Upper limb function in persons with long term paraplegia and implications for independence: Part I

Area of Science:

• Neurology
• Rehabilitation Medicine
• Biomechanics

Background:

• Long-term paraplegia and wheelchair use can lead to significant changes in upper limb function.
• Understanding these changes is crucial for developing effective rehabilitation strategies and improving quality of life for individuals with spinal cord injury (SCI).

Purpose of the Study:

• To investigate the long-term effects of paraplegia and wheelchair use on upper limb isokinetic strength, grip strength, pain, and active range of motion.
• To compare these parameters between individuals with paraplegia and able-bodied individuals.
• To examine the impact of upper limb pain on activities of daily living (ADL) in the paraplegic sample.

Main Methods:

• Compared bilateral upper extremity isokinetic and grip strength, pain, and active range of motion in 52 men with paraplegia and 52 age/activity-matched able-bodied men.
• Assessed the impact of upper limb pain on ADL performance in the paraplegic group.
• Analyzed the influence of age and duration of SCI on strength and range of motion.

Main Results:

• No significant differences in overall strength, except for bilateral shoulder flexion (stronger in able-bodied) and elbow extension (stronger in paraplegia).
• Limited shoulder internal rotation and nondominant external rotation were associated with paraplegia.
• Prevalence of upper limb pain in paraplegia: shoulder (39%), elbow (31%), wrist/hand (40%), with mild to moderate intensity. Shoulder pain correlated with injury duration.

Conclusions:

• Long-term paraplegia affects upper limb range of motion and is associated with mild to moderate pain, particularly in the shoulder.
• Duration of SCI and activity level are significant predictors of upper limb strength in paraplegia, more so than age.
• Findings highlight the need for targeted interventions to manage upper limb dysfunction and pain in individuals with SCI.