UPPER-LIMB FUNCTION IN PERSONS WITH LONG-TERM PARAPLEGIA AND IMPLICATIONS FOR INDEPENDENCE .1.

The intent of this study was to describe the effects of long term para plegia and wheelchair use on upper limb function. Bilateral upper extr emity isokinetic and grip strength, pain, and active range of motion w ere compared in 52 men with paraplegia (mean age 44 years; mean durati on 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 sampl e. Strength was not significantly different between the two samples ex cept for bilateral shoulder flexion (able bodied stronger) and bilater al elbow extension (paraplegia stronger), Strength changed similarly w ith age in the two groups. The effect of duration of SCI on strength, excluding age, was significant for grip strength only. Duration of par aplegia and activity level were better predictors of strength than age in 9 of 14 muscle groups tested, whereas in the able bodied, age was the best strength predictor. Limited bilateral shoulder internal rotat ion and nondominant external rotation were associated with paraplegia (shoulder p < 0.001; elbow p < 0.001; wrist/hand p < 0.001). Reported pain prevalences for the paraplegic sample were: shoulder 39%; elbow 3 1% and wrist/hand 40%. The paraplegic subjects' pain intensity ratings revealed them to be experiencing mild to moderate levels of upper lim b pain. Shoulder pain was associated with duration of injury, exclusiv e of age (p < 0.05). Measurement of the impact of upper limb pain on 1 8 activities of daily living tasks revealed pain to be experienced by the majority of subjects with paraplegia (mobility tasks 60%; self-car e tasks 58%; and general activities tasks 60%). However, only 23-35% h ad made changes in their routines, and 6-16% had sought assistance wit h ADL due to upper limb pain. When age was excluded, it appeared that duration of SCI was more associated with pain during self-care tasks. The tasks most reported to cause upper limb pain were work/ school, sl eep, wheelchair transfers, outdoor wheeling, and driving. These result s suggest that preventative and management steps are required to ensur e 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.