Upper extremity function in long term paraplegia and implications for independence

Abstract

The intent of this study was to describe the effects of long term paraplegia and wheelchair use on upper limb function. Bilateral upper extremity isokinetic and grip strength, pain, and active range of motion were compared in 52 men with paraplegia (mean age 44 years: mean duration of spinal cord injury (SCI) 17 years) and 52 age and activity-level matched able-bodied men. The impact of upper limb pain on activities of daily living (ADL) performance was examined in the paraplegic sample. Strength was not significantly different between the two samples except for bilateral shoulder flexion (able-bodied stronger) and bilateral elbow extension (paraplegia stronger). Strength changed similarly with age in the two groups. The effect of duration of SCI on strength, excluding age, was significant for grip strength only. Duration of paraplegia and activity-level were better predictors of strength than age in 9 of 14 muscle groups, whereas in the able-bodied, age was the best strength predictor. Limited bilateral shoulder internal rotation and non-dominant external rotation were associated with paraplegia. Upper limb pain in the past week was associated with paraplegia (shoulder p<.001; elbow p<.00l; wrist/hand p<.00l). Reported pain prevalences for the paraplegic sample were: shoulder 39%, elbow 31%, wrist/hand 40%. The paraplegic subjects' pain intensity ratings revealed them to be experiencing mild to moderate levels of upper limb pain. Shoulder pain was associated with duration of injury, exclusive of age (p<.05). Measurement of the impact of upper limb pain On 18 activities of daily living (ADL) tasks revealed pain to be experienced by the majority of subjects with paraplegia (mobility tasks 60%; self-care tasks 5 8 % ; general activities tasks 60%). However, only 23-35% had made changes in their routines, and 6-16% had sought assistance with ADL due to upper limb pain. When age was excluded, it appeared that duration of SCI was more associated with pain during ADL, but this was significant only for pain during self-care tasks. The tasks most reported to cause upper limb pain were work/school, sleep, wheelchair transfers, outdoor wheeling, and driving. These results suggest that preventative and management steps are required to ensure continued independence and quality of life in this group over time. The effect of duration of SCI suggests that limitations in upper limb function may be seen in this population at relatively young ages.