Debilitating shoulder pain is prevalent among wheelchair users, however the causes remain unknown. Shoulder pain is reported to be greater among those who began wheeling after skeletal maturity (adulthood-onset, AO) than among those who began wheeling prior to skeletal maturity (childhood-onset, CO). It is unclear whether functional load-bearing from manual wheelchair use affects glenohumeral bone and cartilage morphology. Bone is known to adapt to loading, however the literature is conflicting regarding cartilage’s capacity to adapt to loading. We performed a pilot study to quantify bone and cartilage morphology at the glenohumeral joint of manual wheelchair users (nCO=3, nAO=5) and age- and gender-matched able-bodied controls (nC=8). Bone morphology (volumetric bone mineral density (vBMD) and normalized cross-sectional area (nCSA)) was evaluated using quantitative computed tomography. Bone density distribution was assessed across the glenoid and, for the first time, across the humeral head using a novel quantitative CT-Osteoabsorptiometry method. Cartilage morphology (thickness, volume, and surface area) was evaluated using quantitative magnetic resonance imaging, in the first assessment at 3T MRI. This novel combination of methods provides complementary quantitative data of glenohumeral bone and cartilage morphology. Compared to the AO, the CO in our study had significantly higher (p<0.05) glenoid subchondral nCSA, non-significantly lower glenoid subchondral vBMD, and non-significantly higher humeral head and glenoid trabecular vBMD. A reasonable cross-sectional study (n=22) would likely show higher humeral head and glenoid trabecular vBMD and glenoid subchondral nCSA in CO subjects but would not find differences in nCSA of humeral head total, trabecular, and cortical bone, or glenoid trabecular bone. Surprisingly, vBMD was (non-significantly) lower in the wheelchair users than in the able-bodied controls, however activity levels varied considerably. Significant correlations were found between humeral head and glenoid trabecular vBMD (r=0.94), and between humeral head trabecular vBMD and physical activity scores (r=0.84). Given the small effect sizes and the large variance in humeral head and glenoid cartilage thickness, volume, and surface area, it is not likely that further study of these parameters would provide insight into wheelchair users’ shoulder pain. Gaining a better understanding of how glenohumeral bone and cartilage respond to wheelchair use would allow for rehabilitation programs and wheelchair-design to be tailored to childhood-onset and adulthood-onset wheelchair users.

Debilitating shoulder pain is prevalent among wheelchair users, however the causes remain unknown. Shoulder pain is reported to be greater among those who began wheeling after skeletal maturity (adulthood-onset, AO) than among those who began wheeling prior to skeletal maturity (childhood-onset, CO). It is unclear whether functional load-bearing from manual wheelchair use affects glenohumeral bone and cartilage morphology. Bone is known to adapt to loading, however the literature is conflicting regarding cartilages capacity to adapt to loading. We performed a pilot study to quantify bone and cartilage morphology at the glenohumeral joint of manual wheelchair users (nCO=3, nAO=5) and age- and gender-matched able-bodied controls (nC=8). Bone morphology (volumetric bone mineral density (vBMD) and normalized cross-sectional area (nCSA)) was evaluated using quantitative computed tomography. Bone density distribution was assessed across the glenoid and, for the first time, across the humeral head using a novel quantitative CT-Osteoabsorptiometry method. Cartilage morphology (thickness, volume, and surface area) was evaluated using quantitative magnetic resonance imaging, in the first assessment at 3T MRI. This novel combination of methods provides complementary quantitative data of glenohumeral bone and cartilage morphology. Compared to the AO, the CO in our study had significantly higher (p<0.05) glenoid subchondral nCSA, non-significantly lower glenoid subchondral vBMD, and non-significantly higher humeral head and glenoid trabecular vBMD. A reasonable cross-sectional study (n=22) would likely show higher humeral head and glenoid trabecular vBMD and glenoid subchondral nCSA in CO subjects but would not find differences in nCSA of humeral head total, trabecular, and cortical bone, or glenoid trabecular bone. Surprisingly, vBMD was (non-significantly) lower in the wheelchair users than in the able-bodied controls, however activity levels varied considerably. Significant correlations were found between humeral head and glenoid trabecular vBMD (r=0.94), and between humeral head trabecular vBMD and physical activity scores (r=0.84). Given the small effect sizes and the large variance in humeral head and glenoid cartilage thickness, volume, and surface area, it is not likely that further study of these parameters would provide insight into wheelchair users shoulder pain. Gaining a better understanding of how glenohumeral bone and cartilage respond to wheelchair use would allow for rehabilitation programs and wheelchair-design to be tailored to childhood-onset and adulthood-onset wheelchair users.

Introduction : Bien que les bienfaits de l’Activité Physique (AP) soient largement reconnus, les Utilisateurs de Fauteuil roulant Manuel Pédiatriques (UFMP) ne respectent pas les recommandations canadiennes en matière d’AP quotidienne. Les cours d’Éducation Physique (ÉP) offrent une opportunité d’accroître leur niveau d’AP. Cependant, de nombreux enseignants d’ÉP au Québec ne sont pas familiers avec les habiletés en fauteuil roulant manuel et ne se sentent pas suffisamment préparés pour adapter leurs cours d’ÉP aux besoins des UFMP. Afin de combler cette lacune, ce mémoire de maîtrise vise à identifier les habiletés en fauteuil roulant manuel qui sont utiles à la participation des UFMP aux cours d'ÉP, ainsi que les facteurs contextuels influençant leur participation à ces cours. Méthodes : Une approche qualitative descriptive a été utilisée. Les méthodes d’échantillonnage par convenance et par boule de neige ont été utilisées pour recruter 7 enseignants d’ÉP et 5 UFMP. Des entretiens individuels semi-structurés et un groupe de discussion en ligne ont été menés respectivement avec les 7 enseignants d’ÉP et les 5 UFMP. Les données ont été analysées à l’aide de statistiques descriptives et d’une analyse thématique déductive basée sur le cadre conceptuel de la Classification Internationale, du Fonctionnement, du handicap et de la Santé (CIF). L'accent a été mis spécifiquement sur les composantes : "Activités", "facteurs liés à l’environnement social", et "facteurs liés à l’environnement physique et instrumental". Résultats : Plusieurs habiletés (activités selon la CIF) permettant de se déplacer à l’intérieur et quelques habiletés permettant de se déplacer dans la communauté ont été identifiées comme utiles pour favoriser la participation des UFMP aux cours d'ÉP. Plusieurs stratégies d'adaptation ont été mises en place par les enseignants d'ÉP pour promouvoir l'inclusion et la participation des UFMP aux cours d'ÉP. Cependant, la faible acquisition de ces habiletés par les UFMP et leur faible intégration par les enseignants dans les cours d'ÉP constituent des obstacles à la participation des UFMP aux AP. Conclusion : Il est essentiel de développer un programme d’entraînement basé sur les habiletés en fauteuil roulant manuel identifiées comme étant utiles afin de doter les enseignants des compétences nécessaires pour l'intégration efficace des UFMP dans les cours d'ÉP. / Introduction: Despite the benefits of physical activity (PA) being widely recognized, Pediatric Manual Wheelchair Users (PMWUs) do not adhere to Canadian recommendations for daily PA. Physical Education (PE) classes provide opportunities for developing skills and knowledge required for PA participation in children. However, many PE teachers in Quebec do not have the knowledge about the wheelchair skills necessary to facilitate participation of PMWUs in PE. To address this gap, this master's thesis aimed to identify manual wheelchair skills that are useful for the participation of PMWUs in PE classes, while also examining the contextual factors that influence their participation in these classes. Methods: A qualitative descriptive approach was used. Convenience and snowball sampling methods were used to recruit seven PE teachers and five PMWUs. Online individual semi-structured interviews and an online focus group were conducted with seven PE teachers and five PMWUs, respectively. Data were analyzed using descriptive statistics and a deductive thematic analysis based on the International Classification of Functioning, Disability and Health (ICF) framework. The focus was specifically on the components: "activities", "social environmental factors», and "physical and instrumental environmental factors". Results: Several manual skills for moving indoors and some skills for moving within the community were identified as useful to promote the participation of PMWUs in PE classes. Various adaptation strategies were implemented by PE teachers to enhance the inclusion and participation of PMWUs in PE classes. However, the limited acquisition of these skills by PMWUs and their inadequate integration by teachers into PE classes represent significant barriers to the participation of PMWUs in PE classes. Conclusion: It is essential to develop a training program for PE teachers, based on the manual wheelchair skills identified as useful in order to equip them with the necessary competencies for effective integration of PMWUs into PE classes.