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Abstract
OBJECTIVE To examine the prevalence of joint contractures in the upper limb and association with voluntary strength, innervation status, functional status, and demographics in a convenience sample of individuals with cervical spinal cord injury to inform future prospective studies. DESIGN Cross-sectional convenience sampled pilot study. SETTING Department of Veterans Affairs Research Laboratory. PARTICIPANTS Thirty-eight participants with cervical level spinal cord injury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Contractures were measured with goniometric passive range of motion. Every joint in the upper extremity was evaluated bilaterally. Muscle strength was measured with manual muscle testing. Innervation status was determined clinically with surface electrical stimulation. Functional independence was measured with the Spinal Cord Independence Measure III (SCIM-III). RESULTS Every participant tested had multiple joints with contractures and, on average, participants were unable to achieve the normative values of passive movement in 52% of the joints tested. Contractures were most common in the shoulder and hand. There was a weak negative relationship between percentage of contractures and time post-injury and a moderate positive relationship between percentage of contractures and age. There was a strong negative correlation between SCIM-III score and percentage of contractures. CONCLUSIONS Joint contractures were noted in over half of the joints tested. These joint contractures were associated with decreased functional ability as measured by the SCIM-III. This highlights the need the need for detailed evaluation of the arm and hand early after injury as well as continued monitoring of joint characteristics throughout the life course of the individual with tetraplegia.
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Affiliation(s)
- Dustin Hardwick
- Cleveland FES Center, Cleveland, Ohio, USA,Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA,School of Physical Therapy and Rehabilitation Sciences, University of South Florida, Florida, USA,Correspondence to: Dustin Hardwick, PT, DPT, PhD, School of Physical Therapy and Rehabilitation Sciences, University of South Florida Morsani College of Medicine, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766, USA.
| | - Anne Bryden
- Cleveland FES Center, Cleveland, Ohio, USA,Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA,Department of Orthopedics, MetroHealth Medical Center, Cleveland, Ohio, USA,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Gina Kubec
- Cleveland FES Center, Cleveland, Ohio, USA,Cleveland State University, Cleveland, Ohio, USA
| | - Kevin Kilgore
- Cleveland FES Center, Cleveland, Ohio, USA,Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA,Department of Orthopedics, MetroHealth Medical Center, Cleveland, Ohio, USA,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
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