Upper limb joint kinetics of three sitting pivot wheelchair transfer techniques in individuals with spinal cord injury

The Journal of Spinal Cord Medicine, 2015 · DOI: 10.1179/2045772314Y.0000000258 · Published: July 1, 2015

Spinal Cord Injury Rehabilitation Biomechanics

Simple Explanation

This study examines how different techniques for wheelchair transfers affect the stress on joints in the arms of people with spinal cord injuries. Transfers are a key part of independent living for wheelchair users, but they can lead to upper extremity pain. The research compared three transfer methods, focusing on hand placement and how much the person leans forward. The goal was to find techniques that reduce joint forces and prevent pain. The study found that hand position plays a big role in how much stress is placed on the shoulder, elbow, and wrist. Keeping the hand closer to the body during transfers seems to balance the forces across the arms.

Study Duration

Not specified

Participants

20 individuals with spinal cord injury

Evidence Level

Level 2, Repeated measures design

Key Findings

1
Hand placement is a key factor influencing upper extremity joint kinetics during wheelchair transfers.
2
Using a 'near' leading hand placement (HH-I) balances the distribution of resultant forces across the upper limb joints.
3
Trailing with the same arm when using HH-A or TU techniques could predispose that arm to overuse-related pain and injuries.

Research Summary

The study compared three wheelchair transfer techniques (HH-A, HH-I, and TU) to assess their impact on upper extremity joint kinetics in individuals with spinal cord injury. The HH-I technique, which involves a head-hips method with the leading hand close to the body, showed a more balanced distribution of forces across the upper limb joints compared to HH-A and TU. Hand placement during transfers had a greater effect on upper extremity kinetics than trunk flexion, suggesting that technique training should prioritize hand placement to minimize joint loading.

Practical Implications

Technique Training

Technique training for individuals with SCI should focus on initial hand placement, followed by the amount of trunk flexion needed to facilitate the movement.

Hand Placement Considerations

When presented with various options to place the hands, hands should be positioned as low as possible in the same plane as the buttocks to maximize the recruitment of the larger thoracohumeral musculature.

Personalized Technique Selection

Knowledge of the technique tradeoffs can help a person with choosing which technique may be better in light of existing pathologies and which arm should play the role of leading or trailing.

Study Limitations

1
All transfers began with the left arm leading, which may not represent real-world scenarios where individuals adapt to various environmental situations.
2
The study did not account for differences in anthropometry between subjects (e.g. limb lengths), which may have affected the amount of loading at the “near” versus “far” targets.
3
There may be large differences between their usual techniques and the taught techniques.

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