Shoulder kinetics and ultrasonography changes after performing a high-intensity task in spinal cord injury subjects and healthy controls.

This corrects the article DOI: 10.1038/sc.2015.140.

Shoulder kinetics and ultrasonography changes after performing a high-intensity task in spinal cord injury subjects and healthy controls.

STUDY DESIGN: This is a prospective and comparative study between two groups. OBJECTIVES: The objective of this study was to compare the changes in shoulder joint forces and their moments, as well as any possible ultrasound changes, when subjects with spinal cord injury (SCI) and healthy controls (CG) undertake a high-intensity manual wheelchair propulsion test. SETTING: This study was conducted in an inpatient SCI rehabilitation center. METHODS: A group of 22 subjects with SCI at level T2 or below who use a manual wheelchair (MWU), categorized as AIS grade A or B, were compared with a CG of 12 healthy subjects. Subjects in each group performed a high-intensity wheelchair propulsion test. The variables analyzed were shoulder joint forces and the moments at the beginning and at the end of the test. Ultrasound variables before and after the propulsion test were also analyzed. Correlations were also drawn between the ultrasonography and demographic variables. RESULTS: In both groups, peak shoulder forces and moments increased after the test in almost all directions. No differences in the ultrasound parameters were found. A greater long-axis biceps tendon thickness (LBTT) was associated with more shoulder pain according to WUSPI or VAS (r=0.428, P<0.05 and r=0.452, P<0.05, respectively). CONCLUSIONS: Shoulder joint forces and moments increase after an intense propulsion task. In subjects with SCI, these increases center on forces with less chance of producing subacromial damage. No changes are produced in ultrasonography variables, whereas a poorer clinical and functional evaluation of the shoulder of the MWUs appears to be related to a thicker long-axis biceps tendon.

Determinación del consumo energético de la marcha en personas con alteraciones neurológicas. Revisión de los protocolos empleados / Measurement of energy cost in gait for people with neurological disorders. A review of the protocols used

Objetivo. Actualizar los conocimientos sobre las técnicas de análisis de consumo energético de la marcha en población con patología neurológica. Estrategia de búsqueda. Hasta diciembre de 2009 en las siguientes bases de datos: Medline, Physiotherapy Evidence Database, Ovid, la Biblioteca Cochrane y Sport Discus. Selección de artículos. Aquellos artículos en los que se realizaba una determinación del consumo energético de la marcha en pacientes con patología de origen neurológico y, sobre todo, en los que se describía la metodología. Se localizaron un total de 11 artículos, estructurados en 6 de parálisis cerebral, 1 de lesión cerebral traumática, 2 de ictus y 2 de lesión medular. Síntesis de resultados y conclusiones. Existe una gran disparidad en cuanto a protocolos utilizados para evaluar el consumo energético de la marcha de personas con alteraciones neurológicas. Este tipo de análisis ofrece prometedores resultados sobre la situación funcional de un paciente de forma complementaria al análisis biomecánico(AU)

Objective. To update knowledge about energy cost methods in gait for people with neurological disorders. Search strategy. We reviewed the following databases: Medline, Physiotherapy Evidence Database, Ovid, the Cochrane Library and Sport Discus up to December 2009. Study selection. Those articles in which energy cost was recorded during gait analysis in people with neurological disorders, especially those related to methodological aspects, were selected. A total of 11 articles were located. Six were related to children with cerebral palsy, 1 to traumatic brain injury, 2 to stroke and 2 to spinal cord injury. Results and conclusions. Much difference exists in regards to the protocols used to evaluate energy cost of gait in persons with neurological disorders. This type of analysis can be a useful tool to study functional performance in patients with neurological disorders complementary to the biomechanical analysis(AU)

Evaluación de la distribución de las presiones de apoyo en la interfaz usuario-cojín para determinar la presión de inflado de los cojines de aire / Evaluation of pressure support in user-cushion interface to determine inflated cushion air

Objetivo: Comprobar si la presión de inflado de los cojines antiescaras de aire en personas con lesión medular es la óptima y determinar su influencia sobre el comportamiento mecánico de los cojines. Material y métodos: Se efectuó el análisis de la distribución de presiones en la interfaz usuario-cojín con una malla de sensores capacitivos en 32 pacientes con lesión medular que disponían de cojines de aire. Se realizó un registro en las condiciones habituales de presión de inflado y otro tras realizar una corrección de ésta una vez identificada la situación óptima de distribución de presiones. Los parámetros analizados fueron los valores de presión máxima, la presión isquiática, la presión media y su desviación estándar y, en cuanto a superficies, la superficie total (Stot), la superficie que soporta una presión mayor de 60mmHg (Stot>60) y su valor porcentual (%Stot>60). Resultados: Los valores de las variables relacionadas con la presión fueron más bajos en los registros efectuados tras la corrección de la presión de inflado y, en las relacionadas con la superficie, la Stot fue más alta en el segundo registro, mientras que tanto Stot>60 y %Stot>60 fueron más bajos. En todos los casos se encontraron diferencias significativas (p<0,05). Conclusión: La diferente presión de inflado de un cojín de aire influye en la distribución de presiones en la interfaz usuario-cojín. La distribución de presiones óptima para un cojín determinado se consigue a un nivel de presión de inflado que ha de ser establecido con unos sistemas de medición objetivos (AU)

Objective: Verify if the inflation pressure of anti-bedsore air cushions in persons with bone marrow injury is optimum and determine its influence on the mechanical behavior of the cushions. Material and methods: The distribution of the user-cushion inferface was analyzed with a capacitive mesh sensor in 32 subjects with bone marrow injury who used air cushions. A recording was made of the usual conditions of inflated pressure and another one after making a correction of it once identified the optimum pressure distribution situation. Parameters analyzed were maximum pressure value (Pmax), ischiatic pressure (IschP), mean pressure (meanP) and standard deviation (SD) and, in regards to surfaces, total surface (totS), surface that supports a pressure of 60 mmHg (totS>60) and percentile value (%totS>60). Results: The values of the variables related with the pressure were lower in the recordings made after correcting for inflated pressure. In those related with surface, the TotS was higher in the second recording while the totS >60 and %totS>60 were lower. There were significant differences in all of the cases (p<0.05). Conclusion: The different inflation pressure of an air cushion influences the pressure distribution of the user-cushion interface. The distribution of the optimum pressures for a certain cushion is achieved at an inflated pressure level that must be established with some objective measurement systems (AU)

Shoulder joint kinetics during wheelchair propulsion on a treadmill at two different speeds in spinal cord injury patients.

STUDY DESIGN: Prospective study using biomechanics patient data. OBJECTIVES: To analyze shoulder joint kinetics while propelling a wheelchair placed on a treadmill and compare shoulder joint net forces and moments when changing the speed of wheelchair propulsion on the treadmill. SETTING: National Hospital for Spinal Cord Injury, Toledo, Spain. METHODS: Sixteen subjects with thoracic spinal cord injury participated. A kinematic analysis system consisting of four camcorders (Kinescan-IBV) and a kinetic device that registered the contact force of the hand on the pushrim (SMART(Wheel)) were used. The wheelchair was propelled at 3 and 4 km h(-1) without any ramp. An inverse dynamic model allowed shoulder joint net forces and moments to be calculated from the contact force of the hand on the pushrim and kinematic data. RESULTS: Increasing propulsion speed increased most of the temporal parameters of propulsion and pushrim kinetics and shoulder joint net forces and moments. Compared with other studies that used an ergometer or dynamometer at the same speed, the magnitude of the shoulder joint net forces and moments elicited by wheelchair propulsion on the treadmill were lower than obtained by wheelchair propulsion on other devices. CONCLUSION: Lower magnitude of shoulder joint forces and moments found on the treadmill may be due to the lower friction compared with the other devices reviewed. Shoulder joint forces and moments depended strongly on the propulsion speed, increasing in magnitude when speed increased from 3 to 4 km h(-1).

Comparative biomechanical gait analysis of patients with central cord syndrome walking with one crutch and two crutches.

BACKGROUND: Ambulatory people with central cord syndrome often require assistive devices. The selection of a suitable assistive device should be based on an objective assessment. Our objective in this study was to determine whether there was any difference in using two crutches over one crutch, considering that these patients have bilateral upper-limb involvement. METHODS: Kinematic gait analysis was conducted in 12 patients with central cord syndrome of more than one year of evolution and functional capacity for walking with one crutch or without crutches. Patients were asked to walk with one crutch and with two crutches at a freely chosen walking speed through a 10-m walkway. Three-dimensional kinematic equipment based on active markers was used to analyze temporospatial and articular parameters (maximum, minimum, and range of motion, ROM, throughout the cycle) FINDINGS: During two-crutch versus one-crutch walking, speed was lower (P=0041), stride time and step time were longer (P=0.004 and P=0.005) and there were fewer strides/minute and steps/minute (P=0.005 and P=0.006). The duration of the single support stance was longer during two-crutch walking (P=0.008). With respect to the articular parameters, both ankle ROMs (dorsi-plantar flexion P=0.003 and pronation-supination P=0.004) were greater with one-crutch walking than with two-crutch walking. INTERPRETATION: In patients with central cord syndrome capable of walking with one crutch or without crutches, walking with two crutches decreases speed, increases stride time and step time and improves stability by increasing single support, and diminishes ankle plantar flexion during swing phase.

Evaluación de la marcha con bastones en pacientes con lesión medular incompleta / Assessment of walking on crutches in patients with incomplete spinal cord injury

Objetivo. Determinar las aportaciones que suponen el empleo de técnicas de análisis biomecánico a la hora de recomendar la marcha con uno o dos bastones en personas con lesión medular incompleta. Material y métodos. Se efectuó el análisis cinemático de la marcha en 12 pacientes con lesión medular incompleta de más de un año de evolución y capacidad funcional para caminar con un bastón. Los pacientes caminaron a velocidad libre en un pasillo de 10 m con uno y con dos bastones. Se utilizó un equipo que permite realizar un análisis cinemático en 3 D basado en marcadores activos. Los parámetros analizados fueron los temporo-espaciales y los articulares (máximos, mínimos y rango articular a lo largo del ciclo). Resultados. Caminando con dos bastones la duración del ciclo es mayor (p = 0,010) y la frecuencia de ciclos/minuto es menor (p = 0,014). Respecto a los parámetros articulares, en la marcha con dos bastones el pico de valor máximo (p = 0,036) y el mínimo de basculación anterior pélvica (p = 0,038), así como el recorrido articular de rotación pélvica (p = 0,006) son mayores, y el valor mínimo de flexión de cadera es menor (p = 0,022). Conclusión. A pesar de la mayor seguridad ofrecida para los lesionados medulares que pueden caminar con un bastón, el hacerlo con dos puede constituir una marcha más costosa. Las técnicas de análisis biomecánico constituyen un elemento de soporte a la hora de recomendar una ayuda técnica para la marcha (AU)

Objective. To determine the differences in gait kinematic parameters of people with incomplete spinal cord injury while walking with one or two crutches. Material and methods. Twelve patients with incomplete spinal cord injury whose injury occurred at least one year ago with functional capacity for walking with one crutch were kinetically analyzed. The patients walked at free rate in a 10 m hallway with one or two crutches. A system was used that allowed for kinematic analysis in 3 D based on active markers. The parameters analyzed were time-space and joint values (maximum, minimum and range of movement during the cycle). Results. When walking with two crutches, the stride time is greater (p = 0.021) and the stride/minute is less (p = 0.014). Regarding joint parameters of walking with two crutches, the maximum value peak (p = 0.036) and the minimum of anterior pelvic tilt (p = 0.038) and the joint range of the pelvic rotation (p = 0.006) are greater and the minimum value of hip flexion is less (p = 0.022). Conclusion. In spite of the greater safety offered for the patients suffering spinal cord injuries, for those who can walk with one crutch, the use of 2 crutches can make walking more difficult. Biomechanical analysis techniques are a supportive element when recommending technical help for walking (AU)