Application of a model to analyze shoulder biomechanics in adult patients with spinal cord injury when walking with crutches in two different gait patterns

Article type: Research Article

Authors: Perez-Rizo, Enrique^a | Trincado-Alonso, Fernando^a | Pérez-Nombela, Soraya^a | del Ama-Espinosa, Antonio^a | Jiménez-Díaz, Fernando^b | Lozano-Berrio, Vicente^a | Gil-Agudo, Angel^{a; *}

Affiliations: [a] Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, SESCAM, Toledo, Spain | [b] Laboratory of Performance and Sports Rehabilitation, Faculty of Sport Science, University of Castilla-La Mancha, Toledo, Spain

Correspondence: [*] Address for correspondence: Angel Gil-Agudo, Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Finca la Peraleda s/n, 45071 Toledo, Spain. Tel.: +34 925 247763; Fax: +34 925 396821; E-mail: amgila@sescam.jccm.es.

Abstract: BACKGROUND: Specific biomechanical models have been developed to study gait using crutches. Clinical application of these models is needed in adult spinal cord injury (SCI) population walking with different patterns of gait with crutches to prevent overuse shoulder injuries. OBJECTIVE: To apply a biomechanical model in a clinical environment to analyze shoulder in adult SCI patients walking with two different patterns of gait with crutches: two point reciprocal gait (RG) and swing-through gait (SG). METHODS: Load cells were fixed to the distal ends and forearm cuffs of a pair of crutches. An active markers system was used for kinematics. Five cycles for each gait pattern were analyzed applying a biomechanical model of the upper limbs. Fifteen subjects with SCI were analyzed. RESULTS: The flexo-extension range of motion was significantly greater when using SG (p < 0.01). Similarly, the superior, posterior and medial forces were significantly stronger for SG in all 3 directions. Flexion, adduction and internal rotation torques were also greater in SG (p < 0.01). CONCLUSIONS: A biomechanical model was successfully applied to study shoulder biomechanics in adult patients with SCI walking with crutches in two different gait patterns. Greater loads exerted on the shoulder walking with SG were confirmed compared to RG.

Keywords: Rehabilitation, spinal cord injury, biomechanics, shoulder, gait, crutches

DOI: 10.3233/NRE-161398

Journal: NeuroRehabilitation, vol. 40, no. 1, pp. 129-140, 2017