Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin.
Shriners Hospitals for Children, Chicago, Illinois.
Top Spinal Cord Inj Rehabil. 2021 Fall;27(3):26-37. doi: 10.46292/sci20-00057. Epub 2021 Aug 13.
Manual wheelchair propulsion is a physically demanding task associated with upper extremity pain and pathology. Shoulder pain is reported in over 25% of pediatric manual wheelchairs users, and this number rises over the lifespan. Upper extremity biomechanics in adults has been associated with shoulder pain and pathology; however, few studies have investigated upper extremity joint dynamics in children. Furthermore, sex may be a critical factor that is currently unexplored with regard to pediatric wheelchair mobility.
To investigate differences in upper extremity joint dynamics between pediatric male and female manual wheelchair users with spinal cord injury (SCI) during wheelchair propulsion.
Novel instrumented wheelchair hand-rims synchronized with optical motion capture were used to acquire upper extremity joint dynamics of 20 pediatric manual wheelchair users with SCI (11 males, 9 females). Thorax, sternoclavicular, acromioclavicular, glenohumeral, elbow, and wrist joint kinematics and kinetics were calculated during wheelchair propulsion. Linear mixed models were used to assess differences between sexes.
Females exhibited significantly greater peak forearm pronation ( = .007), normalized wrist lateral force ( = .03), and normalized elbow posterior force ( = .04) than males. Males exhibited significantly greater peak sternoclavicular joint retraction ( < .001) than females. No significant differences between males and females were observed for the glenohumeral joint ( > .012).
This study found significant differences in upper extremity joint dynamics between sexes during manual wheelchair propulsion. Our results underscore the importance of considering sex when evaluating pediatric wheelchair mobility and developing comprehensive wheelchair training interventions for early detection and prevention of upper extremity pain and pathology.
手动轮椅推进是一项体力要求很高的任务，与上肢疼痛和病变有关。超过 25%的儿科手动轮椅使用者报告肩部疼痛，而且这个数字随着寿命的增长而上升。成年人的上肢生物力学与肩部疼痛和病变有关；然而，很少有研究调查儿童上肢关节动力学。此外，性别可能是一个关键因素，目前尚未针对儿科轮椅移动性进行探索。
研究脊髓损伤（SCI）儿童手动轮椅使用者上肢关节动力学在轮椅推进过程中的性别差异。
使用新型仪器化轮椅手柄，与光学运动捕捉同步，获取 20 名 SCI 儿科手动轮椅使用者的上肢关节动力学数据（男性 11 名，女性 9 名）。在轮椅推进过程中计算了胸、胸锁、肩锁、肩肱、肘和腕关节的运动学和动力学。线性混合模型用于评估性别之间的差异。
女性的前臂旋前峰值（ =.007）、手腕侧向力归一化（ =.03）和肘部后向力归一化（ =.04）显著大于男性。男性的胸锁关节回缩峰值（ <.001）显著大于女性。男女之间的肩肱关节无显著差异（ >.012）。
本研究发现男女在手动轮椅推进过程中上肢关节动力学存在显著差异。我们的研究结果强调了在评估儿科轮椅移动性和制定全面的轮椅训练干预措施时，考虑性别的重要性，以便早期发现和预防上肢疼痛和病变。
