THE EFFECT OF WRIST RESTRAINTS ON WHEELING BIOMECHANICS

High intracarpal pressures created by hyperextension of the wrist during wheelchair propulsion is a suggested cause of median nerve dysfunction at the wrist/hand (Burnham & Steadward, 1994). An injury survey conducted by Burnham, Higgins & Steadward (1994) found that the wrist and hand were the most common sites of injury reported by wheelchair basketball players. The purpose of this study was to assess whether various forms of hand/wrist protection (visco-elastic padded glove, wrist splint, glove and splint) could effectively reduce the hyperextension seen at the wrist during wheelchair propulsion, thus potentially reducing the conditions predisposing to carpal tunnel syndrome. In addition, an evaluation of the various forms of hand/wrist protection and their effects on wheeling mechanics was also undertaken. The wheeling performances of thirteen subjects with prior wheeling experience were recorded using two SVHS videorecorders positioned to obtain a front and side view. Each subject propelled a standard wheelchair basketball chair mounted to a set of wheelchair rollers under four different conditions (no splint, visco-elastic padded glove on the palms, wrist splint, and glove and splint together). Under each of the conditions the subjects wheeled for thirty seconds both at their average speed and at their maximum speed. Reflective markers were placed on the joint centers of the shoulder and elbow, on the styloid processes of the radius and ulna, and on the distal ends of the 2nd and 5th metacarpals of the right limb to facilitate subsequent digitizing. Twelve points surrounding the activity space were filmed prior to testing and later utilized for calibration using the DLT method for three-dimensional coordinate data reconstruction, followed by smoothing of the data using a cubic spline. Three-dimensional joint angular displacement-time histories for the elbow and wrist were determined using the 3D coordinate data and the dot product identity. Data were analyzed using an one way AN OVA followed by Scheffe post hoc comparisons where appropriate. No differences were found to be significant between the conditions for the elbow angle, however significant differences were revealed for the wrist extension and wrist range of motion angles. Both splint conditions (splint, glove &splint) were significantly different from the non-restraint conditions (no splint, glove). The data suggest that the splints significantly reduced the amount of wrist extension as compared to the no restraint conditions. No significant differences were found between the conditions for maximum wheeling speed. Within the limitations of this study, it can be concluded that the wrist restraints significantly reduced wrist extension during wheeling and that the restraints did not significantly affect wheeling mechanics as suggested by the consistent elbow-angle time histories and wheeling speeds. REFERENCES Burnham, R & Steadward, R (1994). Upper extremity peripheral nerve entrapments among wheelchair athletes: prevalence, location, and risk factors. Archives of Physical Medicine and Rehabilitation, 75, 519 524. Burnham, R, Higgins, J. & Steadward, R. (1994). Wheelchair basketball injuries. Palaestra, 10(2), 43-49

Carpal tunnel syndrome - modern diagnostic and therapy

Sindrom karpalnog tunela najcešca je kompresivna neuropatija na ljudskom tijelu koja se manifestira ispadima u inervacijskom podrucju živca medianusa s ucestalošcu izmedu 50 i 150 slucajeva na 100.000 stanovnika. Simptomatika ovisi o trajanju i jacini kompresije živca. Smetnje senzibilnosti prvi su i najstalniji simptom, dok motoricke smetnje nastaju u bolesnika s dugotrajnom kompresijom živca. Elektroneurofiziološka dijagnostika "zlatni je standard” u postavljanju dijagnoze, a potrebno ju je uciniti kod svake klinicke sumnje na sindrom karpalnog tunela. Kao dodatna dijagnosticka sredstva u atipicnim slucajevima mogu poslužiti ultrazvuk i magnetska rezonancija karpalnog tunela. Neoperacijsko lijecenje rezervirano je za lakše oblike kompresije živca, te kod pojave sindroma u tranzitornim stanjima, kao što su trudnoca, laktacija, korištenje oralnih kontracepcijskih sredstava i sl. Metoda izbora za perzistentne i progresivne oblike sindroma karpalnog tunela, kao i za one koji ne reagiraju na konzervativnu terapiju, operacijsko je lijecenje. Dekompresija živca medianusa efikasan je i siguran zahvat koji u najvecem broju slucajeva oslobada pacijenta od tegoba. Sam zahvat može se izvršiti metodom "otvorenog polja” ili endoskopski, iako za sada nema pokazatelja o prednosti endoskopske tehnike u odnosu na klasicnu tehniku "otvorenog polja”, a jatrogena oštecenja živca medianusa daleko su cešca pri endoskopskoj tehnici. U svakodnevnoj praksi najvece znacenje ima rano prepoznavanje sindroma karpalnog tunela, te njegovo pravodobno i adekvatno lijecenje. U suprotnom dolazi do nepotrebno dugog trajanja smetnji za pacijenta i težeg oštecenja živca, što smanjuje izglede uspješnog lijecenja, te dovodi do nepotrebnih ekonomskih gubitaka.Carpal tunnel syndrome is the most common compressive neuropathy in the human body, which is expressed by a deficit in the median nerve innervation area, with prevalence of 50 to 150 cases per 100.000 inhabitants. Symptoms depend on nerve compression duration and intensity. Sensibility disorders are the first and one of the most persistent symptoms, while motoric disorders arise in patients with prolonged nerve compression. Electroneurophysiological diagnostics is a "golden standard” in diagnosis setting, and it is necessary to be done in every patient with a clinical doubt on carpal tunnel syndrome. Additional diagnostics means in atypical cases can be performed by ultrasound and magnetic resonance of the carpal tunnel. Non-surgical treatment is reserved for mild forms of nerve compression, and in cases of syndrome in temporary conditions like pregnancy, lactation, taking oral contraceptives etc. The method of choice for persistent and progressive forms of carpal tunnel syndrome, as well for those who don\u27t respond to the conservative treatment, is surgery. Decompression of median nerve is an efficient and secure procedure, which, in most cases, releases the patient from its symptoms. Procedure can be performed by an "open field” method or via endoscopy, although, for now, no indicators on advantages of endoscopic technique vs. classical technique of an "open field” have been found, and iatrogenous damage of the median nerve are much more frequent in surgery via endoscopy. In everyday practice, the most important is early recognition of the carpal tunnel syndrome, and its timely and adequate treatment. On the contrary, unnecessaryprolongation of the condition leads to much more severe nerve damage, which diminishes chances for a successful treatment and causes necessary economy losses

PREVENTIVE ANKLE TAPING -EVALUATION OF MECHANICAL, NEUROMUSCULAR AND THERMAL EFFECTS BEFORE AND AFTER EXERCISE

INTRODUCTION: . Athletes and coaches in different sport disciplines use preventive adhesive tape or bandages in order to avoid ankle sprains since Paul Beiersdorf has invented tape about 100 years ago. Many authors tried to evaluate the main effects of taping in respect to its mechanical support to the ankle joint and its preventive effect concerning injuries in high risk sports like basketball, football, athletics or gymnastics. Clinical studies have shown that ankle taping reduces the risk of injury although it has been demonstrated that the mechanical support does decrease even after a few minutes of practise. The aim of the study was to investigate the mechanical as well as the neuromuscular influence of different tape materials and techniques before and after exercise. Method: 12 subjects underwent different trials in a randomized order with two materials (B,C) and two taping techniques (D,E) and without tape (A). This sense of exercises were used to stress the ankle: 5 Drop jumps (36 cm Height) 10 minutes running (tread mill) 3 minutes jumping using a special “jump-device” with slope surfaces ( increased inversion/eversion and dorsal/plantar flexion during the landing phase). The course was performed two times. The main test was the simulated ankle inversion injury by using a special tilt device to apply randomized ankle movements (300 inversion + 150 Plantarflexion) while the subject is standing on the tilt platform. Magnitude and velocity of ankle joint motion was recorded from 2axial goniometers (Penny&Giles). EMG activity was measured from the mm. peroneus 1., tibialis a., gastrocnemius and vastus medialis. Skin temperature alterations beneath the adhesive tape were recorded after each exercise by thermocouples with an accuracy of 0.1 K. RESULTS: Amplitude and velocity (relative to value without tape) of simulated inversion injury was initially reduced by all tapes significantly: Inversion angle relativ to the trial without tapeJA): If no tape was used then EMG -activity during simulation was reduced up to 12% after 20 minutes of exercise. If the ankle was taped -the EMG reduction after 20 minutes was at a lower level ( 5%). Skin temperature under the tape increased significantly compared to untaped ankle. DISCUSSION: The preventive effect of adhesive taping is achieved at the intitial exercise phase by the mechanical stabilization properties of the material. In the later exercise phase (when the mechanical support decreases) the risc of injury could be reduced by the proprioceptive effect, which can be concluded by the increased EMG-activities. REFERENCES: Fumich, R. M., et al. The measured effect of taping on combined foot and ankle motion before and after exercise. AMJSM, 9(1981):165-170

TOWARDS MONITORING WHEELCHAIR PROPULSION IN NATURAL ENVIRONMENT USING WEARABLE SENSORS

Due to lower limb paralysis, individuals with spinal cord injury (SCI) rely on their upper limbs for activities of daily living (ADLs) and wheelchair propulsion (WP). Previous research has found that specific biomechanical parameters of WP are associated with risk of UE pain and injury. However, the repetitiveness and quality of upper limb movements during WP are unclear. Recently, wearable sensors have been used to collect mobility characteristics of wheelchair users, but little research has looked into using them to monitor the quality of UE movements for WP in the natural environment. The purpose of this thesis was to develop and evaluate a WP monitoring device that can monitor wheelchair users’ activities, and propulsion parameters in the natural environment. This thesis is organized into three studies. The first study aims to develop activity classifiers that can distinguish WP episodes from a range of ADLs. Two classifying models were built using a Machine Learning (ML) technique. The model that yielded the highest accuracy showed an overall accuracy of 88.0%. Time spent on each activity was estimated based on the classifiers, and compared with the video observation. Percentage of difference between the criterion and estimated time ranged from 2.2% to 11.6%. The second study aims to estimate temporal parameters of WP, including the stroke number (SN) and push frequency (PF), using wearable sensors. The estimated SN and PF were compared with the criterion measures using the mean absolute errors (MAE) and mean absolute percentage of error (MAPE). Intraclass Correlation Coefficients were calculated to assess the agreement. The accelerometer placed on the upper arm yielded the highest accuracy with the MAPE of 8.0% for SN and 12.9% for PF. The third study aims to estimate wheelchair propulsion forces. Propulsion forces were estimated from the accelerometer placed on the upper arm using a bagging regression technique. The estimated forces were compared with the criterion. Mean absolute errors (MAE), mean absolute percentage of error (MAPE), were calculated. The results showed an overall MAPE of 17.9%. Intraclass Correlation Coefficients and Bland-Altman plots were used to assess the agreement between the criterion and the estimated force

Quantitative Evaluation of Geared Manual Wheelchair Mobility in Individuals with Spinal Cord Injury: An Integrative Approach

The purpose of this dissertation is to quantify the effects of using geared wheelchair wheels on upper extremity biomechanics and energy expenditure during functional mobility tasks in individuals with spinal cord injury (SCI). The effects of using geared wheels on hand-rim biomechanics, glenohumeral joint dynamics, and shoulder muscle activity were investigated during manual wheelchair propulsion over tiled and carpeted level-floors and up a ramp in low gear (1.5:1) and standard gear (1:1) conditions. The results for the hand-rim biomechanics indicated that regardless of the terrain, using the geared wheels in the low gear condition significantly decreased the propulsion speed, stroke distance, and hand-rim kinetics, including the peak hand-rim resultant force, propulsive moment, and rate of the rise of the resultant force. The significant decrease in the normalized integrated hand-rim propulsive moment suggests that the low gear condition is less demanding than the standard gear condition, in spite of the higher repetition during propulsion in low gear. Analysis of the glenohumeral joint dynamics and shoulder muscle activity during geared manual wheelchair propulsion over carpeted floor showed that the peak glenohumeral joint inferior force and flexion moment, as well as the shoulder flexors muscle activity, decreased significantly during the low gear condition. Manual wheelchair users with SCI were tested during the six-minute push tests on passive wheelchair rollers to evaluate the effects of using geared wheels on energy expenditure. The results indicated that using geared wheels in the low gear condition significantly increased the energy cost of propulsion and decreased the intensity of wheelchair propulsion. The findings of this dissertation demonstrate that using geared wheels in comparison to standard wheels decreases the demands on the upper extremity of manual wheelchair users, which may ultimately help preserve upper limb function leading to higher levels of activity, independence and quality of life

Lesión medular y ejercicio físico: revisión desde una perspectiva deportiva

Una de cada 2000 personas en Europa tiene lesión medular (LM), es normalmente más sedentaria que el resto de la población y encuentra diferentes problemas para practicar ejercicio físico (EF), destacando la escasa formación específica de los profesionales del deporte. Con el objetivo de aportar información sobre la LM y su interacción con la práctica deportiva, se realizó una revisión de literatura científica, que analiza sus alteraciones músculoesqueléticas, cardiovasculares, respiratorias, de termorregulación, genitourinarias e intestinales, las úlceras por presión, la disreflexia autonómica y los aspectos nutricionales, generando recomendaciones prácticas. Como conclusión, la práctica habitual de EF reduce la incidencia de enfermedades respiratorias y cardiovasculares, mejorando la condición física, la autonomía personal y la salud de las personas con LM, así como su calidad y esperanza de vida, pero es imprescindible conocer sus características particulares tanto para optimizar su rendimiento deportivo como para evitar graves complicaciones médicas

Influence of rear wheel tire type on wheelchair propulsion biomechanics

The objective of this study was to determine how rear wheel tire type affects wheelchair propulsion mechanics. Four persons with paraplegia and four persons with tetraplegia propelled their own wheelchairs on a roller system at self-selected speed using five different pairs of tires. Upper limb and trunk kinematics, perceived exertion, stroke pattern and the temporal characteristics of propulsion were measured. When using pneumatic (air filled) tires, with lower rolling resistance, participants had lower push frequency (p \u3c .05), higher self selected speed (p \u3c .05), less perceived exertion, less shoulder internal rotation, and a longer push stroke than when using solid, high rolling resistance tires. As rolling resistance increased, participants experienced negative changes in propulsion characteristic that contradicted current clinical practice guidelines for upper limb preservation following spinal cord injury. In addition, kinematics with solid, high rolling resistance tires were similar to those described during uphill or over carpet propulsion. In order to avoid unnecessary strain on the upper limbs and unwanted changes in propulsion biomechanics, wheelchair users, clinicians, and researchers should consider the use of lower rolling resistance, pneumatic rear tires

INVESTIGATION OF TERRAIN EFFECTS ON WHEELCHAIR PROPULSION AND VALIDITY OF A WHEELCHAIR PROPULSION MONITOR

This thesis is composed of two studies related to wheelchair propulsion biomechanics. The first study investigated the impact of cross-slope and surface roughness on wheelchair propulsion. Fifteen manual wheelchair users propelled across a five-meter platform which were set to level, 1°, or 2° cross slope, and attached with one of three surfaces including Teflon (slippery), wood (normal), and blind guide (rough). The study found main effects of both cross slope and surface roughness on stroke number and sum of work, and a main effect of cross slope on velocity. Subjects travelled slower, used more strokes, and expended more work with increasing cross slope. Subjects also used more strokes when propelling on the slippery and rough surfaces than on the level surface. They expended more work when propelling on the rough surface than on the level surface. When looking into bilateral propulsion parameters, we found that peak resultant force, peak wheel torque, and sum of work became significantly asymmetrical with the increase of cross slopes. Exposure to biomechanics loading can be reduced by avoiding slippery, rough, and cross slopes when possible. The second study consisted of a preliminary analysis on the validity of a wheelchair propulsion monitor (WPM) in estimating wheelchair propulsion biomechanics. The WPM integrates three devices including a wheel rotation datalogger, and an accelerometry-based device on the upper arm and underneath the wheelchair seat, respectively. Five wheelchair users were asked to push their own wheelchairs fitted with a SMARTWheel over level and sloped surfaces on two separate visits. The estimated stroke number and cadence by the WPM were consistent with the criterion measures by the SMARTWheel (ICC= 0.99 for stroke number, ICC=0.97 for cadence) with less than 5% absolute percentage errors for stroke number and 9% for cadence. The peak resultant force and wheel torque could be predicted to some extent by acceleration features on an individual subject basis. The study demonstrated the potential of the WPM in tracking wheelchair propulsion characteristics in the natural environment of wheelchair users