수동 휠체어 추진 속도에 따른 상지 관절 생체역학적 영향 분석
Upper Extremity Biomechanics of Manual Wheelchair Propulsion at Different Speeds
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It is known that chronic pain and injury of upper limb joint tissue in manual wheelchair users is usually caused by muscle imbalance, and the propulsion speed is reported to increase this muscle imbalance. In this study, kinematic variables, electromyography, and ultrasonographic images of the upper limb were measured and analyzed at two different propulsion speeds to provide a quantitative basis for the risk of upper extremity joint injury. Eleven patients with spinal cord injury for the experimental group (GE) and 27 healthy adults for the control group (GC) par- ticipated in this study. Joint angles and electromyography were measured while subjects performed self-selected com- fortable and fast-speed wheelchair propulsion. Ultrasound images were recorded before and after each propulsion task to measure the acromiohumeral distance (AHD). The range of motion of the shoulder (14.35 deg in GE; 20.24 deg in GC) and elbow (5.25 deg in GE; 2.57 deg in GC) joints were significantly decreased (p<0.001). Muscle activation levels of the anterior deltoid, posterior deltoid, biceps brachii, and triceps brachii increased at fast propulsion. Spe- cifically, triceps brachii showed a significant increase in muscle activation at fast propulsion. AHD decreased at fast propulsion. Moreover, the AHD of GE was already narrowed by about 60% compared to the GC from the pre-tests. Increased load on wheelchair propulsion, such as fast propulsion, is considered to cause upper limb joint impingement and soft tissue injury due to overuse of the extensor muscles in a narrow joint space. It is expected that the results of this study can be a quantitative and objective basis for training and rehabilitation for manual wheelchair users to prevent joint pain and damage.
Abstract
It is known that chronic pain and injury of upper limb joint tissue in manual wheelchair users is usually caused by muscle imbalance, and the propulsion speed is reported to increase this muscle imbalance. In this study, kinematic variables, electromyography, and ultrasonographic images of the upper limb were measured and analyzed at two different propulsion speeds to provide a quantitative basis for the risk of upper extremity joint injury. Eleven patients with spinal cord injury for the experimental group (GE) and 27 healthy adults for the control group (GC) par- ticipated in this study. Joint angles and electromyography were measured while subjects performed self-selected com- fortable and fast-speed wheelchair propulsion. Ultrasound images were recorded before and after each propulsion task to measure the acromiohumeral distance (AHD). The range of motion of the shoulder (14.35 deg in GE; 20.24 deg in GC) and elbow (5.25 deg in GE; 2.57 deg in GC) joints were significantly decreased (p<0.001). Muscle activation levels of the anterior deltoid, posterior deltoid, biceps brachii, and triceps brachii increased at fast propulsion. Spe- cifically, triceps brachii showed a significant increase in muscle activation at fast propulsion. AHD decreased at fast propulsion. Moreover, the AHD of GE was already narrowed by about 60% compared to the GC from the pre-tests. Increased load on wheelchair propulsion, such as fast propulsion, is considered to cause upper limb joint impingement and soft tissue injury due to overuse of the extensor muscles in a narrow joint space. It is expected that the results of this study can be a quantitative and objective basis for training and rehabilitation for manual wheelchair users to prevent joint pain and damage.
참고문헌 (44)
- Dubowsky SR, "Comparison of kinematics, kinetics, and EMG throughout wheelchair pro-pulsion in able-bodied and persons with paraplegia: An integrative approach", J BioMech Eng, 131(2), pp.021015~ (2009)
- Rice IM, "Handrim wheelchair propulsion training effect on overground pro-pulsion using biomechanical real-time visual feedback", Arch Phys Med Rehabil, 94(2), pp.256~263 (2013)
- Mulroy SJ, "Electromyo-graphic activity of shoulder muscles during wheelchair pro-pulsion by paraplegic persons", Arch Phys Med Rehabil, 77(2), pp.187~193 (1996)
- Collinger JL, "Shoulder biomechanics during the push phase of wheelchair propulsion: a multisite study of persons with paraplegia", Arch Phys Med Rehabil, 89(4), pp.667~676 (2008)
- Gil-Agudo A, "Shoulder kinetics and ultrasonography changes after performing a high-intensity task in spinal cord injury subjects and healthy controls", Spinal Cord, 54(4), pp.277~282 (2016)
- Qi L, "Patterns of shoulder muscle coordination vary between wheelchair propul-sion techniques", IEEE Trans Neural Syst Rehabil Eng, 22(3), pp.559~566 (2014)
- Ballinger DA, "The relation of shoul-der pain and range-of-motion problems to functional lim-itations, disability, and perceived health of men with spinal cord injury: a multifaceted longitudinal study", Arch Phys Med Rehabil, 81(12), pp.1575~1581 (2000)
- Cohen RB, "Impingement syndrome and rotator cuffdisease as repetitive motion disorders", Clin Orthop Relat Res, (351), pp.95~101 (1998)
- Dalyan M, "Upper extremity pain after spinal cord injury", Spinal Cord, 37(3), pp.191~195 (1999)
- Boninger ML, "Propulsion patterns and pushrim biomechan-ics in manual wheelchair propulsion", Arch Phys Med Reha-bil, 83(5), pp.718~723 (2002)
- Kwarciak AM, "The effects of four different stroke patterns on manual wheelchair pro-pulsion and upper limb muscle strain", Disabil Rehabil Assist Technol, 7(6), pp.459~463 (2012)
- Qi L, "Patterns of shoulder muscle coordination vary between wheelchair pro-pulsion techniques", IEEE Trans Neural Syst Rehabil Eng, 22(3), pp.559~566 (2014)
- Slowik JS, "The influ-ence of speed and grade on wheelchair propulsion hand pat-tern", Clin Biomech, 30(9), pp.927~932 (2015)
- Richter WM, "Stroke pattern and handrim biomechanics for level and uphill wheelchair propulsion at self-selected speeds", Arch Phys Med Rehabil, 88(1), pp.81~87 (2007)
- Boninger ML, "Wrist biomechanics during two speeds of wheelchair propulsion:an analysis using a local coordinate system", Arch Phys Med Rehabil, 78(4), pp.364~372 (1997)
- Koontz AM, "Shoulder kinematics and kinetics during two speeds of wheelchair propulsion", J Rehabil Res Dev, 39(6), pp.635~649 (2002)
- Gil-Agudo A, "Upper limb joint kinetics during manual wheelchair propulsion in patients with different levels of spinal cord injury", J Biomech, 43(13), pp.2508~2515 (2010)
- Bayley JC, "The weight-bearing shoulder. The impingement syndrome in paraplegics", J Bone Joint Surg Am, 69(5), pp.676~678 (1987)
- Kulig K, "Shoulder joint kinetics during the push phase of wheelchair propulsion", Clin Orthop Relat Res, (354), pp.132~143 (1998)
- Heyward OW, "Shoulder complaints in wheelchair athletes: A systematic review", PLoS One, 12(11), pp.0188410~ (2017)
- Mason B, "Managing shoulder pain in manual wheelchair users: a scoping review of conservative treatment interventions", Clin Rehabil, 34(6), pp.741~753 (2020)
- Liampas A, "Musculoskeletal Pain Due to Wheelchair Use: A Systematic Review and Meta-Anal-ysis", Pain Ther, 10(2), pp.973~984 (2021)
- Burnham RS, "Shoulder pain in wheelchair athletes. The role of muscle imbalance", Am J Sports Med, 21(2), pp.238~242 (1993)
- Mozingo JD, "Shoulder mechanical impingement risk associ-ated with manual wheelchair tasks in individuals with spi-nal cord injury", Clin Biomech, 71, pp.221~229 (2020)
- Surg Radiol Anat, "Subacromial space width changes during abduction and rotation--a 3-D MR imaging study", Surg Radiol Anat, 21(1), pp.59~64 (1999)
- Royer PJ, "Fluoroscopic assessment of rota-tor cufffatigue on glenohumeral arthrokinematics in shoul-der impingement syndrome", J Shoulder Elbow Surg, 18(6), pp.968~975 (2009)
- Chopp JN, "Superior humeral head migration occurs after a protocol designed to fatigue the rotator cuff: a radiographic analysis", J Shoulder Elbow Surg, 19(8), pp.1137~1144 (2010)
- van Drongelen S, "Ultrasound imaging of acute biceps tendon changes after wheelchair sports", Arch Phys Med Rehabil, 88(3), pp.381~385 (2007)
- Cheng SC, "Comparison of dynamic ultrasound and stress radiology for assessment of inferior glenohumeral laxity in asymptomatic shoulders", Skeletal Radiol, 37(2), pp.161~168 (2008)
- Fournier Belley A, "Ultra-sonographic Measures of the Acromiohumeral Distance and Supraspinatus Tendon Thickness in Manual Wheel-chair Users With Spinal Cord Injury", Arch Phys Med Reha-bil, 98(3), pp.517~524 (2017)
- Seitz AL, "Ultrasonographic measures of sub-acromial space in patients with rotator cuffdisease: A sys-tematic review", J Clin Ultrasound, 39(3), pp.146~154 (2011)
- Mulroy SJ, "Effects of spi-nal cord injury level on the activity of shoulder muscles during wheelchair propulsion: an electromyographic study", Arch Phys Med Rehabil, 85(6), pp.925~934 (2004)
- Qi L, "The Effect of Manual Wheel-chair Propulsion Speed on Users' Shoulder Muscle Coordi-nation Patterns in Time-Frequency and Principal Component Analysis", IEEE Trans Neural Syst Rehabil Eng, 27(1), pp.60~65 (2019)
- Rodgers MM, "Biomechanics of wheelchair propulsion during fatigue", Arch Phys Med Rehabil, 75(1), pp.85~93 (1994)
- Mulroy SJ, "Electromyo-graphic activity of shoulder muscles during wheelchair pro-pulsion by paraplegic persons", Arch Phys Med Rehabil, 77(2), pp.187~193 (1996)
- Ballinger DA, "The relation of shoul-der pain and range-of-motion problems to functional lim-itations, disability, and perceived health of men with spinal cord injury: a multifaceted longitudinal study", Arch Phys Med Rehabil, 81(12), pp.1575~1581 (2000)
- Gil-Agudo Á, "Echographic and kinetic changes in the shoulder joint after manual wheelchair propulsion under two different work-load settings", Front Bioeng Biotechnol, 2, pp.77~ (2014)
- Sanderson DJ, "Kinematic features of wheelchair propulsion", J Biomech, 18(6), pp.423~429 (1985)
- Kwarciak AM, "Redefining the manual wheelchair stroke cycle: identification and impact of nonpropulsive pushrim contact", Arch Phys Med Rehabil, 90(1), pp.20~26 (2009)
- Seitz AL, "The scapular assistance test results in changes in scapular position and subacromial space but not rotator cuffstrength in subacro-mial impingement", J Orthop Sports Phys Ther, 42(5), pp.400~412 (2012)
- Desmeules F, "Acromio-humeral distance variation measured by ultraso-nography and its association with the outcome of rehabili-tation for shoulder impingement syndrome", Clin J Sport Med, 14(4), pp.197~205 (2004)
- Kirsch RF, "Measure-ment of isometric elbow and shoulder moments: position-dependent strength of posterior deltoid-to-triceps muscltendon transfer in tetraplegia", IEEE Trans Rehabil Eng, 4(4), pp.403~409 (1996)
- Lin Y, "Effect of muscle fatiguing tasks on subacromial space in manual wheelchair users", Rehabilitation Engineering and Assistive Technology Society of North America 2012 Annual Con-ference (2012)
- Park H J, "Association Between Subacromial Impingement and Acromiohumeral Distance on MRI", Iran J Radiol, 15(2), pp.13811~ (2018)