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

The intent of this study was to describe the effects of long term paraplegia and wheelchair use on upper limb function. Bilateral upper extremity isokinetic and grip strength, pain, and active range of motion were compared in 52 men with paraplegia (mean age 44 years; mean duration of spinal cord injury (SCI) 17 years) and 52 age and activity level matched able bodied men. The impact of upper limb pain on activities of daily living (ADL) performance was examined in the paraplegic sample. Strength was not significantly different between the two samples except for bilateral shoulder flexion (able bodied stronger) and bilateral elbow extension (paraplegia stronger). Strength changed similarly with age in the two groups. The effect of duration of SCI on strength, excluding age, was significant for grip strength only. Duration of paraplegia and activity level were better predictors of strength than age in 9 of 14 muscle groups tested, whereas in the able bodied, age was the best strength predictor. Limited bilateral shoulder internal rotation and nondominant external rotation were associated with paraplegia (shoulder p < 0.001; elbow p < 0.001; wrist/hand p < 0.001). Reported pain prevalences for the paraplegic sample were: shoulder 39%; elbow 31% and wrist/hand 40%. The paraplegic subjects' pain intensity ratings revealed them to be experiencing mild to moderate levels of upper limb pain. Shoulder pain was associated with duration of injury, exclusive of age (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)