[논문]수동 휠체어 추진 속도에 따른 상지 관절 생체역학적 영향 분석

황선홍

doi:10.9718/jber.2022.43.4.241

수동 휠체어 추진 속도에 따른 상지 관절 생체역학적 영향 분석
Upper Extremity Biomechanics of Manual Wheelchair Propulsion at Different Speeds 원문보기

Journal of biomedical engineering research : the official journal of the Korean Society of Medical & Biological Engineering, v.43 no.4, 2022년, pp.241 - 250

황선홍 (호서대학교 생명보건대학 물리치료학과, 호서대학교 스마트헬스케어융복합연구센터, 호서대학교 기초과학연구소)

Abstract ▼ AI-Helper

It is known that chronic pain and injury of upper limb joint tissue in manual wheelchair users is usually caused by muscle imbalance, and the propulsion speed is reported to increase this muscle imbalance. In this study, kinematic variables, electromyography, and ultrasonographic images of the upper limb were measured and analyzed at two different propulsion speeds to provide a quantitative basis for the risk of upper extremity joint injury. Eleven patients with spinal cord injury for the experimental group (GE) and 27 healthy adults for the control group (GC) participated in this study. Joint angles and electromyography were measured while subjects performed self-selected comfortable and fast-speed wheelchair propulsion. Ultrasound images were recorded before and after each propulsion task to measure the acromiohumeral distance (AHD). The range of motion of the shoulder (14.35 deg in GE; 20.24 deg in GC) and elbow (5.25 deg in GE; 2.57 deg in GC) joints were significantly decreased (p<0.001). Muscle activation levels of the anterior deltoid, posterior deltoid, biceps brachii, and triceps brachii increased at fast propulsion. Specifically, triceps brachii showed a significant increase in muscle activation at fast propulsion. AHD decreased at fast propulsion. Moreover, the AHD of GE was already narrowed by about 60% compared to the GC from the pre-tests. Increased load on wheelchair propulsion, such as fast propulsion, is considered to cause upper limb joint impingement and soft tissue injury due to overuse of the extensor muscles in a narrow joint space. It is expected that the results of this study can be a quantitative and objective basis for training and rehabilitation for manual wheelchair users to prevent joint pain and damage.

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표/그림 (7)

그림 그림 1. 측정장비 (a) 관성센서(EBIMU24GV3, E2box Co., KOR), (b) 휴대용 초음파 영상측정기기(Vscan, GE Healthcare Co., USA), (c) 근전도 측정시스템(Trigno, Delsys Co., USA) Fig. 1. Measurement systems. (A) inertia measurement unit (IMU) (EBIMU24GV3, E2box Co., KOR), (B) ultrasonography device (Vscan, GE Healthcare Co., USA), (C) electromyogram measurement system (Trigno, Delsys Co., USA)
그림 그림 2. IMU 센서 부착 위치 Fig. 2. IMU sensor attachment location on the subjects' body
그림 그림 3. (a) 어깨관절 견봉하 공간 초음파 영상 획득, (b) 영상분석 소프트웨어를 이용한 경봉-상완골 거리(AHD) 측정 Fig. 3. (a) Recording of ultrasonography on shoulder joint and measurement of AHD using image processing software
그림 그림 4. 추진 속도에 따른 어깨와 팔꿈지 관절 가동범위의 그룹내 비 교 및 그룹간 비교 Fig. 4. Comparison of shoulder and elbow joint range of motion for two different propulsion speeds (a) within and (b) between groups. (V_C: self-selected comfortable speed propulsion; V_F: fast speed propulsion; ROM_SH: shoulder joint range of motion; ROM_EL: elbow joint range of motion; G_E: experimental group; G_C: control group), Asterisks (*) indicate differences of statistical significance (p<0.05) within the groups determined by the Wilcoxon signed rank test or between the groups determined by the Mann-Whitney U-test
표 표 1. 실험군 대상자 신체적, 임상적 특징 Table 1. Subject characteristics of experimental group
그림 그림 5. 추진 속도에 따른 상지 주요 근육의 근활성도 그룹내 비교 및 그룹간 비교 Fig. 5. Comparison of muscle activation levels for two different propulsion speeds within and between groups; (a) within experimental group, (b) within control group, (c) between groups for each speed, and (d) between groups for difference between speeds. (V_C: self-selected comfortable speed propulsion; VF: fast speed propulsion; DA: deltoid anterior; DP: deltoid posterior; BB: biceps brachii; TB: triceps brachii; G_E: experimental group; G_C: control group), Asterisks (*) indicate differences of statistical significance (p<0.05) within the groups determined by the Wilcoxon signed rank test or between the groups determined by the Mann-Whitney U-test
그림 그림 6. 2가지 서로 다른 휠체어 추진 속도에 따른 평균 견봉-상완골 거리 변화량 집단내, 집단간 비교 Fig. 6. Comparison of mean acromiohumeral distance (AHD) for two different propulsion speeds. (ΔAHD_C: percentage difference between AHD_Pre and AHD_C; ΔAHD_F: percentage difference between AHD_Pre and AHD_F), Asterisks (*) indicate differences of statistical significance (p<0.05) within the groups determined by the Wilcoxon signed rank test or between the groups determined by the Mann-Whitney U-test

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