{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T02:15:00Z","timestamp":1793067300702,"version":"4.5.0"},"reference-count":50,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,4,6]],"date-time":"2018-04-06T00:00:00Z","timestamp":1522972800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Shoulder dysfunction is common in persons with spinal cord injury (SCI) with an incidence of up to 63%. Dysfunction is a result of muscle imbalances, specifically denervated rotator cuff muscles that are repetitively used during manual wheelchair propulsion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine which arm stroke technique, pump (P) or semicircular (SC), is most energy efficient for long periods of propulsion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A randomized study with repeated measures observations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>The study was performed at an institutional gait analysis laboratory.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>18 able\u2010bodied (AB) male participants were studied and randomized into one of 2 conditions, SC or P.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Shoulder muscle fatigue was measured by changes in Borg CR10 Rate of Perceived Exertion (Borg RPE) and upper extremity strength via a handheld dynamometer. Participants were studied and assigned into one of 2 conditions of wheelchair arm propulsion patterns, SC or P group, and propelled on a wheelchair treadmill for 10 minutes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>The primary outcomes included recordings of Borg RPE scale during continuous wheelchair propulsion and pre\u2010 and post\u2010test dynamometer testing means for bilateral elbow and shoulder extension. Analysis of covariance, <jats:italic>t<\/jats:italic>\u2010tests, and Kruskal\u2010Wallis tests were used in analyzing data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Although not significant (<jats:italic>P<\/jats:italic> = .23), the Borg RPE scores for the SC condition were consistently higher than the scores for the P condition. In addition, the dynamometer pre\u2010 and post\u2010test readings demonstrated a larger decrease for the SC condition participants than for the P condition participants, but were not statistically significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These data demonstrate that the SC wheelchair propulsion pattern appears to be more fatiguing to shoulder muscles than the P propulsion pattern. However, more data would need to be collected to find a significant difference.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>II<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.pmrj.2018.03.022","type":"journal-article","created":{"date-parts":[[2018,4,6]],"date-time":"2018-04-06T07:56:51Z","timestamp":1523001411000},"page":"1004-1011","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Effect of Wheelchair Stroke Pattern on Upper Extremity Muscle Fatigue"],"prefix":"10.1002","volume":"10","author":[{"given":"Brittany","family":"Bickelhaupt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakiko","family":"Oyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Benfield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Burau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuko","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Trbovich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,4,6]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002508-199206000-00005"},{"key":"e_1_2_7_3_2","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/S0003-9993(99)90285-X","article-title":"Shoulder pain in wheelchair users with tetraplegia and paraplegia","volume":"80","author":"Curtis K.A.","year":"1999","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.sc.3100802"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1080\/10790268.2004.11753724"},{"key":"e_1_2_7_6_2","first-page":"132","article-title":"Late complications of the weight bearing upper extremity in the paraplegic patient","volume":"233","author":"Gellman H.","year":"1998","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2010.05.004"},{"key":"e_1_2_7_8_2","volume-title":"Spinal Cord Medicine: Principles and Practice","author":"Lin V.W.","year":"2010"},{"key":"e_1_2_7_9_2","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1243\/0954411041561027","article-title":"Muscle forces analysis in the shoulder mechanism during wheelchair propulsion","volume":"218","author":"Lin H.T.","year":"2004","journal-title":"Proc Inst Mech Eng H"},{"key":"e_1_2_7_10_2","first-page":"177","article-title":"Prevalence of shoulder discomfort in paraplegic subjects","volume":"83","author":"Pelligrini A.","year":"2012","journal-title":"Acta Biomed"},{"key":"e_1_2_7_11_2","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1053\/apmr.2001.21855","article-title":"Chronic pain associated with spinal cord injuries: A community survey","volume":"82","author":"Turner J.A.","year":"2008","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.medengphy.2005.12.001"},{"issue":"272","key":"e_1_2_7_13_2","first-page":"141","article-title":"Shoulder pain and functional disability in spinal cord injury","author":"Silfverskiold J.","year":"1991","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_2_7_14_2","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1080\/10790268.2005.11753840","article-title":"Biomechanics and strength of manual wheelchair users","volume":"28","author":"Ambrosio F.","year":"2005","journal-title":"J Spinal Cord Med"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198769050-00006"},{"key":"e_1_2_7_16_2","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1080\/10790268.2004.11753742","article-title":"Upper limb pain in a national sample of veterans with paraplegia","volume":"27","author":"Gironda R.J.","year":"2004","journal-title":"J Spinal Cord Med"},{"key":"e_1_2_7_17_2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1080\/10790268.1995.11719374","article-title":"Prevalence and impact of wrist and shoulder pain in patients with spinal cord injury","volume":"18","author":"Subbarao J.V.","year":"1994","journal-title":"J Spinal Cord Med"},{"key":"e_1_2_7_18_2","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1682\/JRRD.2012.06.0109","article-title":"Coordination patterns of shoulder muscles during level\u2010ground and incline wheelchair propulsion","volume":"50","author":"Qi L.","year":"2013","journal-title":"J Rehabil Res Dev"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659302100213"},{"key":"e_1_2_7_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2008.05.015"},{"key":"e_1_2_7_21_2","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1038\/sj.sc.3100608","article-title":"Premature degenerative shoulder changes in spinal cord injury patients","volume":"36","author":"Lal S.","year":"1998","journal-title":"Spinal Cord"},{"key":"e_1_2_7_22_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.sc.3101490"},{"key":"e_1_2_7_23_2","first-page":"401","article-title":"Shoulder imaging abnormalities in individuals with paraplegia","volume":"38","author":"Boninger M.L.","year":"2001","journal-title":"J Rehabil Res Dev"},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.168.4.9124140"},{"key":"e_1_2_7_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004728-200001000-00028"},{"key":"e_1_2_7_26_2","doi-asserted-by":"publisher","DOI":"10.1038\/sc.1988.20"},{"key":"e_1_2_7_27_2","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1007\/s002560050184","article-title":"Does osteolysis of the distal clavicle occur following spinal cord injury?","volume":"26","author":"Roach N.A.","year":"1997","journal-title":"Skeletal Radiol"},{"key":"e_1_2_7_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02580386"},{"key":"e_1_2_7_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2006.04.010"},{"key":"e_1_2_7_30_2","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/1050-6411(91)90014-V","article-title":"Load on the upper extremity in manual wheelchair propulsion","volume":"4","author":"Veeger H.E.J.","year":"1991","journal-title":"J Electromyogr Kinesiol"},{"key":"e_1_2_7_31_2","first-page":"210","article-title":"Kinematic characterization of wheelchair propulsion","volume":"35","author":"Shimada S.D.","year":"1998","journal-title":"J Rehabil Res Dev"},{"key":"e_1_2_7_32_2","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1097\/01.PHM.0000133437.58810.C6","article-title":"Effect of wheelchair stroke pattern on efficiency","volume":"83","author":"Groot S.","year":"2004","journal-title":"Am J Phys Med Rehabil"},{"key":"e_1_2_7_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9290(85)90277-5"},{"key":"e_1_2_7_34_2","doi-asserted-by":"crossref","first-page":"197","DOI":"10.2340\/165019778921197203","article-title":"Wheelchair propulsion technique at different speeds","volume":"21","author":"Veeger H.E.","year":"1989","journal-title":"Scand J Rehabil Med"},{"key":"e_1_2_7_35_2","doi-asserted-by":"publisher","DOI":"10.1080\/10790268.2005.11753844"},{"key":"e_1_2_7_36_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199809000-00016"},{"key":"e_1_2_7_37_2","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2008.139"},{"key":"e_1_2_7_38_2","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1682\/JRRD.2011.01.0009","article-title":"Changes in surface electromyography signals and kinetics associated with progression of fatigue at two speeds during wheelchair propulsion","volume":"49","author":"Qi L.","year":"2012","journal-title":"J Rehabil Res Dev"},{"key":"e_1_2_7_39_2","first-page":"454","article-title":"Strength testing with a portable dynamometer: Reliability for upper and lower extremities","volume":"68","author":"Agre J.C.","year":"1987","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_7_40_2","doi-asserted-by":"publisher","DOI":"10.1080\/00140139408964911"},{"key":"e_1_2_7_41_2","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1682\/JRRD.2003.01.0027","article-title":"Upper\u2010limb fatigue\u2010related joint power shifts in experienced wheelchair users and nonwheelchair users","volume":"40","author":"Rodgers M.M.","year":"2003","journal-title":"J Rehab Res Dev"},{"key":"e_1_2_7_42_2","doi-asserted-by":"publisher","DOI":"10.1186\/1746-1340-15-4"},{"key":"e_1_2_7_43_2","first-page":"776","article-title":"IPAQ interview version: Convergent validity with accelerometers and comparison of physical activity and sedentary time levels with self\u2010administered version","volume":"55","author":"Van Dyck D.D.","year":"2015","journal-title":"J Sports Med Phys Fitness"},{"key":"e_1_2_7_44_2","doi-asserted-by":"crossref","first-page":"150","DOI":"10.32098\/mltj.03.2013.06","article-title":"Instruments and techniques for the analysis of wheelchair propulsion and upper extremity involvement in patients with spinal cord injuries: current concept review","volume":"3","author":"Dellabianca F.","year":"2013","journal-title":"Muscles Ligaments Tendons J"},{"key":"e_1_2_7_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2007.08.141"},{"key":"e_1_2_7_46_2","volume-title":"An Introduction to Borg's RPE\u2010Scale","author":"Borg G.","year":"1985"},{"key":"e_1_2_7_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0001-6918(01)00055-5"},{"key":"e_1_2_7_48_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0838.2005.00448.x"},{"key":"e_1_2_7_49_2","doi-asserted-by":"publisher","DOI":"10.1053\/apmr.2002.32455"},{"key":"e_1_2_7_50_2","doi-asserted-by":"crossref","unstructured":"L.Qi J.Wakeling S.Grange M.Ferguson\u2010Pell.Patterns of shoulder muscle coordination vary between wheelchair propulsion techniques.Trans Neural Syst Rehabil Eng2013.","DOI":"10.1109\/TNSRE.2013.2266136"},{"key":"e_1_2_7_51_2","doi-asserted-by":"crossref","first-page":"459","DOI":"10.3109\/17483107.2011.650781","article-title":"The effects of four different stroke patterns on manual wheelchair propulsion and upper limb muscle strain","volume":"7","author":"Kwarciak A.M.","year":"2012","journal-title":"Disabil Rehabil Assist Technol"}],"container-title":["PM&amp;R"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1016%2Fj.pmrj.2018.03.022","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1934148217300758?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1934148217300758?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.pmrj.2018.03.022","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T13:05:58Z","timestamp":1694696758000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1016\/j.pmrj.2018.03.022"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,6]]},"references-count":50,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2018,10]]}},"alternative-id":["10.1016\/j.pmrj.2018.03.022"],"URL":"https:\/\/doi.org\/10.1016\/j.pmrj.2018.03.022","archive":["Portico"],"relation":{},"ISSN":["1934-1482","1934-1563"],"issn-type":[{"value":"1934-1482","type":"print"},{"value":"1934-1563","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4,6]]},"assertion":[{"value":"2017-02-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-03-21","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-04-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}