University of Wisconsin-Milwaukee, Department of Rehabilitation Sciences and Technology, Milwaukee, WI 53211, USA; University of Wisconsin-Milwaukee, Department of Mechanical Engineering, Milwaukee, WI 53211, USA.
University of Wisconsin-Milwaukee, Department of Rehabilitation Sciences and Technology, Milwaukee, WI 53211, USA; University of Illinois Urbana-Champaign, College of Applied Health Sciences, Urbana, IL 61801, USA; University of Illinois Urbana-Champaign, Beckman Institute for Advanced Science and Technology, Urbana, IL 61801, USA.
Gait Posture. 2024 Sep;113:561-569. doi: 10.1016/j.gaitpost.2024.08.075. Epub 2024 Aug 15.
Most manual wheelchair users with pediatric-onset spinal cord injury (SCI) will experience shoulder pain or pathology at some point in their life. However, guidelines for preservation of the upper limb in children with SCI are limited.
What are the relationships between manual wheelchair handrim kinetics and quantitative ultrasound parameters related to subacromial impingement in individuals with pediatric-onset SCI?
Subacromial impingement risk factors including supraspinatus tendon thickness (SST), acromiohumeral distance (AHD), and occupation ratio (OR; SST/AHD) were measured with ultrasound in 11 manual wheelchair users with pediatric-onset SCI. Handrim kinetics were acquired during the stroke cycle, including peak resultant force (F), peak rate of rise of resultant force (ROR) and fractional effective force (FEF). Variability of handrim kinetics was computed using the coefficient of variation and linear regression was performed to assess correlations between handrim metrics and quantitative ultrasound parameters.
Peak resultant force significantly increased 1.4 % and variability of FEF significantly decreased 8.0 % for every 0.1 cm increase in AHD. FEF decreased 3.5 % for every 0.1 cm increase in SST. Variability of peak resultant force significantly increased 3.6 % and variability of peak ROR of resultant force significantly increased 7.3 % for every 0.1 cm increase in SST. FEF variability significantly decreased 11.6 % for every 0.1 cm increase in SST. Peak ROR significantly decreased 1.54 % with every 10 % increase in OR. FEF variability significantly decreased 1.5 % with every 10 % increase in OR.
This is the first study to investigate relationships among handrim kinetics and shoulder structure in manual wheelchair users with pediatric-onset SCI. Associations were identified between subacromial impingement risk factors and magnitude and variability of wheelchair handrim kinetics. These results indicate the critical need to further explore the relationships among wheelchair handrim kinetics, shoulder joint dynamics, and shoulder pathology in manual wheelchair users with pediatric-onset SCI.
大多数儿童期起病的脊髓损伤（SCI）的手动轮椅使用者在其一生中的某个时间会经历肩部疼痛或病变。然而，针对儿童 SCI 患者上肢保护的指南有限。
在儿童期起病的 SCI 患者中，手动轮椅手轮动力学与与肩峰下撞击相关的定量超声参数之间有什么关系？
使用超声测量 11 名儿童期起病的 SCI 手动轮椅使用者的肩峰下撞击危险因素，包括冈上肌腱厚度（SST）、肩峰肱骨头间距（AHD）和占比（OR；SST/AHD）。在手轮的冲程周期中获取手轮动力学，包括峰值合力（F）、峰值合力上升率（ROR）和有效力分数（FEF）。使用变异系数计算手轮动力学的变异性，并进行线性回归以评估手轮指标与定量超声参数之间的相关性。
AHD 每增加 0.1cm，峰值合力就会增加 1.4%，FEF 的变异性就会降低 8.0%。SST 每增加 0.1cm，FEF 就会降低 3.5%。SST 每增加 0.1cm，峰值合力的变异性就会增加 3.6%，峰值合力的 ROR 变异性就会增加 7.3%。SST 每增加 0.1cm，FEF 的变异性就会降低 11.6%。OR 每增加 10%，峰值 ROR 就会降低 1.54%。OR 每增加 10%，FEF 的变异性就会降低 1.5%。
这是第一项研究手动轮椅使用者中儿童期起病的 SCI 患者手轮动力学与肩部结构之间关系的研究。确定了肩峰下撞击的危险因素与手轮动力学的幅度和变异性之间的关联。这些结果表明，迫切需要进一步探索儿童期起病的 SCI 患者的轮椅手轮动力学、肩关节动力学和肩部病理学之间的关系。
