Graf, Adam

Harris, Gerald

Krzak, Joseph

Paul, Alyssa

Slavens, Brooke

Vogel, Lawrence

English

Harris, Gerald F.

epublications@Marquette

Marquette Universitye-Publications@MarquetteBiomedical Engineering Faculty Research andPublications Biomedical Engineering, Department of1-1-2012Upper Extremity Kinematics in Children withSpinal Cord Injury during Wheelchair MobilityBrooke SlavensMarquette University, brooke.slavens@marquette.eduAlyssa PaulMarquette UniversityAdam GrafShriners Hospitals for ChildrenJoseph KrzakShriners Hospitals for ChildrenLawrence VogelShriners Hospitals for ChildrenSee next page for additional authorsPublished as part of the proceedings of the conference, Galt & Clinical Movement Analysis Society2012 Annual Conference, 2012, pp. 79-80, Permalink: gcmas.amrms.com/dnn/Portals/9/CONFERENCE_PROCEEDINGS_-_FINAL_FOR_WEBSITE.pdf.AuthorsBrooke Slavens, Alyssa Paul, Adam Graf, Joseph Krzak, Lawrence Vogel, and Gerald HarrisThis presentation is available at e-Publications@Marquette: https://epublications.marquette.edu/bioengin_fac/24  UPPER EXTREMITY KINEMATICS IN CHILDREN WITH SPINAL CORD INJURY DURING WHEELCHAIR MOBILITY  Brooke Slavens1-4, Alyssa Paul4-5, Adam Graf3, Joseph Krzak3, Lawrence Vogel3 & Gerald Harris 3-5  1Department of Occupational Science & Technology, University of Wisconsin-Milwaukee (UWM), Milwaukee, WI, 2Rehabilitation Research Design and Disability (R2D2) Center, UW-M, Milwaukee, WI, 3Shriners Hospitals for Children, Chicago, IL, 4Orthopaedic and Rehabilitation Engineering Center (OREC), Marquette University/Medical College of Wisconsin, Milwaukee, WI, 5Department of Biomedical Engineering, Marquette University, Milwaukee, WI  INTRODUCTION  Manual wheelchair propulsion is highly repetitive and imposes considerable weight-bearing demands on the upper extremities (UE) [1]. Excessive joint range of motion (ROM) and propulsion in awkward postures have been associated with upper limb pain and injuries [2], which are reported in 50% of manual wheelchair users (MWU) with Spinal Cord Injury (SCI) [3]. Some MWU only experience unilateral UE pain and, since asymmetric stroke biomechanics may be a contributing factor, UE symmetry during propulsion should not be assumed [4].  In the pediatric population the musculoskeletal system is not fully developed and improper propulsive techniques can predispose children to early-onset injury.  In this study, we propose a triaxial UE kinematic model to quantify and evaluate manual wheelchair mobility in children with SCI.   CLINICAL SIGNIFICANCE  A better understanding of the UE kinematics of propulsive stroke patterns will help define the biomechanical parameters associated with wheeled movement strategies and related upper limb pathologies. These data may also be beneficial to further promote injury prevention, patient education, diagnosis, and improved treatment approaches for pediatric wheelchair users.   METHODS  Our UE kinematic model is comprised of seven rigid body segments [5] and follows ISB recommendations [6].  The respective X, Y and Z –axes are directed anteriorly, superiorly, and laterally. Thirteen MWU with SCI, aged 9-25 years-old, participated in the study. Each subject propelled their wheelchair along a 15 meter walkway at a self-selected speed for multiple trials. Motion data was collected at 120 Hz using a 14 camera Vicon MX motion capture system.  RESULTS  Group mean joint angles over the wheelchair stroke cycle were characterized (Figure 1). The mean peak angles and ROMs of each joint were also computed over the stroke cycle and two sample t-tests were applied to assess asymmetry (Table 1).  DISCUSSION  Joint ROM was found to range from 13° at the wrist in the transverse plane to 72° at the shoulder in the sagittal plane. The large joint ROMs at the shoulder and elbow highlight the concern of increased demands during manual wheelchair propulsion for the pediatric user. Since inappropriate positioning and loading may lead to pain and pathology in children with SCI, it is essential to characterize UE joint dynamics during wheelchair use. Asymmetry was most significant for the shoulder in the 79  transverse plane. Detection of asymmetry may help improve training guidelines and propulsion techniques incorporating limb dominance effects. This model serves as a basis for developing a kinetic model of internal joint load demands. Future work includes completion of a validated kinetic model along with integrated functional outcomes measures with regard to injury.    0 20 40 60 80 100020406080Elbow Rotation0 20 40 60 80 100-40-200204060Shoulder Rotation0 20 40 60 80 100-60-40-20020Wrist RotationSagittal Plane Flex(+)/Ext(-) (Deg)0 20 40 60 80 100-101  LeftRight0 20 40 60 80 100-60-40-20Add(+)/Abd(-) (Deg)0 20 40 60 80 100-20020Coronal Plane Ulnar(+)/Radial(-) (Deg)0 20 40 60 80 1006080100120140160Wheelchair Cycle (%)Int(+) / Ext(-) (Deg)0 20 40 60 80 100-200204060Wheelchair Cycle (%)0 20 40 60 80 100-15-10-505Wheelchair Cycle (%)Transverse Plane Pron(+)/Sup(-) (Deg) Figure 1: Mean (bold) and +/- 1 SD of bilateral joint kinematics for 13 subjects during the stroke cycle.  Table 1: Mean (SD) peak angles and ROM for wrists, elbows and shoulders in all planes of motion. (*, ** indicate statistically significant difference, p<0.05)  JointMaximum Angle (deg)Minimum Angle (deg) ROM (deg)Maximum Angle (deg)Minimum Angle (deg) ROM (deg)Maximum Angle (deg)Minimum Angle (deg) ROM (deg)RWrist 16.9 (16.4) -36.0 (15.0) 52.9 (13.4) 14.9 (10.8) -14.1 (7.5) 29.0 (7.2) 2.2 (2.7) -10.6 (6.1) 12.9 (5.7)LWrist 16.5 (19.1) -35.5 (20.9) 52 (16.1) 11.2 (16.2) -17.5 (12.3) 28.6 (9.1) 2.2 (3.3) -10.7 (5.7) 12.8 (5.5)LElbow 68.5 (18.0) 15.2 (9.7) 53.3 (15.7) 143.9 (46.8) 73.5 (33.9) 70.4 (49.6)RElbow 71.4 (17.7) 19.0 (9.5) 52.4 (18.1) 144.6 (32.2) 84.1 (16.6) 60.5 (25.9)LShoulder 53.3 (12.9) -16.8 (22.4) 70.1 (18.6) -22.4 (5.9) -43.4 (11.0) 21.0 (8.3) 51.8 (31.0)* -8.0 (36.5) 59.8 (42.3)**RShoulder 51.3 (14.4) -21.4 (19.4) 72.7 (16.0) -25.7 (8.6) -46.8 (13.2) 21.1 (8.8) 36.5 (21.1)* -1.3 (23.5) 37.7 (13.8)**elbow coronal plane motion is constrainedSagittal Plane Coronal Plane Transverse Plane  REFERENCES  1. Kulig, K. et al. (2001) Clinical Biomechanics, 16: 744-51. 2. Corfman, T.A. et al. (2003) Journal of Spinal Cord Medicine, 26 (2):135-140. 3. Boninger, M. L. et al. (2005) Journal of Rehabilitation Research and Development, 42:9-19. 4. Hurd, W. (2008) Archives of Physical Medicine and Rehabilitation, 89:1996-2002. 5. Slavens, B. et al. (2011) Journal of Biomechanics, 44 (11):2162-2167. 6. Wu, G. et al. (2005) Journal of Biomechanics, 38:981-992.  ACKNOWLEDGMENTS  We would like to acknowledge the Department of Education NIDRR grant H133E100007.    DISCLOSURE STATEMENT  UWM, Shriners Hospital-Chicago and OREC have no conflicts of interest to disclose. 80

Upper Extremity Kinematics in Children with Spinal Cord Injury during Wheelchair Mobility

https://epublications.marquette.edu/cgi/viewcontent.cgi?article=1026&amp;context=bioengin_fac

Upper Extremity Kinematics in Children with Spinal Cord Injury during Wheelchair Mobility

Abstract

Similar works

Full text

Available Versions

epublications@Marquette