title: Application of a model to analyze shoulder biomechanics in adult patients with spinal cord injury when walking with crutches in two different gait patterns.
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.
authors.affiliation: Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, SESCAM, Toledo, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Perez-Rizo
authors.affiliation: Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, SESCAM, Toledo, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Trincado-Alonso
authors.affiliation: Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, SESCAM, Toledo, Spain.
authors.forename: Soraya
authors.initials: S
authors.lastname: Pérez-Nombela
authors.affiliation: Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, SESCAM, Toledo, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Del Ama-Espinosa
authors.affiliation: Laboratory of Performance and Sports Rehabilitation, Faculty of Sport Science, University of Castilla-La Mancha, Toledo, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Jiménez-Díaz
authors.affiliation: Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, SESCAM, Toledo, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Lozano-Berrio
authors.affiliation: Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, SESCAM, Toledo, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Gil-Agudo
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D003446:Crutches; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012782:Shoulder / Q000503:physiopathology*; D013119:Spinal Cord Injuries / Q000503:physiopathology*
keywords: Rehabilitation; biomechanics; crutches; gait; shoulder; spinal cord injury