Effect of fatiguing wheelchair propulsion on risk factors for shoulder pain in persons with spinal cord injury
Creators: name: Bossuyt, Franziska
Publisher: name: Zenodo
Year: 2020

description: <strong>Background:</strong> Shoulder pain is commonly reported within the spinal cord injury (SCI) population and can have a detrimental impact on one’s functioning, participation, and quality of life. Although wheel-chair propulsion is a highly inefficient mode of mobility and places the shoulder at risk for injury, it is one of the most important and most frequently used mobility devices. The mobile shoulder, compro-mised in mobility, relies on muscles and tendons to stabilise the joint. However, these muscles are prone to fatigue; how fatiguing propul-sion modifies biomechanics and muscular activation and relates to pathology and injury risk is poorly understood. <strong>Overall objective:</strong> To examine the effect of fatiguing wheelchair pro-pulsion on risk factors for shoulder pain in persons with SCI. The specific aims are threefold:1. To describe the prevalence of musculoskeletal shoulder pain and associated factors in the Swiss SCI population - Study 1 2. To define how fatiguing wheelchair propulsion changes biome-chanical and neuromuscular risk factors for shoulder pain in per-sons with SCI - Study 2 and Study 33. To evaluate how acute changes in tendon appearance with fa-tiguing wheelchair propulsion are associated with risk factors for shoulder pain in persons with SCI - Study 4. <strong>Methods: </strong>The first study used data from the Swiss SCI cohort study (SwiSCI) Community Survey database and investigated a large popu-lation based sample including persons with SCI living in Switzerland (n = 1549). The following quasi-experimental studies had a pre-test, post-test design, and examined the effect of fatiguing wheelchair pro-pulsion in wheelchair users with SCI via the implementation of an intervention of 15 minutes wheelchair propulsion including right and left turns, starts and stops, and rest periods. The second study defined how fatigue altered start-up propulsion biomechanics (n = 26). The third and fourth study were addressed with a SwiSCI nested project (n = 50). The third study defined how fatigue altered propulsion bio-mechanics and neuromuscular activation during treadmill propulsion at fixed power output, and the fourth study evaluated acute changes in ultrasound markers of tendon appearance following fatigue. <strong>Results</strong>: Shoulder pain was prevalent in 36% of Swiss residents with SCI and was associated with sex, lesion level, completeness of the injury, and health conditions. Fatiguing propulsion caused compensa-tion mechanisms in propulsion biomechanics - shorter strokes - and increased muscular activation in the pectoralis major pars sternalis, deltoideus pars acromialis, and upper trapezius. These compensation mechanisms have been associated with increased shoulder loads and muscle imbalances. Persons susceptible to fatigue were more likely to have a complete lesion, less time since injury, older age at injury, higher body weight, greater anaerobic capacity, and used more strain-ing propulsion biomechanics (shorter strokes and higher maximum applied forces). Finally, findings from this thesis identified that acute changes in the supraspinatus and biceps tendon following fatiguing propulsion were associated with fatigability, sex, body weight and the acromio-humeral distance, which may play a role in the development of shoulder pain. <strong>Conclusion:</strong> This project provides insights into fatiguing propulsion as a potential risk factor for the development of shoulder pain and informs targeted injury interventions to improve mobility, participa-tion, and quality of life in persons with SCI. Further research is need-ed that investigates the long-term consequences of fatigue-induced changes and the effectiveness of training strategies to prevent the oc-currence of fatigue in wheelchair users with SCI.