Preserving transfer independence among individuals with spinal cord injury

Study design: Literature review. Objectives: Upper extremity (UE) joint degeneration, particularly at the sh oulder, detrimentally influences functional independence, quality of life, cardiovascular disease risk, and life expectancy of individuals following s pinal cord injury (SCI). This review (1) describes UE use for transfers amo ng individuals with SCI; (2) describes contributing factors associated with UE joint degeneration and loss of transfer independence; (3) summarizes an d identifies gaps in existing research; and (4) provides suggestions for fu ture research. Results: Investigations of wheelchair transfer related UE joint and functio n preservation among individuals with SCI should consider factors including age and length of time from SCI onset, interface between subject-wheelchai r, pain, shoulder joint range of motion (ROM) and muscle strength deficienc ies or imbalances, exercise capacity and tolerance for the physical strain of activities of daily living (ADL), body mass and composition, previous UE injury or disease history, and transfer techniques. Existing studies of tr ansfers among individuals with SCI have relied on small groups of either as ymptomatic or non-impaired subjects, with minimal integration of kinematic, kinetic and electromyographic data. Descriptions of UE joint ROM, forces, and moments produced during transfers are lacking. Conclusions: Biomechanical measurement and computer modeling have provided increasingly accurate tools for acquiring the data needed to guide interven tion planning to prevent UE joint degeneration and preserve function among individuals with SCI. The identification of stressful sub-components during transfers will enable intervening clinicians and engineers who design and modify assistive and adaptive devices to better serve individuals with SCI.