• Fransiska M Bossuyt, Ursina Arnet, Ann Cools, Stephanie Rigot, Wiebe de Vries, Inge Eriks-Hoogland, Michael L Boninger, and SwiSCI Study Group.
• From the Shoulder Health & Mobility Group, Swiss Paraplegic Research, Nottwil, Switzerland (FMB, UA, WdV); Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland (FMB, UA, WdV); Department of Rehabilitation Sciences and Physiotherapy, University of Ghent, Gent, Belgium (AC); Department of Occupational and Physical Therapy and Institute of Sports Medicine, Bispebjerg Hospital, University of Copenhagen, København, Denmark (AC); Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Department of Veterans Affairs, Pittsburgh, Pennsylvania (SR, MLB); Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania (SR, MLB); Swiss Paraplegic Centre, Nottwil, Switzerland (IE-H); Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania (MLB); and Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania (MLB).
• Am J Phys Med Rehabil. 2020 Feb 1; 99 (2): 91-98.

ObjectiveThe aims of the study were to examine whether fatigue-inducing wheelchair propulsion changes neuromuscular activation and propulsion biomechanics and to determine predictor variables for susceptibility to fatigue.DesignThis study with a quasi-experimental, one-group, pretest-posttest design investigates a population-based sample of wheelchair users with a spinal cord injury (n = 34, age: 50.8 ± 9.7 yrs, 82% males). Neuromuscular activation and propulsion biomechanics during treadmill propulsion at 25 W and 45 W were assessed before and after a protocol designed to cause fatigue.ResultsWith the induced fatigue, wheelchair users propelled with increased neuromuscular activation in the pectoralis major pars sternalis, deltoideus pars acromialis and upper trapezius (45 W, P < 0.05), and a slightly reduced push angle (25 W: 75-74 degrees, P < 0.05, 45 W: 78-76 degrees, P < 0.05). Wheelchair users susceptible to fatigue (47%) were more likely to have a complete lesion, to be injured at an older age, and had less years since injury. This group propelled in general with shorter push angle and greater maximum resultant force, had a greater anaerobic capacity, and had less neuromuscular activation.ConclusionsCompensation strategies in response to fatiguing propulsion could increase the risk for shoulder injury. Predictor variables for susceptibility to fatigue inform interventions preserving shoulder health and include lesion characteristics, propulsion technique, anaerobic capacity, and neuromuscular activation.To Claim Cme CreditsComplete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Explain a neuromuscular compensation strategy and the corresponding muscles in response to fatiguing wheelchair propulsion; (2) Recommend propulsion biomechanics associated to reduced susceptibly to fatiguing wheelchair propulsion; and (3) List examples of predictor variables of susceptibility to fatigue.LevelAdvanced.AccreditationThe Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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