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Use it or Lose it?

Use it or Lose it?. A Look at Shoulder Pain and Shoulder Preservation in Manual Wheelchair Users. Presented by: Jill Alm. Use it or Lose it?. As we age Aerobic activity (VO2 max), maximum heart rate, flexibility and muscle strength is all decreasing. Our body fat is increasing.

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Use it or Lose it?

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  1. Use it or Lose it? A Look at Shoulder Pain and Shoulder Preservation in Manual Wheelchair Users Presented by: Jill Alm

  2. Use it or Lose it? • As we age • Aerobic activity (VO2 max), maximum heart rate, flexibility and muscle strength is all decreasing. • Our body fat is increasing. • Our own experiences with sickness/injury.

  3. The Good News • We are all trainable. • Can be reversed.

  4. What about Wheelchair Mobility? • Exercise has shown to reduce shoulder pain and improved function. • Wheelchair athletes vs. non-athletes. • Shoulder Pain in adult vs. child onset wheelchair users.

  5. www.nextstepfitness.org

  6. Pushing-boundaries.orgRedmond, WA

  7. www.mindbodysolutions.org

  8. mo·bil·i·tynoun 1. The quality or state of being in motion.

  9. freedom, noun 1. the state of being free or at liberty rather than in confinement or under physical restraint

  10. Freedom = Mobility

  11. Shoulder Pain and Mobility Goals • Examine the prevalence and effects of shoulder pain in MWC users. • Learn about wheeled technology available to decrease shoulder pain.

  12. Prevalence of Shoulder Pain in MWC users Up to 80% of Manual Wheelchair Users suffer from shoulder pain. • Chronic UE pain is the most frequently identified medical concern and interferes with work, home, social and recreational activities. • Using the WUSPI, the highest intensity of pain is: • Pushing up an incline • Pushing for longer than 10 minutes • While sleeping

  13. Possible Correlations to Shoulder Pathologies • Time since injury • Repetitive nature of wc propulsion • Strength of shoulder muscles • Loading of joints at extremes of motion • Muscular weakness or imbalance • Transfers

  14. Anatomy of the Shoulder • Most movable joint in the body. • Unstable joint due to the ROM. • Subject to injury because the ball is larger than the socket that holds it. • To maintain stability, it must be anchored by its muscles, tendons, and ligaments.

  15. To Add to the Shoulder Pain… • Increases with age. • Can lead to activity limitations. • Lowers subjective quality of life and physical activity scores. • Even a relatively benign ramp (2.9 degrees) places a large demand on the musculature of the UE.

  16. Conclusions • Strategies should be developed. • Need to develop programs of prevention, patient education, diagnosis and treatment. • Attention to and interventions for shoulder pain may improve their overall quality of life and physical activity. • Shoulder pain is a multidimensional process.

  17. Spinning our Wheels? • Published in 2005 • Consolidates research findings and relates them directly to clinical practice. • www.pva.org

  18. Wheeled Technology Geared Wheels General Application • MAGICWHEELS 2-Gear Wheels Specialty Application • Renegade Wheelchairs (Multi-gear lever drive system) • Mountain Trike, UK (3 Wheel with lever drive system)

  19. Wheeled Technology Power Assist • E-motion • Xtender • Tail Wind • Zinger Other • Wijit (Lever Drive System with added speed)

  20. Compatible with any manual wheelchair • 24” and 25” wheels • Quick release • Handrim and tire choices available • No batteries or motors

  21. The gears add 5 lbs per wheel • No added width • Up to 6 degrees of camber available • Standard wheels are interchangeable • Fully RESNA tested and 5 year warranty • MSRP: $4995.00 • HCPCS code: E2227

  22. 1:1 gear for standard use • 2:1 Low gear (think bicycle gears) • Easy gear shifting • Climb hills/ramps with 50% less effort • Automatic hill holder • Increased downhill control • Other uses of the low gear

  23. Users • Shoulder pain • Mobility/independence is important! • In a chair for 15-30+ years • Can push on a flat surface • Experiencing a change in lifestyle • Van ramp • Experiencing difficulty with current mobility • Change in health • Going to college • Self reliant

  24. Effect of 2-Speed Geared Manual Wheelchair Propulsion (MAGICWHEELS) on Shoulder Pain and Function Archives of Physical Medicine and Rehabilitation Volume 88, p. 1622 – 1627, December 2007 Margaret A. Finley, PhD, PTMary M. Rogers, PhD, PTUniversity of Maryland School of MedicineDepartment of Physical Therapyand Rehabilitation Sciences

  25. OBJECTIVE: To investigate the impact of a manual 2-gear wheelchair wheel (MAGICWHEELS) on shoulder pain and function in manual wheelchair users. • DESIGN: A single-group, repeated-measures pre- and post- design with baseline and retention. • SETTING: General community. • PARTICIPANTS: Full time manual wheelchair users currently experiencing shoulder pain.

  26. Methods 17 MWCU with shoulder pain (WUSPI score >10)Age: 46.014.0 yearsDuration WC use: 15.110.1 yearsGender: Male=9 ; Female =8Disabilities: Spina bifida(1) ;SCI (11); post-polio(1);stroke (1);ataxia (1);Rheumatoid arthritis(1);spinal stenosis(1)

  27. Protocol • Phase I (baseline): one month using own wheelchair and wheels • Phase II (MAGICWHEELS): five months with the 2-speed MAGICWHEELS attached to own wheelchair • Phase III (retention): one month in own wheelchair and wheels

  28. MAIN OUTCOME MEASURES: Wheelchair Users Shoulder Pain Index (WUSPI)

  29. WUSPI items Showing Significant Reduction • ten minute push • ramp ascent • driving • chores • sleeping

  30. Conclusions • MAGICWHEELS 2-gear wheels has been shown to reduce shoulder pain with short time use (2 weeks) indicating a rapid response to the intervention. • A progressive reduction in pain continued throughout 20 week study. • These findings indicate the potential (p=0.015) for shoulder pain reduction with the use of MAGICWHEELS during mobility, even in highly functional manual wheelchair users.

  31. Weight …before the study we considered the possibility that the added weight (~ 10lbs) of the MAGICWHEELS would lead to an increase in shoulder pain.

  32. Weight The concerns proved UNFOUNDED as the individual item analysis on the WUSPI revealed that there was no increase in pain on the weight-dependent item, “loading wheelchair into car,” as reported by the 9 participants who regularly performed the task, and overall shoulder pain was reduced significantly.

  33. Weight ADP testing by the Ontario Government. Patricia O’Neill, M.Sc.E, P.Eng., Research Engineer • The Ottawa Hospital Rehabilitation Centre • RESNA Testing, Rolling Resistance. Force to maintain rolling. • Regular wheels = 10.3 N • MW = 8.5 N (18% reduction)

  34. Effects of Geared Wheels on Shoulder Muscle Activity (EMG) During Wheelchair Ramp Ascent and DescentDepartment of Kinesiology, University of Waterloo, Waterloo, Ontario, CanadaLynne Pronovost, Sam Howarth, Clark Dickerson, Jan Miller-Polgar, Jack Callaghan. • The study could not differentiate between MW in 1:1 and standard wheels pushing up a ramp. • Showed the measured muscle activation when propelling MAGICWHEELS in low gear up a 5 degree incline is less than 50% of maximal voluntary contraction. • This is below levels known from other studies to cause muscle damage in repetitive situations like pushing a wheelchair.

  35. Effects of Geared Wheels on Shoulder Muscle Activity (EMG) During Wheelchair Ramp Ascent and Descent Conclusion It appears geared wheels may prolong time to fatigue and decrease risk of injury for MWC users. Submitted to Archives of Physical Medicine and Rehabilitation, Clinical Biomechanics, and ISS 2010.

  36. Pushrim Activated Power Assist Wheels (PAPAW) E-motion Drive Wheel M15 • 22” or 24” wheels • Quick Release • Wheelchair Compatibility chart reference Easy, Moderate, Difficult to install • Motor integrated into the wheel hub • Widens the wheelchair by 1-1.5” depending on the model • Handrims: Stainless steel, removable rubber covers, vinyl coated.

  37. E-motion Drive Wheel M15 Weight • 2 wheels: 50 lbs2 batteries: 10 lbs • 1 charger: 4 lbs. Battery Pack • Up to 16 miles range per charge • Lithium-Ion technology, optional spare batteries available • Charging time: 6 hours

  38. E-motion Drive Wheel M15 Ergonomic Control System (ECS) • Rollback delay • Activation via ECS • Prevents wheelchair from rolling back while climbing inclines or ramps • ECS Features • Programming of driving parameters (10 parameters in all) • On/Off, assistance levels, info button for current status display • Two assistance levels • High/Low, individually programmable • Remote Battery Monitor • Check battery capacity from the upright sitting position • Self-diagnosis • Display of service and diagnostic codes via LCD screen on the ECS • Coded Radio Transmission • Prevents interferences with other electrical devices

  39. E-motion Drive Wheel M15 Warranty Limited 24-month period - excluding accessories and batteries. After the initial 12-month warranty period, problems are dealt with on a case by case basis. Price: MSRP $7295 Extra battery Packs, Set of 2 Li-Ion: $1495 Code: E0986

  40. Quickie Xtender • 24” Wheels • 18” seat to floor height required • Quad release axle, quick disconnect • Automatic wheel synchronization system which compensates for any arm strength imbalance the user may have. • Available in two versions • Increases the force by a factor of 1.5. • Increases the force applied by a factor of 3. • The motor also acts as a break when traveling downhill. • Total additional weight is 37 lbs.

  41. Quickie Xtender Compatibility • Available on the Quickie 2, 2HP, GP/GPV, GP Swing Away, GP, GT, GTX, and Titanium chair models. • Redesigned axle-plate allows the chair's width to stay constant when converting to a power-assist platform. Battery A single battery weighing 6 1/4 lbs. • Battery has its own charger • Takes 2 - 3 hours to charge. • Range 9.5 miles

  42. Quickie Xtender Warranty: 2 year MSRP: $6,295.00 Extra battery: MSRP $1200 Extra Charger: MSRP $850 Code:E0986

  43. Power Assist Users • Shoulder pain • Difficulty pushing on flat surface • Distanced pushed during the day may be a factor • Home environment may not accommodate PWC • Willing to accept a power solution

  44. Power-Assisted Wheels Ease Energy Costs and Perceptual Responses to Wheelchair Propulsion in Persons With Shoulder Pain and SCI Archives of Physical Medicine and Rehabilitation Vol. 89, p. 2080-2085, November 2008. Mark S. Nash, PhD, Daan Koppens, MD, Miriam van Haaren, MD, Andrew L. Sherman, MD, James P. Lippiatte, John E. Lewis, PhD. Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL

  45. Protocol OBJECTIVE: Test effects of pushrim-activated power-assisted wheelchairs (PAPAWs) on the energetics and perceptual responses to steady-state and intensity-graded wheelchair propulsion in persons with paraplegia and tetraplegia having chronic shoulder pain. DESIGN: Test, retest with a control condition. SETTING: Academic medical center.

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