Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States of America.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States of America.
PLoS One. 2021 Apr 23;16(4):e0248978. doi: 10.1371/journal.pone.0248978. eCollection 2021.
Shoulder pain and pathology are extremely common for individuals with spinal cord injuries (SCI) who use manual wheelchairs (MWC). Although risky humeral kinematics have been measured during wheelchair-based activities performed in the lab, little is known about arm kinematics in the free-living environment. The purpose of this study was to measure the humeral elevation workspace throughout a typical day for individuals with SCI who use a MWC and matched able-bodied controls. Thirty-four individuals with SCI who use a MWC (42.7±12.7 years of age, 28 males/6 females, C6-L1) and 34 age-and sex-matched controls were enrolled. Participants wore three inertial measurement units (IMU) on their upper arms and torso for one to two days. Humeral elevation angles were estimated and the percentage of time individuals spent in five elevation bins (0-30°, 30-60°, 60-90°, 90-120°, and 120-180°) were calculated. For both arms, the SCI cohort spent a significantly lower percentage of the day in 0-30° of humeral elevation (Dominant: SCI = 15.7±12.6%, Control = 32.1±15.6%, p<0.0001; Non-Dominant: SCI = 21.9±17.8%, Control = 34.3±15.5%, p = 0.001) and a significantly higher percentage of time in elevations associated with tendon compression (30-60° of humeral elevation, Dominant: SCI = 62.8±14.4%, Control = 49.9.1±13.0%, p<0.0001; Non-Dominant: SCI = 58.8±14.9%, Control = 48.3±13.6%, p = 0.003) than controls. The increased percentage of time individuals with SCI spent in elevations associated with tendon compression may contribute to increased shoulder pathology. Characterizing the humeral elevation workspace utilized throughout a typical day may help in understanding the increased prevalence of shoulder pain and pathology in individuals with SCI who use MWCs.
肩部疼痛和疾病在使用手动轮椅（MWC）的脊髓损伤（SCI）患者中极为常见。虽然在实验室进行的轮椅相关活动中已经测量到危险的肱骨运动学，但在自由生活环境中手臂运动学知之甚少。本研究的目的是测量使用 MWC 的 SCI 患者和匹配的健全对照组在典型一天中的肱骨抬高工作空间。34 名使用 MWC 的 SCI 患者（年龄 42.7±12.7 岁，28 名男性/6 名女性，C6-L1）和 34 名年龄和性别匹配的对照组被纳入研究。参与者在手臂和躯干上佩戴三个惯性测量单元（IMU），持续一到两天。估计肱骨抬高角度，并计算个人在五个抬高箱（0-30°、30-60°、60-90°、90-120°和 120-180°）中花费的时间百分比。对于双臂，SCI 队列在 0-30°肱骨抬高范围内花费的时间百分比明显较低（优势臂：SCI = 15.7±12.6%，对照组 = 32.1±15.6%，p<0.0001；非优势臂：SCI = 21.9±17.8%，对照组 = 34.3±15.5%，p=0.001），而在与肌腱压缩相关的抬高范围内花费的时间百分比明显较高（30-60°肱骨抬高，优势臂：SCI = 62.8±14.4%，对照组 = 49.9.1±13.0%，p<0.0001；非优势臂：SCI = 58.8±14.9%，对照组 = 48.3±13.6%，p=0.003）。与对照组相比，SCI 患者花费更多的时间处于与肌腱压缩相关的抬高范围内，这可能导致肩部病变增加。描述典型一天中使用的肱骨抬高工作空间可能有助于理解使用 MWC 的 SCI 患者肩部疼痛和病变增加的原因。
