Cain, S. M.

Background: Individuals with spinal cord injury (SCI) who use manual wheelchairs (MWCs) have a higher rate of rotator cuff pathology progression than able-bodied individuals. Objectives: This study aimed to test the ability of risk and recovery metrics of arm use to differentiate between (1) MWC users with SCI and matched able-bodied participants (cross-sectional matched-sample study) and (2) MWC users with rotator cuff pathology progression over 1 year from those without pathology progression (longitudinal study). Methods: Thirty-four MWC users and 34 age- and sex-matched able-bodied individuals were recruited. Upper arm risk (humeral elevation >60°) and recovery (static ≥5 seconds and humeral elevation <40°) metrics were calculated from wireless inertial measurement units (IMUs) worn on the upper arms and torso in the free-living environment. Two separate magnetic resonance imaging studies were completed and assessed for a subset of 16 MWC users approximately 1 year apart. Results: The frequency of risk events ( p = .019), summated duration of recovery events ( p = .025), and duration of each recovery event ( p = .003) were higher for MWC users than able-bodied participants. The summated duration of risk events ( p = .047), frequency of risk events ( p = .027), and risk to recovery ratio ( p = .02) were higher and the summated duration of recovery events ( p = .036) and frequency of recovery events ( p = .047) were lower for MWC users with rotator cuff pathology progression ( n = 5) compared to those without progression ( n = 11). Conclusion: IMU-derived metrics quantifying arm use at postures >60° and risk to recovery ratios may provide insights of potential risk factors for rotator cuff pathology progression.