Shoulder Kinematics and Acute Ultrasonographic Changes in Manual Wheelchair Users With Spinal Cord Injury

Study Overview
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Brief Summary
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People who lose function of the lower limb due to spinal cord injury (SCI) need to use their arms for activities of daily life especially during weight-bearing tasks, such as transfers, and manual wheelchair (MWC) propulsion in order to maintain mobility. Persistent use of the upper limbs constitutes biomechanical difficulties, especially in the shoulder joint. The most commonly affected area in the shoulder is supraspinatus and biceps tendon. Four different stoke patterns have been classified in MWC users. Distinct amounts of force may be applied to the shoulder joint during propulsion with different stroke patterns and this can affect the shoulder tendons in different rates. In this study, investigators aimed to evaluate and compare the acute sonographic changes in supraspinatus and biceps tendons after a wheelchair propelling test in MWC users with SCI with different stroke patterns. Also, it is intended to determine the risk factors related to the stroke patterns that may be associated with these sonographic changes.

Detailed Description
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Fourty male MWC users with SCI were will be divided into 4 groups according to their stroke patterns (arcing, semicirculer, single loop, and double loop). Participants will use their own wheelchairs with their preferred stroke pattern for 20 minutes at a speed of 1 m / s on a motorized treadmill for a wheelchair propelling test. Wheelchair propelling videos will be recorded during the test. Shoulder kinematics will be analyzed using Kinovea motion analysis software and stoke pattern will be confirmed. Ultrasonographic assesment of participants' nondominant shoulder will be performed before and after testing procedure.

Official Title
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Shoulder Kinematics and Acute Ultrasonographic Changes in Four Different Stroke Patterns in Manual Wheelchair Users With Spinal Cord Injury

Conditions
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Traumatic Spinal Cord Injury

Intervention / Treatment
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* Diagnostic Test: Musculoskeletal ultrasonography
* Other: Wheelchair propelling test


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: People with traumatic spinal cord injury Age between 18 to 65 years, Neurologic injury level at T2 or below, with AIS grade A or B, Time since injury at least 6 months, Using manual wheelchair as their primary mobility tools Exclusion Criteria: Fractures in nondominant upper limb at any time, Shoulder surgery within the past 5 years or corticosteroid injections within the past 3 months to the nondominant shoulder, Upper limb pain that restricts propulsion of a manual wheelchair, A history of cardiopulmonary problems and degenerative joint diseases

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Male

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Arcing<br>10 patients with traumatic spinal cord injury using the arcing stroke pattern to propel manual wheelchair | Diagnostic Test: Musculoskeletal ultrasonography<br>* The ultrasonographic assesment will be used to examine the supraspinatus tendon thickness, the long head of the biceps brachii tendon thickness and acromio-humeral distance before and after wheelchair propelling test.<br>Other: Wheelchair propelling test<br>* Participants will use their own wheelchairs with their preferred stroke pattern for 20 minutes at a speed of 1 m / s on a motorized treadmill for a wheelchair propelling test. Wheelchair propelling videos will be recorded during the test. Shoulder kinematics will be analyzed using Kinovea motion analysis software and stoke pattern will be confirmed<br>|
| Semicirculer<br>10 patients with traumatic spinal cord injury using the semicirculer stroke pattern to propel manual wheelchair | Diagnostic Test: Musculoskeletal ultrasonography<br>* The ultrasonographic assesment will be used to examine the supraspinatus tendon thickness, the long head of the biceps brachii tendon thickness and acromio-humeral distance before and after wheelchair propelling test.<br>Other: Wheelchair propelling test<br>* Participants will use their own wheelchairs with their preferred stroke pattern for 20 minutes at a speed of 1 m / s on a motorized treadmill for a wheelchair propelling test. Wheelchair propelling videos will be recorded during the test. Shoulder kinematics will be analyzed using Kinovea motion analysis software and stoke pattern will be confirmed<br>|
| Single loop<br>10 patients with traumatic spinal cord injury using the single loop stroke pattern to propel manual wheelchair | Diagnostic Test: Musculoskeletal ultrasonography<br>* The ultrasonographic assesment will be used to examine the supraspinatus tendon thickness, the long head of the biceps brachii tendon thickness and acromio-humeral distance before and after wheelchair propelling test.<br>Other: Wheelchair propelling test<br>* Participants will use their own wheelchairs with their preferred stroke pattern for 20 minutes at a speed of 1 m / s on a motorized treadmill for a wheelchair propelling test. Wheelchair propelling videos will be recorded during the test. Shoulder kinematics will be analyzed using Kinovea motion analysis software and stoke pattern will be confirmed<br>|
| Double loop<br>10 patients with traumatic spinal cord injury using the double loop stroke pattern to propel manual wheelchair | Diagnostic Test: Musculoskeletal ultrasonography<br>* The ultrasonographic assesment will be used to examine the supraspinatus tendon thickness, the long head of the biceps brachii tendon thickness and acromio-humeral distance before and after wheelchair propelling test.<br>Other: Wheelchair propelling test<br>* Participants will use their own wheelchairs with their preferred stroke pattern for 20 minutes at a speed of 1 m / s on a motorized treadmill for a wheelchair propelling test. Wheelchair propelling videos will be recorded during the test. Shoulder kinematics will be analyzed using Kinovea motion analysis software and stoke pattern will be confirmed<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Supraspinatus tendon thickness | Transverse images of the suprasinatus tendon will be performed by using musculoskeletal ultrasonography before and after the wheelchair propelling test | Through study completion, an average of 1 month | 
| Long head of the biceps tendon thickness | Longitudinal images of the long head of the biceps tendon will be performed by using musculoskeletal ultrasonography before and after the wheelchair propelling test | Through study completion, an average of 1 month | 
| Acromio-humeral distance | Acromio-humeral distance measurements will be performed by using musculoskeletal ultrasonography before and after the wheelchair propelling test | Through study completion, an average of 1 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Shoulder range of motion in the sagittal plane | Shoulder range of motion in the sagittal plane (flexion and extension, degree) will be analyzed using by Kinovea version 0.8.27 motion analysis software. | Through study completion, an average of 1 month | 
| Contact angle | Contact angle (angle at which the handrim is held, degree) will be analyzed using by Kinovea version 0.8.27 motion analysis software. | Through study completion, an average of 1 month | 
| Cadence | Cadence (number of strokes per minute, stroke number/minute) will be analyzed using by Kinovea version 0.8.27 motion analysis software. | Through study completion, an average of 1 month | 
| Push phase | Push phase (time elapsed since the handrim is held until it is released, second) will be analyzed using by Kinovea version 0.8.27 motion analysis software. | Through study completion, an average of 1 month | 
| Recovery phase | Recovery phase (time elapsed since the handrim is released until it is held again, second) will be analyzed using by Kinovea version 0.8.27 motion analysis software. | Through study completion, an average of 1 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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spinal cord injury, stroke pattern, ultrasonography