Longitudinal Evaluation of Variability of Stroke Patterns and Shoulder Forces in Pediatric SCI Wheelchair Users
Archives of Physical Medicine and Rehabilitation
To investigate changes in propulsive stroke patterns, glenohumeral joint forces, and pain in pediatric manual wheelchair users with respect to age to better understand risk for injury and contribute to training and rehabilitation.
Motion Analysis Lab at Shriners Hospitals for Children-Chicago.
Three pediatric manual wheelchair users with spinal cord injury (SCI). Mean subject age for the first and second visit: 14.8 years (2.5 years) and 16.3 years (2.7 years), respectively. Bony level of SCI ranged from sixth cervical to ninth thoracic vertebra.
Main Outcome Measures
Propulsive stroke patterns and glenohumeral joint forces.
There was significant variation in the stroke patterns, both within and between visits for all subjects. Additionally, patterns not represented by any of the four adult classifications were observed . Further variation was seen in GH joint forces, as determined by our pediatric biomechanical model . The average superior GH joint forces and the average lateral joint forces, both correlated with shoulder pathology , increased between visits, changing from 6.79 %BW to 8.53 %BW and from 5.70 %BW to 7.71 %BW, respectively. All other GH forces did not follow similar trends among subjects. Also, subjects with similar weight, time since injury, SCI level, and age differed in their joint forces and stroke patterns. The average reported pain on the Visual Analog Scale (VAS)  decreased from 6.67 (9.42) to 3.33 (4.71); however, one subject reported no change in pain.
While limited by the population size, the increased joint forces and fluctuating stroke patterns demonstrate the variability between these pediatric users. The variation in joint forces potentially resulting from the varied stroke patterns may be important in preventing overuse injuries and pain.
Schlidt, Kevin; Slavens, Brooke A.; Schnorenberg, Alyssa J.; Vogel, Lawrence C.; and Harris, Gerald F., "Longitudinal Evaluation of Variability of Stroke Patterns and Shoulder Forces in Pediatric SCI Wheelchair Users" (2017). Biomedical Engineering Faculty Research and Publications. 593.