Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics\ud

Objective: To investigate the impact of upper extremity deficit in subjects with tetraplegia.\ud \ud Setting: The United Kingdom and The Netherlands.\ud \ud Study design: Survey among the members of the Dutch and UK Spinal Cord Injury (SCI) Associations.\ud \ud Main outcome parameter: Indication of expected improvement in quality of life (QOL) on a 5-point scale in relation to improvement in hand function and seven other SCI-related impairments.\ud \ud Results: In all, 565 subjects with tetraplegia returned the questionnaire (overall response of 42%). Results in the Dutch and the UK group were comparable. A total of 77% of the tetraplegics expected an important or very important improvement in QOL if their hand function improved. This is comparable to their expectations with regard to improvement in bladder and bowel function. All other items were scored lower.\ud \ud Conclusion: This is the first study in which the impact of upper extremity impairment has been assessed in a large sample of tetraplegic subjects and compared to other SCI-related impairments that have a major impact on the life of subjects with SCI. The present study indicates a high impact as well as a high priority for improvement in hand function in tetraplegics.\ud \u

Surface electromyography activity of trunk muscles during wheelchair propulsion

Background: Trunk instability due to paralysis can have adverse effects on posture and function in a wheelchair. The purpose of this study was to record trunk muscle recruitment patterns using surface electromyography from unimpaired individuals during wheelchair propulsion under various propulsion speed conditions to be able to design trunk muscle stimulation patterns for actual wheelchair users with spinal cord injury. Methods: Fourteen unimpaired subjects propelled a test wheelchair on a dynamometer system at two steady state speeds of 0.9 m/s and 1.8 m/s and acceleration from rest to their maximum speed. Lower back/abdominal surface electromyography and upper body movements were recorded for each trial. Based on the hand movement during propulsion, the propulsive cycle was further divided into five stages to describe the activation patterns. Findings: Both abdominal and back muscle groups revealed significantly higher activation at early push and pre-push stages when compared to the other three stages of the propulsion phase. With increasing propulsive speed, trunk muscles showed increased activation (P < 0.0001). Back muscle activity was significantly higher than abdominal muscle activity across the three speed conditions (P < 0.0005), with lower back muscles predominating. Interpretation: Abdominal and back muscle groups cocontracted at late recovery phase and early push phase to provide sufficient trunk stability to meet the demands of propulsion. This study provides an indication of the amount and duration of stimulation needed for a future application of electrical stimulation of the trunk musculature for persons with spinal cord injury. © 2006 Elsevier Ltd. All rights reserved

Biomechanical analysis of functional electrical stimulation on trunk musculature during wheelchair propulsion

Background. The objective of this study was to examine how surface electrical stimulation of trunk musculature influences the kinematic, kinetic, and metabolic characteristics, as well as shoulder muscle activity, during wheelchair propulsion. Methods. Eleven participants with spinal cord injury propelled their own wheelchairs on a dynamometer at a speed of 1.3 m/s for three 5-minute trials. During a propulsion trial, 1 of 3 stimulation levels (HIGH, LOW, and OFF) was randomly applied to the participantĝ€™s abdominal and back muscle groups with a surface functional electrical stimulation device. Propulsion kinetics, trunk kinematics, metabolic responses, and surface electromyographic (EMG) activity of 6 shoulder muscles were collected synchronously. Kinetic, kinematic, and EMG variables were recorded during 3 time intervals (30 seconds each) within a 5-minute trial. Metabolic variables were recorded through the entire 5-minute trial. Results. Participants with HIGH stimulation increased their gross mechanical efficiency (P =.05) during wheelchair propulsion. No differences were found in shoulder EMG activity, energy expenditure, and trunk motion between stimulation levels. Conclusion. Functional electrical stimulation on the trunk musculature has potential advantages in helping manual wheelchair users with spinal cord injury improve propulsion efficiency without placing additional demands on shoulder musculature