Comparative shoulder kinematics during free standing, standing depression lifts and daily functional activities in persons with paraplegia: Considerations for shoulder health

Study design: Case series; nonparametric repeated-measures analysis of variance. Objective: To compare and contrast three-dimensional shoulder kinematics during frequently utilized upper extremity weight-bearing activities (standing depression lifts used in brace walking, weight-relief raises, transfers) and postures (sitting rest, standing in a frame) in spinal cord injury (SCI). Setting: Movement Analysis Laboratory, Department of Physical Therapy, Ithaca College, Rochester, NY, USA. Methods: Three female and two male subjects (39.2±6.1 years old) at least 12 months post-SCI (14.6±6.7 years old), SCI distal to T2 and with an ASIA score of A. The Flock of Birds magnetic tracking device was used to measure three-dimensional positions of the scapula, humerus and thorax during various activities. Results: Standing in a frame resulted in significantly less scapular anterior tilt (AT) and greater glenohumeral external rotation (GHER) than standing depression lifts and weight-relief raises. Conclusions: Standing frame posture offers the most favorable shoulder joint positions (less scapular AT and greater GHER) when compared to sitting rest posture, weight-relief raises, transfers and standing depression lifts. Knowledge of kinematic patterns associated with each activity is an essential first step to understanding the potential impact on shoulder health. Choosing specific activities or modifying techniques within functional activities that promote favorable shoulder positions may preserve long-term shoulder health. Sponsorship: National Institute of Health (R15HD41379-01) and the Spinal Cord Research Foundation (2251-01).