title: Neck discomfort of wheelchair users: effect of neck position.
abstract: OBJECTIVE
  To test the hypothesis that wheelchair users experience more discomfort when holding their necks in extended and/or rotated positions than when in their self-selected most comfortable positions (MCPs).
  
  
  METHODS
  We studied 20 wheelchair users, first determining their MCPs with the eyes closed. Then, subjects assumed and maintained (for 5 min each) four neck positions in random order: level (L) and elevated (E), both straight ahead of the subject (S) and with the neck rotated (R). We measured neck extension angles (from digital photographs) and neck discomfort (using visual analogue scales [VAS], in %).
  
  
  RESULTS
  The mean neck-extension angles were MCP - 2.6 degrees, LS 9.5 degrees, LR 8.1 degrees, ES 23.9 degrees and ER 25.4 degrees (ANOVA p < 0.0001). The mean VAS neck discomfort scores were LS 5.7%, LR 17.4%, ES 24.0% and ER 34.1% (ANOVA p < 0.0001).
  
  
  CONCLUSIONS
  Sustained extension and rotation of the neck, alone or in combination, increase the neck discomfort of wheelchair users. The MCP for most wheelchair users is straight ahead with the neck slightly flexed, about 11 degrees and 27 degrees more flexed, respectively, than when looking at an average-height sitting or standing person. These findings have implications for wheelchair design, the behaviour of clinicians and wheelchair users, and the built environment.
authors.affiliation: Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Nova Scotia, Canada. kirby@dal.ca
authors.forename: R Lee
authors.initials: RL
authors.lastname: Kirby
authors.forename: Christine L
authors.initials: CL
authors.lastname: Fahie
authors.forename: Cher
authors.initials: C
authors.lastname: Smith
authors.forename: Emma L
authors.initials: EL
authors.lastname: Chester
authors.forename: Donald A
authors.initials: DA
authors.lastname: Macleod
mesh_terms: D005260:Female; D019416:Head Movements; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000503:physiopathology; D019547:Neck Pain / Q000209:etiology* / Q000523:psychology; D010147:Pain Measurement; D012399:Rotation; D014910:Wheelchairs / Q000009:adverse effects*