@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2018;10(1):27-31

Background
Spinal cord injury is an acute and devastating event that results in significant and permanent changes in the lives of people injured [1].
Previous Studies
… [2-7]. After spinal cord injury, excessive load is imposed on the upper limb, especially the shoulders. A total of 51% of people with spinal cord injury have shoulder problems [8]. Studies in the domain of upper limb pain have reported the prevalence of pain in the upper limbs of subjects with tetraplegia and paraplegia as 59% and 41% respectively [9]. The most common problem in people with spinal cord injury is muscle imbalance, which can lead to glenohumeral instability, Impingement syndrome, rupture of the cuff and subsequent degenerative joint disease. These problems can be attributed to the functional requirements that apply to the shoulders, especially in patients with spinal cord injury including over-head activities, wheelchairs, and displacements [10].
Aim(s)
The purpose of this study was to investigate the effect of centralized shoulder training and wheelchair facilitator on pain and function of shoulder in wheelchair veterans with paraplegic spinal cord injury.
Research type
The present applied research is a semi-experimental with pretest and posttest design.
Research society, place and time
This research was conducted among the community of wheelchair veterans with paraplegic spinal cord injury and shoulder pain referring to Kosar Orthosis and Prosthesis Center in 2015.
Sampling method and number
Samples were selected through a targeted sampling method in a sample of 20 people and randomly divided into experimental and control groups. Both control and experimental groups were assigned randomly in order to reduce the effect of the differences between the samples as well as control of interfering and intrusive variables. Entry criteria included spinal cord injury in the thoracic region and complete paralysis of the lower extremities, experience of at least 6 months of shoulder pain, and time lapse of 27 to 35 years from the onset of lesion. Exit criteria included neurological defects (such as acute myocardial infarction, acute heart failure, and uncontrolled hypertension), tetraplegia paralysis, history of acute injuries such as fracture or dislocation in the shoulder region, or history of shoulder injury.
Used devices&materials
Data on individual characteristics of subjects were collected and recorded using a demographic questionnaire and the following questionnaires were used to determine pain and shoulder function: 1- Wheelchair User`s Shoulder Pain Index (WUSPI): This questionnaire was used to assess shoulder pain. The structure of WUSPI is self-report and includes 15 questions that are ranked in 10 points from zero (painless) to 10 (maximum pain) as visual analogues. The Cronbach's alpha coefficient of the items was 0.98 and its reliability was 0.99 [11, 12]. 2- Shoulder Rater Questionnaire (SQR) for evaluation of shoulder function. This questionnaire has four parts and a total of 21 questions including global assessment of pain, daily activities, sports and recreational activities, work, satisfaction, and the areas of improvement. The overall scale and scale of each section were tested in terms of validity, reliability and response to clinical changes. One of the scoring ranges is a series of five-choice questions rated from one (weakest) to five (best). Therefore, the overall score range is between 17 and 100. So that the higher score points show the higher operation of shoulder and the lowest score show the low function of the shoulder. This index was translated into Persian by Hesabi that its correlation coefficient is 0.85 and its Cronbach's alpha is 0.90 [13]. After performing pretest in both groups, the exercises were performed for 8 weeks and 3 days each week, every other day, and 10 to 20 repetitions by subjects in the experimental group using wheelchair facilitator at home. The exercises that were used included exercises that were used on spinal cord injuries using manual wheelchairs [14]. The subjects also were using wheelchair facilitator along with the practice protocol within 8 weeks of their daily life activities. The control group performed their daily activity without any of the stated steps. The shoulder training protocol included 3 or 4 tensile exercises and 3 or 4 strength exercises (Table 1). Due to the time limitation, no intervention was done on the control group. Descriptive and inferential statistical methods were used to analyze the data using SPSS 19 software. Normal distribution of data was investigated using Kolmogorov-Smirnov test. To compare the variables of pain and shoulder function in pretest and posttest stages in each group and between the two groups, dependent t-test and covariance analysis were used.
Findings by Text
There was no significant difference between the demographic characteristics of both experimental and control groups (p>0.05; Table 2).In the experimental group, the pain level and function of the shoulder decreased and increased significantly respectively in the posttest compared to the pretest stage. There was also a significant difference between the experimental and control groups (Table 3).
Main comparison to the similar studies
In a research, the mechanical efficiency of the moving facilitation device was considerably higher than that of the manual wheelchairs in the subjects. When the participants were thrusting themselves out, the participants needed to use more force on average of 3.65 times that the device significantly reduced the efficiency of the device and reduced the need for user power [15]. Nash in a study showed that the use of pushrim-activated power assist wheelchair (PAPAW) by paraplegic and tetraplegical subjects with shoulder pain significantly reduced the amount of energy consumed and perceived effort compared to manual wheelchairs, while it increases the travelled distance significantly [16]. In a research study, it has been observed that during wheelchair drive facilitating thrust, a significant reduction in maximum angles of bending and internal combustion of the shoulder and decrease in the peak force applied to thrust ring has been observed. Also, muscle activity was reduced in the Pectoralis muscle, deltoid muscle, and triceps brachii. Therefore, the interpretation of this research has shown that the wheelchair facilitator has been effective on the work needed to drive wheelchairs by healthy people [17]. … [18-20]. Fullerton has shown that there was no significant difference between people with and without pain with the number of years of using wheelchairs and being athletes [21]. In a study to investigate the effects of shoulder pain reduction on quality of life and social activity of people with paraplegia spinal cord injury, the results indicated that reducing shoulder pain is associated with increased social participation and quality of life [22]. In a study that included an exercise intervention program including strengthening and stretching movements and techniques for movement, lifting and holding wheelchairs, intervention has been effective to improve muscle strength and reduce long-term pain in the subjects [14]. … [23-26].
Suggestions
It is suggested that these exercises be considered as part of the therapeutic program and that occupational therapists and rehabilitation practitioners should assist them. Also, it is suggested that along with using wheelchair facilitator, other exercise be used to prevent muscle weakness.
Limitations
From the limitations of this study, telephone follow-up of clients and the impossibility of direct supervision to complete the recommended exercises and the regular use of the wheelchair facilitator can be mentioned. Therefore, self-report of the participants was sufficient information.
Conclusions
The shoulder-focused exercises, along with the use of the wheelchair facilitator are effective in reducing the amount of pain and improving the performance of the shoulder in wheelchair veterans with paraplegic spinal cord injury.
Acknowledgments
All the veterans participated in the study are appreciated.
Conflict of interest
Non-declared
Ethical Permissions
This research was approved after examination by the Vice-Chancellor of Ethics of Allameh Tabatabi University. For the participants in the research, the consent form was distributed and collected.
Funding Sources
This research is part of the master's degree in Pathology and Reform Movement at Allameh Tabatabai University.

TABLES and CHARTS

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