Reduce the Risk Factors of Pressure Ulcers in SCI Patients

描述（由申请人提供）：申请人的长期研究目标是利用先进技术帮助改善轮椅使用者的生活质量，特别是那些因脊髓损伤（SCI）而残疾的人。更具体地说，申请人的目标是通过减少或消除危险因素来防止软组织破裂，这是坐轮椅最常见的次要并发症。在美国，依靠轮椅行动的140万人中，近50%的人在坐骨和大转子等受压点区域出现严重的组织破裂。这对受影响人口的生活质量产生有害影响，并对保健造成巨大的经济负担。在本研究中，申请人专注于开发和优化复杂的计算有限元（FE）建模理论和技术，以研究软组织对外部坐载的响应。所提出的有限元模型将模拟真实坐姿的承载情况。这些模型不仅将成为更好地了解软组织对坐载荷反应的有力工具，而且还将有助于开发针对软组织破裂的改进预防和治疗策略。目的1：发展和完善建立臀部-大腿几何有限元模型的方法。该方法实现了实际坐姿中臀部-大腿结构解剖几何的真实表示。这些模型将建立四种版本，分别代表男性和女性，每个版本包括健全和慢性脊髓损伤（SCI）个体。这些模型也将被校准和验证。目的2：在有限元模型中实现实验获得的生物软组织（包括人类和实验动物）在健康、受伤和脊髓损伤条件下的力学特性；研究了有限元模型对材料性能变化和组织层间接触行为的敏感性；并研究完好和脊髓损伤人群臀部组织特性的变化。目的3：使用验证的FE模型评估慢性脊髓损伤患者坐姿时臀部组织内部机械环境，并将FE模型预测结果与健全对照组的预测结果进行比较。与公共卫生的相关性：这项研究将提供更好地了解轮椅坐时软组织破裂的病因，并有助于找到更好的治疗和预防策略。

DESCRIPTION (provided by applicant): The applicant's long term research objectives are to use advanced technology to help improve the quality of life of wheelchair users, especially those with disabilities from spinal cord injury (SCI). More specifically, the applicant sets his target at preventing the soft tissue breakdown, the most common secondary complication of wheelchair sitting, by reducing or eliminating risk factors. In the US, nearly 50% of the 1.4 million people who rely on wheelchairs for mobility develop serious tissue breakdown at pressure point areas such as the ischia and the greater trochanters. This has a detrimental impact on the quality of life of the affected population and imposes a tremendous economic burden to health care. In this study, the applicant focuses on development and optimization of the sophisticated computational finite-element (FE) modeling theory and technology to investigate the soft tissue response to external sitting loads. The proposed FE models will simulate the load-bearing condition as in real sitting. It is expected that the models will not only be powerful tools for better understanding the response of soft tissues to sitting loads, but they will also facilitate development of improved prevention and treatment strategies against the soft tissue breakdown. Aim 1: To develop and refine the methodology for establishing the geometry of FE models for the buttock-thigh. The methodology implements a true representation of the anatomical geometry of buttock-thigh structure in actual sitting. Four versions of these models will be established representing males and females, each including able-bodied and chronic spinal cord injury (SCI) individuals. The models will also be calibrated and validated. Aim 2: To implement into the FE model the experimentally acquired mechanical properties of biological soft tissue (both human and experimental animal) under healthy, wounded, and SCI conditions; to investigate the sensitivity of the FE modeling to the variation of the material properties and the contact behavior among tissue layers; and to investigate the variation of buttock tissue properties in intact and SCI populations. Aim 3: To evaluate the buttock tissue internal mechanical environment in the sitting posture in individuals with chronic SCI using the validated FE models, and compare the FE model predictions with those obtained from the able-bodied controls. Relevance to Public Health: This research will provide a better understanding of the etiology of soft tissue breakdown in wheelchair sitting and help finding better strategies of treatment and prevention.