People who use a manual wheelchair as their primary or
only source of locomotion are subject to shoulder problems
after several years of usage. The length of time
before the onset of shoulder problems can vary from 5
to 20 years, depending on factors such as the age of the
individual, the level of injury, and the type of use.
Moreover, people frequently adopt techniques for transfers,
loading their wheelchairs, and miscellaneous upper
extremity activities that are responsible for part of the
shoulder problems experienced later.1–3 This complication
may compromise people’s daily activities, cause them various degrees of pain, and in its most severe
form may result in turning a person who was initially
paraplegic into someone who is functionally tetraplegic.4
The structure of the human shoulder joint is not
optimal for locomotion. Its purpose is primarily to position
the hand, to be able to lift weights, and to counterbalance
the walking motion. People with paraplegia due
to spinal cord injury (SCI) are particularly at risk for
developing shoulder problems and pain because their
average age of onset is about 40 years of age and as a
group they are now experiencing near-normal life expectancies5
In one of our studies conducted by the rehabilitation
research and training center on aging with SCI, it was discovered that approximately 40% of people