EAGER: Advancement of Computational Modeling to Understand Mechanisms of Neonatal Brachial Plexus Injury

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Neonatal brachial plexus palsy (NBPP) occurs at a rate of 1/1000 births, with 10-20% of children who sustain the injury experiencing a permanent paralysis of some or all of the muscles in one of their arms. It occurs when the nerves that supply the arm – the brachial plexus – is injured. It is widely accepted that the vast majority of NBPP are biomechanical in nature and occur during the birth process. An improved understanding of the mechanisms through which the brachial plexus is stretched during the birth process is necessary in order to better inform clinical interventions and decision making that may reduce the occurrence or severity of the injury. Computational modeling provides the best approach to understand the mechanism of injury in a vulnerable population, such as newborns. This project will develop an advanced computational model to represent natural biological variability and the full process of delivery in order to investigate the mechanism of NBPP. The paralysis that results from NBPP can result in a lifelong disability, as it affects motor innervation of the entire upper extremity. Before new recommendations for clinical interventions and decision making can be developed, it is imperative that the mechanism of injury is more completely understood. Once developed and validated, this model will serve as a foundation for future computational work to investigate the mechanisms of other biomechanical injuries that occur during the birth process – including potentially vascular injuries (e.g. cerebral hemorrhages) and bony fractures. In addition to the scientific impact, the research team will work with established outreach programs at Michigan State to explain the importance of biomechanics in understanding how injuries occur and to excite the public about the field of biomechanics. Modules developed for outreach will be made available in virtual formats, which will broaden the reach of these materials.Two scientific objectives have been established to support the goal of this project: 1) to develop an advanced model that combines finite element and rigid body modeling methods to mimic the appropriate boundary conditions and delivery forces involved with the occurrence of NBPP; and 2) to utilize the model to parametrically investigate the factors that affect the stretch that occurs in the brachial plexus during the birth process, which subsequently increases the risk of injury. The model will integrate and advance techniques related to modeling of biological soft tissues, including non-linear soft tissue structures of complex geometries and active muscle tissue. It will significantly advance the science of NBPP biomechanics by including advanced modeling for both maternal and neonatal tissues, a novel approach within the field.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.