Musculoskeletal Problems in Wheelchair Users: A Review Study

Abstract

Mobility is the basic need for functionality in human life. Physically disabled people often require mobility aids and wheelchairs are the most commonly preferred assistive mobility devices for enhancing independent functional mobility. Today, powered and manual wheelchair technology is available. Manual wheelchair propulsion necessitates more repetitive loading, but because the human body is not designed for such movement, musculoskeletal and functional issues such as pain and joint limitation may arise among manual wheelchair users. They require more support from their spine, arm, elbow, and wrist for mobility, transfer, pressure relief, and most daily activities. During these tasks, repetitive weight-bearing and mobility activities tend to increase the risk of injury, increasing dependence on helpers and a lower quality of life. Accordingly, this review synthesizes musculoskeletal problems and preventive strategies in wheelchair users. Improved understanding of risk factors can assist health professionals who assess, treat, and guide manual wheelchair users.

Keywords

• wheelchairs
• musculoskeletal pain
• cumulative trauma disorders

Tekerlekli Sandalye Kullanıcılarında Kas İskelet Sistemi Problemleri: Bir Derleme Çalışması/Musculoskeletal Problems in Wheelchair Users: A Review Study

Abstract

Mobilite, insan yaşamında fonksiyonellik için temel ihtiyaçtır. Fiziksel engelli insanlar, genellikle mobilite için yardıma ihtiyaç duyarlar. Tekerlekli sandalyeler, bağımsız fonksiyonel hareketliliği artırmak için en yaygın tercih edilen yardımcı cihazlardır. Günümüzde elektrikli ve manuel tekerlekli sandalye teknolojisinden yararlanılmaktadır. Tekrarlayan yüklenmeler, manuel tekerlekli sandalyenin ilerletilmesi için gereklidir, ancak ne yazık ki insan vücudu bu hareket için özelleşmemiştir ve ağrı, eklem kısıtlaması ve ilgili fonksiyonel problemler gibi kas-iskelet sistemi sorunlarına neden olur. Manuel tekerlekli sandalye kullanıcısı, mobilite, transfer ve günlük yaşam aktivitelerinin çoğu için kollarından daha fazla destek almalıdır. Bu görevler sırasında tekrarlayan ağırlık taşıma ve hareketlilik aktiviteleri, yaralanma riskini artırır ve kişinin bir dış desteğe bağımlılığı artırarak yaşam kalitesinin azalmasına neden olur. Bu derlemenin amacı tekerlekli sandalye kullananlarda kas-iskelet sistemi problemlerini sentezlemektir. Risk faktörlerinin daha iyi anlaşılması, manuel tekerlekli sandalye kullanıcısını değerlendiren, tedavi eden ve yönlendiren sağlık uzmanlarına yardımcı olacaktır.

Keywords

• Tekerlekli sandalyeler
• kas-iskelet ağrısı
• kümülatif travma bozuklukları

References

1. Sanford JA. Universal design as a rehabilitation strategy: Design for the ages: Springer Publishing Company; 2012.
2. Liampas A, Neophytou P, Sokratous M, Varrassi G, Ioannou C, Hadjigeorgiou GM, et al. Musculoskeletal pain due to wheelchair use: a systematic review and meta-analysis. Pain Ther. 2021;10(2):973-84.
3. Stineman MG, Ross RN, Fiedler R, Granger CV, Maislin G. Functional independence staging: conceptual foundation, face validity, and empirical derivation. Arch Phys Med Rehabil. 2003;84(1):29-37.
4. Khasnabis C, Mines K, Organization WH. Wheelchair service training package: basic level: World Health Organization; 2012.
5. Cratsenberg KA, Deitrick CE, Harrington TK, Kopecky NR, Matthews BD, Ott LM, et al. Effectiveness of exercise programs for management of shoulder pain in manual wheelchair users with spinal cord injury. J Neurol Phys Ther. 2015;39(4):197-203.
6. Organization WH. Fact sheet on wheelchairs. 2010.
7. Barbetta D, Lopes A, Chagas F, Soares P, Casaro F, Poletto M, et al. Predictors of musculoskeletal pain in the upper extremities of individuals with spinal cord injury. J Neurol Phys Ther. 2016;54(2):145-9.
8. Finley MA, Rasch EK, Keyser RE, Rodgers MM. The biomechanics of wheelchair propulsion in individuals with and without upper-limb impairment. J Rehabil Res Dev. 2004;41(3B):385-94.

9. Wellisch M, Lovett K, Harrold M, Juhl C, Juul-Kristensen B, McKenna L, et al. Treatment of shoulder pain in people with spinal cord injury who use manual wheelchairs: a systematic review and meta-analysis. Spinal Cord. 2021:1-8.
10. Howarth SJ, Polgar JM, Dickerson CR, Callaghan JP. Trunk muscle activity during wheelchair ramp ascent and the influence of a geared wheel on the demands of postural control. Arch Phys Med Rehabil. 2010;91(3):436-42.
11. Sprigle S. Measure it: Proper wheelchair fit is key to ensuring function while protecting skin integrity. Adv Skin Wound Care. 2014;27(12):561-72.
12. Boninger ML, Cooper RA, Fitzgerald SG, Lin J, Cooper R, Dicianno B, et al. Investigating neck pain in wheelchair users. Am J Phys Med Rehabil. 2003;82(3):197-202.
13. Ballinger DA, Rintala DH, Hart KA. The relation of shoulder pain and range-of-motion problems to functional limitations, disability, and perceived health of men with spinal cord injury: a multifaceted longitudinal study. Arch Phys Med Rehabil. 2000;81(12):1575-81.
14. Lin Y-S, Boninger M, Worobey L, Farrokhi S, Koontz A. Effects of repetitive shoulder activity on the subacromial space in manual wheelchair users. Biomed Res Int. 2014;2014
15. Rankin JW, Richter WM, Neptune RR. Individual muscle contributions to push and recovery subtasks during wheelchair propulsion.J Biomech. 2011;44(7):1246-52.
16. Akbar M, Balean G, Brunner M, Seyler TM, Bruckner T, Munzinger J, et al. Prevalence of rotator cuff tear in paraplegic patients compared with controls. J Bone Joint Surg Am. 2010;92(1):23-30.
17. Hastings J, Goldstein B. Paraplegia and the shoulder. Phys Med Rehabil Clin N Am. 2004;15(3):699-718.
18. Bayley JC, Cochran T, Sledge C. The weight-bearing shoulder. The impingement syndrome in paraplegics. J Bone Joint Surg Am. 1987;69(5):676-8.
19. Morrow M, Van Straaten MG, Murthy NS, Braman JP, Zanella E, Zhao KD. Detailed shoulder MRI findings in manual wheelchair users with shoulder pain. Biomed Res Int. 2014;2014.
20. Diong J, Harvey LA, Kwah LK, Eyles J, Ling M, Ben M, et al. Incidence and predictors of contracture after spinal cord injury—a prospective cohort study. Spinal Cord. 2012;50(8):579-84.
21. Eriks-Hoogland IE, de Groot S, Post MW, van der Woude LH. Passive shoulder range of motion impairment in spinal cord injury during and one year after rehabilitation. J Rehabil Med. 2009;41(6):438-44.
22. Müller R, Brinkhof MW, Arnet U, Hinrichs T, Landmann G, Jordan X, et al. Prevalence and associated factors of pain in the Swiss spinal cord injury population. Spinal Cord. 2017;55(4):346-54.
23. Pentland W, Twomey L. Upper limb function in persons with long term paraplegia and implications for independence: Part II. Spinal Cord. 1994;32(4):219-24.
24. Roy V, Lee L, Uihlein M, Roy I, Lee K. Ultrasonographic comparison of the lateral epicondyle in wheelchair-user (and able-bodied) tennis players: A pilot study. J Spinal Cord Med. 2021;44(1):29-36.
25. Erhan B, Gündüz B, Bardak A, Özcan S, Çarlı A, Er H, et al. Elbow problems in paraplegic spinal cord injured patients: frequency and related risk factors—a preliminary controlled study. Spinal Cord. 2013;51(5):406-8.
26. Yang J, Boninger ML, Leath JD, Fitzgerald SG, Dyson-Hudson TA, Chang MW. Carpal tunnel syndrome in manual wheelchair users with spinal cord injury: a cross-sectional multicenter study. Am J Phys Med Rehabil. 2009;88(12):1007-16.
27. Akbar M, Penzkofer S, Weber M, Bruckner T, Winterstein M, Jung M. Prevalence of carpal tunnel syndrome and wrist osteoarthritis in longterm paraplegic patients compared with controls. J Hand Surg Eur Vol. 2014;39(2):132-8.
28. Cloud BA, Zhao KD, Ellingson AM, Nassr A, Windebank AJ, An K-N. Increased seat dump angle in a manual wheelchair is associated with changes in thoracolumbar lordosis and scapular kinematics during propulsion. Arch Phys Med Rehabil. 2017;98(10):2021-7. e2.
29. Kovacs FM, Seco J, Royuela A, Barriga A, Zamora J. Prevalence and factors associated with a higher risk of neck and back pain among permanent wheelchair users: a cross-sectional study. Spinal Cord. 2018;56(4):392-405.
30. Sawatzky B, DiGiovine C, Berner T, Roesler T, Katte L. The need for updated clinical practice guidelines for preservation of upper extremities in manual wheelchair users: a position paper. Am J Phys Med Rehabil. 2015;94(4):313-24.
31. Morrow MM, Kaufman KR, An K-N. Scapula kinematics and associated impingement risk in manual wheelchair users during propulsion and a weight relief lift. Clin Biomech (Bristol, Avon). 2011;26(4):352-7.
32. Thyberg M, Gerdle B, Samuelsson K, Larsson H. Wheelchair seating intervention. Results from a client-centred approach. Disabil Rehabil. 2001;23(15):677-82.
33. Hammill H, Swanepoel M, Ellapen T, Strydom G. The health benefits and constraints of exercise therapy for wheelchair users: A clinical commentary. Afr J Disabil. 2017;6(1):1-8. 34. Reston A, Nock J. Promoting Healthy Posture for Wheelchair Users
34. Reston A, Nock J. Promoting Healthy Posture for Wheelchair Users through Appropriate Lumbar Support and Effective Ergonomic Design. Qual Prim Care. 2016;24(3):133-6.
35. Rushton P, Giesbrecht E, Kirby RL, Viswanathan P, editors. Outcome measurement in wheelchair seating, positioning and mobility. European Seating Symposium; 2016: Invacare.
36. Brandt Å, Samuelsson KA. Wheelchair Intervention: Principles and Practice. International Handbook of Occupational Therapy Interventions: Springer; 2015. p. 299-309.
37. Kesiktaş FN, Kaşıkçıoğlu E, Paker N, Bayraktar B, Karan A, Ketenci A, et al. Comparison of the functional and cardiovascular effects of home-based versus supervised hospital circuit training exercises in male wheelchair users with chronic paraplegia. Turk J Phys Med Rehabil. 2021;67(3):275.
38. Gitlow L, Flecky K. Assistive Technologies and Environmental Interventions in Healthcare: An Integrated Approach: John Wiley & Sons; 2019.
39. Organization WH. Guidelines on the provision of manual wheelchairs in less resourced settings: World Health Organization; 2008.
40. Medicine PVoACfSC. Preservation of upper limb function following spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med. 2005;28(5):434.
41. Rader J, Jones D, Miller L. The importance of individualized wheelchair seating for frail older adults. J Gerontol Nurs. 2000;26(11):24-32.
42. Chénier F, Aissaoui R. Effect of wheelchair frame material on users’ mechanical work and transmitted vibration. Biomed Res Int. 2014;2014.
43. Batavia M. The wheelchair evaluation: A clinician’s guide: Jones & Bartlett Learning; 2010.
44. Radomski MV, Latham CAT. Occupational therapy for physical dysfunction: Lippincott Williams & Wilkins; 2008.
45. Letcher R. Smarthub: A low cost manual wheelchair fitness metrics tool for clinicians, researchers, and wheelchair users: The Ohio State University; 2017.
46. Thomas L, Borisoff J, Sparrey C, editors. Defining the stability limits of a manual wheelchair with adjustable seat and backrest. Rehabilitation Engineering and Assistive Technology Society of North America Conference New Orleans, LA; 2017.
47. Shin H, Kim J, Kim J-J, Kim H-R, Lee H-J, Lee B-S, et al. Pressure Relieving Effect of Adding a Pelvic Well Pad to a Wheelchair Cushion in Individuals With Spinal Cord Injury. Ann Rehabil Med. 2018;42(2):270.
48. Yang Y-S, Koontz AM, Yeh S-J, Chang J-J. Effect of backrest height on wheelchair propulsion biomechanics for level and uphill conditions. Arch Phys Med Rehabil. 2012;93(4):654-9.
49. Rankin JW, Kwarciak AM, Richter WM, Neptune RR. The influence of wheelchair propulsion technique on upper extremity muscle demand: a simulation study. Clin Biomech (Bristol, Avon). 2012;27(9):879-86.
50. Gorgey AS, Dolbow DR, Dolbow JD, Khalil RK, Castillo C, Gater DR. Effects of spinal cord injury on body composition and metabolic profile– Part I. J Spinal Cord Med. 2014;37(6):693-702.
51. Haubert LL, Mulroy SJ, Eberly VJ, Gronley JK, Hatchett PE, Conners SG. Shoulder Pain Prevention Program for Manual Wheelchair Users With Paraplegia: A Randomized Clinical Trial. Top Spinal Cord Inj Rehabil. 2021;27(4):40-52.
52. Van der Woude L, de Groot S, van Drongelen S, Janssen T, Haisma J, Valent L, et al. Evaluation of manual wheelchair performance in everyday life.Top Spinal Cord Inj Rehabil. 2009;15(2):1-15.
53. Bruce B, Fries JF, Lubeck DP. Aerobic exercise and its impact on musculoskeletal pain in older adults: a 14 year prospective, longitudinal study. Arthritis Res Ther. 2005;7(6):1-8.
54. Lisman PJ, Sarah J, Gribbin TC, Jaffin DP, Murphy K, Deuster PA. A systematic review of the association between physical fitness and musculoskeletal injury risk: part 1—cardiorespiratory endurance. J Strength Cond Res. 2017;31(6):1744-57.
55. Yildirim A, Sürücü GD, Karamercan A, Gedik DE, Atci N, Dülgeroǧlu D, et al. Short-term effects of upper extremity circuit resistance training on muscle strength and functional independence in patients with paraplegia. J Back Musculoskelet Rehabil. 2016;29(4):817-23.
56. Sasso E, Backus D. Home-based circuit resistance training to overcome barriers to exercise for people with spinal cord injury: a case study. J Neurol Phys Ther. 2013;37(2):65-71.
57. Mat Rosly M, Mat Rosly H, Davis OAM GM, Husain R, Hasnan N. Exergaming for individuals with neurological disability: a systematic review. Disabil Rehabil. 2017;39(8):727-35.
58. Hicks A, Martin K, Ditor D, Latimer A, Craven C, Bugaresti J, et al. Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being. Spinal Cord. 2003;41(1):34-43