Reliability of Upper-Extremity Muscle Activity and Kinematics During Adaptive Rowing.

CONTEXT: The purpose of this study was to determine test-retest reliability of upper-extremity muscle activity and kinematics during submaximal adapted rowing. DESIGN: A repeated-measures design was used. METHODS: Data were collected on 10 individuals (7 male and 3 female) with mobility impairment. Surface electromyography of muscles of the dominant arm (upper, middle, and lower trapezius, anterior and posterior deltoid, latissimus dorsi, and infraspinatus) was acquired. Muscle activity was analyzed using the area under the curve, peak amplitude, and mean amplitude. Kinematic analysis determined joint motions for shoulder plane and angle of elevation, and trunk flexion/extension, and rotation at the catch (0%) and finish (100%) of the stroke. Three submaximal rowing trials (20 strokes each) were completed with the middle 10 strokes of each trial averaged for analysis. RESULTS: An interclass correlation coefficient (3, 10) determined test-retest reliability across trials (interclass correlation coefficient defined as poor < .5; moderate .5-.75; and good .75-.9). Moderate to excellent reliability existed across all muscles for the area under the curve, peak amplitude, and mean amplitude. Excellent reliability was seen for all kinematic measures. CONCLUSION: Results indicate upper-extremity muscle activity and kinematics of the adapted rowing stroke are reliable in a diverse group of individuals with mobility impairment.

Relationship of psychosocial factors and musculoskeletal pain among individuals with newly acquired spinal cord injury.

STUDY DESIGN: Cross-sectional analysis of baseline data of a longitudinal cohort study. OBJECTIVES: Little evidence exists on pain-related psychosocial factors in individuals with newly acquired spinal cord injury (SCI). To understand a biopsychosocial model of pain, we must first understand the presenting psychological pain-related factors at injury onset. Therefore, we assessed musculoskeletal pain and pain-related psychological constructs in a group of individuals with newly acquired SCI. We hypothesized that individuals with new SCI would report musculoskeletal shoulder pain with elevated levels of kinesiophobia and pain catastrophizing. SETTING: Data were collected in three rehabilitation hospitals located in urban and suburban communities. METHODS: Thirty-five individuals with newly acquired SCI participated. Demographics, Musculoskeletal Pain Survey shoulder subscale, Tampa Kinesiophobia Scale-11, Pain Catastrophizing Scale, Fear of Pain Questionnaire, Chronic Pain Coping Inventory-42, and Subjective Quality of Life Questionnaire were administered. Descriptive analysis of all measures was determined and relationships between pain and psychosocial measures determined. RESULTS: Moderate shoulder pain existed in 40% of people with new SCI along with clinically elevated kinesiophobia, pain catastrophizing, fear of pain, and reduced quality of life. Shoulder pain was statistically associated with pain catastrophizing (ρ = 0.41, p = 0.01). Kinesiophobia positively correlated with fear of pain (ρ = 0.38, p = 0.02) with an inverse relationship to quality of life (ρ = -0.47, p = 0.01). CONCLUSIONS: Elevated pain, and pain-related psychological characteristics, such as catastrophizing and kinesiophobia exist during the early stages after SCI. Early identification of pain-related factors can guide clinical intervention potentially ameliorating pain-linked functional impairments. TRIAL REGISTRY: This trial is registered with ClinTrial.gov ID NCT03137394.

Movement Coordination During Humeral Elevation in Individuals With Newly Acquired Spinal Cord Injury.

Humeral elevation is a critical motion for individuals who use a manual wheelchair given that, in a typical day, wheelchair users reach overhead 5 times more often than able-bodied controls. Kinematic analyses in individuals with chronic spinal cord injury (SCI) have focused on weight-bearing tasks rather than overhead reaching. This technical report presents shoulder movement coordination during overhead reaching in individuals with newly acquired SCI. Eight volunteers with acute SCI and 8 matched, uninjured controls participated. Three-dimensional kinematics were collected during seated, humeral elevation. Scapular and thoracic rotations during humeral elevation were averaged across repetitions. The linear relationship of scapular upward rotation to humeral elevation provided movement coordination analysis. Maximal elevation was reduced in SCI with increased thoracic kyphosis. Medium to large effect sizes were found at each elevation angle, with reduced scapular external rotation, posterior tilt, and increased thoracic kyphosis for those with SCI. The linear relationship occurred later and within a significantly (P = .02) smaller range of humeral elevation in SCI. Altered movement coordination, including a diminished linear association of scapular upward rotation and humeral elevation (scapulohumeral rhythm), is found with reduced maximal elevation and increased thoracic kyphosis during overhead reaching tasks in those with acute SCI.

Shoulder impairment and pain of individuals with newly acquired spinal cord injury compared to uninjured peers.

STUDY DESIGN: Cohort study. OBJECTIVES: Shoulder pain prevalence is high in those with spinal cord injury (SCI) and is associated with decreased function, participation restrictions and decreased quality of life. Limited evidence exists regarding physical impairments of newly acquired SCI. The current study compared musculoskeletal factors at rehabilitation initiation in individuals with newly acquired SCI to uninjured individuals. We hypothesized no impairment differences of shoulder pain, strength, mobility, muscle extensibility, or rotator cuff integrity would exist between groups. SETTING: Multi-site laboratory setting. METHODS: Thirty-five individuals with newly acquired SCI and age and gender-matched controls without SCI (n = 34) participated. Musculoskeletal Pain Survey, shoulder range of motion (ROM), strength, pectoralis minor muscle extensibility (PM) and tissue integrity [Ultrasound Pathology Rating Scale (USPRS)] were obtained. RESULTS: Higher pain was reported by individuals experiencing new SCI along with lower strength across all bilateral measures, reduced elevation, external rotation, and horizontal adduction ROM, with large effect sizes. PM bilateral extensibility was reduced compared to controls, with moderate between group effect size; however, no USPRS score difference existed. CONCLUSIONS: This study provided the first comprehensive clinical description for individuals with newly acquired SCI. In comparison to matched uninjured controls, participants with new SCI reported greater shoulder pain with impairments in mobility, strength, and extensibility. The identified early clinical impairments aligned with progressive impairment including further pain development and persistence. Awareness and modification of these early clinical impairments may lead to improved long-term outcomes, improving the overall health and well-being of individuals with newly acquired SCI. SPONSORSHIP: Spinal Cord Injury Research Program Investigator-Initiated Research Award under Award No. W81XWH-17-1-0476.

Association of musculoskeletal pain, fear-avoidance factors, and quality of life in active manual wheelchair users with SCI: A pilot study.

Objective: Limited evidence examines the association of psychological factors, such as fear of movement and pain catastrophizing, with musculoskeletal pain patterns in active manual wheelchair users with spinal cord injury (SCI). This study investigated the relationship among musculoskeletal pain, fear avoidance factors, quality of life (QoL), activity and duration of injury in individuals with SCI. Design: Cross-sectional correlational. Setting: Community setting. Participants: Twenty-six individuals with SCI (age = 42 ± 14 years, duration manual wheelchair use = 17 ± 13 years, work/school/volunteer hours/week = 31 ± 14; recreation/sports hours/week 10 ± 12). Outcome Measures: Demographics and self-report measures including the Musculoskeletal Pain Survey (MPS), Wheelchair Users Shoulder Pain Index (WUSPI), Tampa Scale of Kinesiophobia (TSK-11), Pain Catastrophizing Scale (PCS), Fear of Pain (FPQ), Subjective Quality of Life Questionnaire (SQoL), and the Social Interaction Inventory (SII). Spearman's rho (ρ) assessed correlation among measures. Results: Strong association existed between age and duration of injury (ρ = 0.66, P < 0.001). SQoL offered a strong, direct correlation with age (ρ = 0.63, P = 0.01), duration of injury (ρ = 0.70, P = 0.001), and strong, inverse relationship with MPStotal (ρ = -0.66, P = 0.003) and MPS shoulder subscore (ρ = -0.64, P = 0.004). WUSPI demonstrated strong, inverse association with self-reported work hours (ρ = -0.52, P = 0.02) and a strong, direct relationship to PCS (ρ = 0.79, P = <0001). PCS demonstrated a strong, inverse relationship to work/school/volunteer hours (ρ = 0.71, P < 0.001) and strong association to TSK-11_total (ρ = 0.61, P = 0.001). A moderate, inverse relationship was identified for recreational/sports hours and FPQ (ρ = 0.48, P = 0.03). Conclusion: This cyclical relationship of musculoskeletal pain, reduced activity, and maladaptive psychological factors allude to interdependence of factors, supporting the multidisciplinary approach to care.