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Supplement Number 1
Volume 42 Number 3, May/June 2005 Supplement 1
Pages 9 — 20


Abstract - Pushrim biomechanics and injury prevention in spinal cord injury: Recommendations based on CULP-SCI investigations

Michael L. Boninger, MD;1-2* Alicia M. Koontz, PhD, RET;1-2 Sue Ann Sisto, PhD;3-4 Trevor A. Dyson-Hudson, MD;3-4 Michael Chang, MD, PhD;5 Robert Price, MSME;5 Rory A. Cooper, PhD1-2

1Human Engineering Research Laboratories, Departments of Physical Medicine and Rehabilitation, University
of Pittsburgh, Bioengineering and Rehabilitation Science and Technology, Pittsburgh, PA; 2Department of Veterans Affairs, Center of Excellence in Wheelchairs and Related Rehabilitation Engineering, Pittsburgh, PA; 3Department
of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ; 4Kessler Medical Rehabilitation Research and Education Corporation, West Orange, NJ; 5Department of Rehabilitation Medicine, University of Washington, Seattle, WA
Abstract — Over 50 percent of manual wheelchair users with spinal cord injury (SCI) are likely to develop upper-limb pain and injury. The majority of studies related to pain have implicated wheelchair propulsion as a cause. This paper draws from a large multisite trial and a long-standing research program to make specific recommendations related to wheelchair propulsion that may decrease the risk of upper-limb injury. The studies include over 60 subjects over 1 yr after a traumatic SCI below the second thoracic level. Specific aspects of the propulsive stroke that may relate to injury include cadence, magnitude of force, and the pattern of the hand during the nonpropulsive part of the stroke. Lower peak forces, slower cadence, and a circular propulsive stroke in which the hand falls below the pushrim during recovery may help prevent injury. In addition, wheelchair users should use the lightest weight adjustable wheelchair possible. Future work should include interventional trials and larger studies that allow for more complex statistical models that can further detail the relationship between wheelchair propulsion, user characteristics, and upper-limb injuries.
Key words: arm, biomechanics, carpal tunnel syndrome, equipment, prevention, rehabilitation, repetitive strain injury, rotator cuff injury, spinal cord injury, technique, wheelchair.

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