Transdisciplinary Approaches for Preserving Shoulder Health in Children and Adults with Spinal Cord Injury/Dysfunction

Abstract

Manual wheelchair mobility places high demands on the upper extremity, often leading to shoulder pain and injuries. Despite existing clinical practice guidelines for upper limb preservation following spinal cord injury/dysfunction (SCI/D), most still experience shoulder pain. These guidelines are applied to children with SCI/D without sufficient evidence of effectiveness over their lifespan. Individuals with pediatric-onset SCI/D live longer with secondary health conditions than those with adult-onset SCI, making it crucial to understand the relationship between shoulder function, pain, and pathology across ages. We are therefore investigating the relationship between pediatric-onset and adult-onset SCI/D manual wheelchair propulsion and their association with shoulder pain and pathology. Together our team is exploring innovative, transdisciplinary strategies to enhance shoulder health and function, leveraging insights from engineering, physiatry, radiology, behavioral science, and data analytics. We are working together to conduct a mixed-methods study integrating quantitative assessments of shoulder function and rotator cuff integrity, and qualitative insights from individuals with SCI/D. Our team is also determining the effects of age at onset and movement variability on rotator cuff and bony forces using personalized musculoskeletal simulations. Results suggest age of onset significantly affects shoulder dynamics and tendon integrity with decreased variability linked to increased shoulder pain and pathology. These findings will ultimately be used to develop age-appropriate rehabilitation guidelines, improving functional independence, participation, and quality of life for individuals with SCI/D. Our transdisciplinary approach is crucial for solving the multifactorial issue of alleviating shoulder dysfunction in manual wheelchair users across the lifespan to develop lasting rehabilitation impacts.