The increased demand on the upper limbs during manual wheelchair use results in a high prevalence of shoulder pathology in people with spinal cord injury (SCI). Because individuals with SCI are dependent on their upper extremities for mobility and daily activities, shoulder dysfunction can present a devastating loss of independence and decreased quality of life. Research on quantification of shoulder loading and muscular demands during wheelchair propulsion, self-transfers, weight-relief raises, and overhead activities is presented. This review examines evidence-based recommendations aimed at preserving shoulder function by addressing environmental factors related to ergonomics, equipment selection, and performance technique and personal factors related to enhancement of the load-bearing capacity of shoulder structure through strengthening and resistance training.

exercise, joint loading, muscular demands electromyography, pain, paraplegia, shoulder, spinal cord injury, tetraplegia, wheelchair
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