title: Effect of fore-aft seat position on shoulder demands during wheelchair propulsion: part 2. An electromyographic analysis.
abstract: OBJECTIVE
  Shoulder pain is common in persons with complete spinal cord injury. Adjustment of the wheelchair-user interface has been thought to reduce shoulder demands. The purpose of this study was to quantify the effect of seat fore-aft position on shoulder muscle activity during wheelchair propulsion.
  
  
  METHODS
  Shoulder electromyography (EMG) was recorded while 13 men with paraplegia propelled a wheelchair in the following 2 seat positions: (a) shoulder joint center aligned with the wheel axle (anterior) and (b) shoulder joint center 8 cm posterior to the wheel axle (posterior) in 3 test conditions (free, fast, and graded). Duration of EMG activity and median and peak intensities were compared.
  
  
  RESULTS
  During free propulsion, the median EMG intensity of all muscles was similar between anterior and posterior seat positions. The major propulsive muscles (pectoralis major and anterior deltoid) demonstrated significant reductions in their median and peak intensities in the posterior seat position. Pectoralis major median intensity was significantly reduced in the posterior position during fast (52% vs 66% maximal muscle test [MMT]) and graded (41 % vs 49% MMT) conditions, and peak intensity was significantly reduced in the free condition (29% vs 52% MMT) and the fast condition (103% vs 150% MMT). Anterior deltoid intensity was significantly reduced in the posterior position during fast propulsion only (26% vs 31% MMT). For all muscles, EMG duration was similar between positions in all test conditions.
  
  
  CONCLUSIONS
  Reduction in the intensity of the primary push phase muscles (pectoralis major and anterior deltoid) during high-demand activities of fast and graded propulsion may reduce the potential for shoulder muscle fatigue and injuries.
authors.affiliation: Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Building 800, Room 33, Downey, CA, 90242, USA. dgutierrez@larei.org
authors.forename: Dee D
authors.initials: DD
authors.lastname: Gutierrez
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Mulroy
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Newsam
authors.forename: Joanne K
authors.initials: JK
authors.lastname: Gronley
authors.forename: Jacquelin
authors.initials: J
authors.lastname: Perry
mesh_terms: D000054:Acceleration; D000328:Adult; D004576:Electromyography; D004867:Equipment Design; D006801:Humans; D008297:Male; D008875:Middle Aged; D012785:Shoulder Joint / Q000503:physiopathology*; D020069:Shoulder Pain / Q000517:prevention & control; D013314:Stress, Mechanical; D014910:Wheelchairs