Shoulder pain in persons with thoracic spinal cord injury: prevalence and characteristics.

OBJECTIVE: To document the prevalence of shoulder pain, associated patient characteristics, and intensity and interference with shoulder function in activities in wheelchair users. DESIGN: A cross-sectional survey. PATIENTS: Individuals with a thoracic spinal cord injury. METHODS: A 3-part questionnaire on patient characteristics, medical history, supplemental questions, and the Wheelchair Users Shoulder Pain Index was administered to 101 patients. RESULTS: Of the 88 subjects (87%) who completed the questionnaire, 40% reported experiencing current shoulder pain, often chronic in nature. The highest median intensity of shoulder pain was reported for pushing the wheelchair up ramps or inclines outdoors. Reports of limitations regarding the ability to use the shoulder in activities were common. Most subjects used no upper extremity assistive devices during transfer or wheelchair propulsion. Of those with current shoulder pain, 37% had not sought medical attention. Age was associated with ongoing shoulder pain. CONCLUSION: Shoulder pain is a common problem in wheelchair users with a thoracic spinal cord injury, it seems more likely to occur with increased age, and is a potential cause of activity limitations. The findings indicate a need to develop programmes of prevention, patient education, diagnosis and treatment, possibly including more frequent use of upper extremity assistive devices.

Sitting balance and effects of kayak training in paraplegics.

OBJECTIVES: The objectives of this study were to evaluate biomechanical variables related to balance control in sitting, and the effects of kayak training, in individuals with spinal cord injury. SUBJECTS: Twelve individuals with spinal cord injury were investigated before and after an 8-week training period in open sea kayaking, and 12 able-bodied subjects, who did not train, served as controls. METHODS: Standard deviation and mean velocity of centre of pressure displacement, and median frequency of centre of pressure acceleration were measured in quiet sitting in a special chair mounted on a force plate. RESULTS: All variables differed between the group with spinal cord injury, before training, and the controls; standard deviation being higher and mean velocity and median frequency lower in individuals with spinal cord injury. A significant training effect was seen only as a lowering of median frequency. CONCLUSION: The results indicate that individuals with spinal cord injury may have acquired and consolidated an alternative strategy for balance control in quiet sitting allowing for only limited further adaptation even with such a vigorous training stimulus as kayaking.

Measuring seating pressure, area, and asymmetry in persons with spinal cord injury.

The goal of this study was to measure characteristics of seat loading in manual wheelchair users with complete spinal cord injury (SCI). Pressure distribution on the seating area of 25 adult males with SCI and eight non-injured adult males was measured in a relaxed and an upright posture on a standardized hard surface. Subjects with SCI were also tested in their wheelchairs. Maximum pressure, contact area, area of the highest pressure, and three asymmetry indices were compared. Subjects with SCI have higher pressure distributed over a smaller area, have a much smaller contact area, and distribute the loading more asymmetrically than non-injured subjects. Upright posture only corrects for some loading problems, while the wheelchair corrects for more loading parameters. Routine clinical seat loading evaluation may lead to improved chair and cushion selection for patients with SCI and may even alert clinicians to patients at high risk for complications due to high or unbalanced loads.