Collaboration on Upper Limb Pain in Spinal Cord Injury (CULP-SCI)

Principal Investigators: Michael L. Boninger, MD, Rory A. Cooper, PhD

Co-Investigators: Michael Chang, MD, PhD, Shirley Fitzgerald, PhD, Sue Ann Sisto, PT, MA, PhD, Alicia Koontz, PhD, Robert Price MS, Trevor A. Dyson-Hudson, MD, Barry Goldstein, MD, PhD, Rosemarie Cooper, MPT

2001-2008

Overview: This is a collaborative study with investigators at the Kessler Medical Rehabilitation Research and Education Corporation (KMRREC), the University of Washington (UW), and the University of Pittsburgh (UP). The goals of this study parallel those of the VA funded project Longitudinal Collaborative Investigations of Arm Pain in Paraplegia. Over 85 individuals with paraplegia from KMRREC and UW have been enrolled in the study. Together there have been over 135 individuals across all three sites tested. A summary database contains all questionnaire data, physical exam results, wheelchair measurements, anthropometric measurements, pain measures, NCS results, and MRI and X-ray findings. Kinetic and kinematic data have been pre-processed and examined for quality and accuracy. It was found that subjects tested at UW pushed with less force and torque than the other two sites. An analysis of coast down determined the difference to be caused by a reduced rolling resistance in UW’s wheelchair dynamometer. A correction factor was devised for subsequent analyses. A second paper that was published contained a complete description of shoulder biomechanics for the largest sample size to date (n= 61). This study was also the first to directly examine the relationship between shoulder pain, both in the last month and during propulsion, and biomechanics during wheelchair propulsion. We found no significant differences in the way people with shoulder pain propelled their wheelchair compared to individuals without pain. Because we previously found a relationship between shoulder biomechanics variables and pathology, this finding strengthens our belief that propulsion biomechanics contributes to pathology, rather than pain or pathology influencing propulsion style. A third multi-site paper currently in press is the largest cross-sectional study of manual wheelchair users with paraplegia and CTS that includes physical examinations, symptoms and NCS (n=126). This study discovered that nearly 60% of individuals who were symptomatic showed greater changes on NCS. More striking was the finding that individuals with NCS-confirmed CTS performed at the same functional level as those without CTS. This study also found an association between duration of injury and functional decline. A fourth multi-site paper was published which redefines the manual wheelchair stroke cycle. KMRREC and UW have finished the testing phase of this project. Data analysis is ongoing. The findings of this project have direct applications to preserving upper limb health among manual wheelchair users.