Quantification of Musculoskeletal Structural Adaptations Underlying Passive Wrist Joint Properties in Children and Adults with Hemiparetic Cerebral Palsy

偏瘫脑瘫儿童和成人被动腕关节特性下的肌肉骨骼结构适应性的量化

• 批准号: 10538153
• 负责人: Divya Joshi
• 金额: $ 4.2万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-12 至 2024-09-11
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10538153
• 关键词: 18 year old; Adult; Affect; Algorithms; Anatomy; Anisotropy; Articular Range of Motion; Biological Markers; Biomechanics; Birth; Brain; Brain Injuries; Cerebral Palsy; Child; Childhood; Clinical; Clinical Treatment; Collagen; Connective Tissue; Contracture; Deformity; Deterioration; Development; Devices; Diffusion; Diffusion Magnetic Resonance Imaging; Distal; Ensure; Extensor; Extracellular Matrix; Fascicle; Fellowship; Fiber; Fibrosis; Fingers; Flexor; Forearm; Goals; Hand functions; Imaging Techniques; Impairment; Individual; Intramuscular; Joints; Knowledge; Lead; Length; Limb structure; Link; Longevity; Magnetic Resonance; Measurement; Measures; Mechanics; Methods; Modality; Morphology; Motor; Movement Disorders; Muscle; Muscle Fibers; Musculoskeletal; Musculoskeletal Development; Nervous System Trauma; Operative Surgical Procedures; Pain; Paresis; Passive Range of Motion function; Patients; Pharmacological Treatment; Physical therapy; Population; Positioning Attribute; Prevention; Production; Property; Quality of life; Rehabilitation therapy; Research; Resistance; Secondary to; Side; Skeletal Muscle; Structure; Techniques; Testing; Time; Tissues; Torque; Work; Wrist; Wrist joint; arm; arm paresis; base; biomechanical test; bone; clinically relevant; cohort; effective therapy; hemiparesis; imaging biomarker; improved; in vivo; in vivo imaging; innovation; insight; model development; motor impairment; multimodality; muscular structure; novel; novel strategies; portability; prevent; relating to nervous system; response; spasticity; targeted treatment; therapeutic target; tractography; water diffusion

Project Summary Cerebral palsy is the most common movement disorder in childhood and has a profound impact on lifelong musculoskeletal development and function. Children with cerebral palsy often develop an increased resistance to passive range of motion in the affected limbs, particularly prevalent at distal joints such as the wrist, leading to pain, discomfort, and reduced mobility. The underlying structural mechanisms that cause changes in passive biomechanical properties are unknown, but it has been shown that these impairments are progressive over time, resulting in exacerbated function of the affected limbs in adults as compared to children with cerebral palsy. It has been suggested that following the initial brain injury in cerebral palsy, the affected skeletal muscles undergo drastic structural changes that consequently impact biomechanical properties. Thus, I propose to apply a novel approach that integrates innovative in vivo imaging techniques with robust measures of passive joint mechanics to determine the contribution of structural forearm muscle parameters to passive wrist joint properties. Identification of the structural mechanisms underlying deterioration of passive mobility represents the possibility for morphological biomarkers for reduced function in children and adults with cerebral palsy, indicating targets for improved treatment and rehabilitation. The goals of the proposed project are to 1) determine adaptations in muscle structure of the affected limb, and 2) quantify the extent of passive property changes in the paretic limb in children and adults with hemiparetic cerebral palsy. Each aim will have an independent quantitative measurement modality. In Aim 1, magnetic resonance (MR) based diffusion tensor imaging (DTI) techniques will be used to extrapolate fascicle lengths and illustrate changes in the extracellular matrix and intramuscular connective tissue of the paretic forearm muscles. In Aim 2, dynamometry will be used to determine the passive-torque angle relationship at the paretic wrist, giving insight into passive wrist torques (resistance to passive muscle elongation) and passive range of motion. Preliminary work shows that measures of muscle structural adaptations are highly correlated with measures of passive biomechanical properties, indicating promising potential of the proposed research to establish the musculoskeletal underpinnings of progressive motor impairments in individuals with cerebral palsy. Findings from this study will deepen our understanding of the secondary, progressive musculoskeletal impairments that result from a non-progressive neurological injury, specifically evident in cerebral palsy. Furthermore, the proposed research will be critical in informing future research and clinical treatment for the prevention of musculoskeletal impairment exacerbation over the lifespan of individuals with cerebral palsy to improve daily living in this population.

项目摘要 脑瘫是儿童时期最常见的运动障碍，对终身影响深远。 肌肉骨骼发育和功能。脑瘫患儿的大脑会产生一种 受影响肢体的被动运动范围，特别是在远端关节如手腕处普遍存在，导致 疼痛不适和行动不便导致被动语态变化的潜在结构机制 生物力学特性是未知的，但是已经表明这些损伤随着时间的推移是渐进的， 导致与患有脑瘫的儿童相比，成年人患肢的功能恶化。它 已经提出，在脑性瘫痪的初始脑损伤之后，受影响的骨骼肌经历了 剧烈的结构变化，从而影响生物力学性能。因此，我建议用一本小说 将创新的体内成像技术与被动关节力学的稳健措施相结合的方法 以确定前臂肌肉结构参数对被动腕关节特性的贡献。 被动流动性恶化的结构机制的识别代表了一种可能性， 对于脑瘫儿童和成人功能减退的形态学生物标志物， 以改善治疗和康复。 拟议项目的目标是：1）确定患肢肌肉结构的适应性， 和2）量化儿童和成人偏瘫患者的偏瘫肢体被动特性变化的程度， 脑瘫每个目标将有一个独立的定量测量模式。在目标1中，磁性 基于磁共振（MR）的弥散张量成像（DTI）技术将用于外推神经束长度， 说明了麻痹前臂肌肉的细胞外基质和肌内结缔组织的变化。 在目标2中，测力法将用于确定麻痹手腕处的被动扭矩角关系， 深入了解被动腕关节扭矩（对被动肌肉拉伸的阻力）和被动运动范围。 初步工作表明，肌肉结构适应性的测量与肌肉结构适应性的测量高度相关。 被动生物力学性能，表明拟议的研究建立的有希望的潜力， 脑瘫患者进行性运动障碍的肌肉骨骼基础。结果 这项研究将加深我们对继发性、进行性肌肉骨骼损伤的理解， 由非进行性神经损伤引起，在脑瘫中特别明显。而且 拟议的研究将是至关重要的，为未来的研究和临床治疗，以预防 肌肉骨骼损伤恶化在脑瘫患者的生命周期，以改善每天 生活在这个人群中。