Rehabilitation Engineering Research Center on Spinal Cord Injury

Project Directors: David Brienza, PhD; Patricia Karg, MS

2007-2012

RERC on Spinal Cord Injury Website: http://www.rercsci.pitt.edu

Project R3: Effects of Handrim Technology on Upper Extremity Musculoskeletal Injury

Project Principle Investigator: Michael Boninger, MD

Project Co-Investigator: Dan Ding, Ph.D.

Upper Extremity pain among manual wheelchair users has been well documented with prevalence estimates between 30 and 73%. The purpose of this research study is to determine differences for muscle activity, metabolic activity, and nerve and tendon responses for wheelchair propulsion with a standard handrim, the Natural Fit Handrim and the Flex Rim. A secondary objective is to develop a preliminary agent based model of inflammation and healing of upper extremity injury following spinal cord injury. The study is a one-way repeated measures design, in which one group of subjects is exposed to all levels of the treatment variable (the three handrims). In order to randomize the order in which the handrims will be tested, to control for fatigue and learning, subjects will be randomized into one of six groups. Thirty men and women with a spinal cord injury below T1 (at least one year from injury), between the ages of 18 and 65, who use a manual wheelchair as their primary source of mobility will be recruited. Participants with a history of cardiovascular or cardiopulmonary disease will be excluded. We will collect demographic information, history of pain and wheelchair use, metabolic data, perceived exertion, pain rating and EMG activity during wheelchair propulsion with a selected handrim, over-ground propulsion with a selected handrim, and ultrasound examinations. All, excluding the collection of demographic and history of pain and wheelchair use information will be repeated for each of the three types of handrims. Handrims will be mounted on identical tires with quick release mechanisms to allow for quick change during testing. A subset of individuals
will have blood draws for the second objective of the study. One blood sample will be taken following the baseline ultrasound examination, a second blood sample will be taken following the last over-ground propulsion trial, and a third blood sample will be taken at the end of the last follow-up ultrasound examination. We are currently working on getting IRB approval and the study set up. A more ergonomically designed handrim may improve propulsion performance and decrease upper extremity pain.