Natural History of Shoulder Pathology in Wheelchair Users

轮椅使用者肩部病理学的自然史

• 批准号: 8936621
• 负责人: MELISSA M. MORROW
• 金额: $ 45.96万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-06 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8936621
• 关键词: Adult; Affect; Age; Bilateral; Chronic; Collection; Coupled; Custom; Data; Development; Disease; Equipment; Etiology; Exposure to; Foundations; General Population; Goals; Health; Image; Incidence; Individual; Injury; Insurance; Joint structure of shoulder region; Joints; Knowledge; Life; Link; Magnetic Resonance Imaging; Manual wheelchair; Measurement; Measures; Methods; Modeling; Motion; Natural History; Onset of illness; Outcome; Pain; Pathology; Pattern; Persons; Phase; Positioning Attribute; Pre-Clinical Model; Prevalence; Primary Prevention; Quality of life; Rehabilitation therapy; Relative (related person); Risk Factors; Rotator Cuff; Self-Help Devices; Sex Behavior; Shoulder; Spinal cord injury; Stream; Symptoms; Task Performances; Tendinopathy; Tendon Injuries; Tendon structure; Thick; Time; Traction; Translating; United States; Upper Extremity; Weight; Weight-Bearing state; Wheelchairs; Work; base; biceps brachii muscle; cohort; disability; early onset; evidence based guidelines; experience; hand grasp; instrumentation; joint loading; kinematics; novel; pre-clinical; prevent; public health relevance; response; soft tissue

 DESCRIPTION (provided by applicant): Of the 1.7 million wheelchair users in the United States (US), 90 percent, or 1.5 million persons use manual wheelchairs (MWCs). People with traumatic and non-traumatic spinal cord injuries (SCI) make up approximately 20% of the MWC users, and 12,000 new traumatic SCIs occur every year. While MWCs are immediately available and enable independence, 63% of MWC users will have one or multiple rotator cuff tears after decades of WC use as compared to 15% of age-matched able-bodied adults. A crucial gap in knowledge exists in understanding how the shoulder of MWC users functions from an almost permanent seated position as an agent for mobility, weight bearing, and hand grasping; and how this altered function translates to longitudinal shoulder health decline. The objective of this application is to define the longitudinal components of the early phase (before chronic symptom onset) of shoulder health decline specific to new MWC users by characterizing the exposure to altered shoulder function and the associated MRI signs of early onset of shoulder pathology. We propose to: (Aim 1) quantify shoulder joint motion and loading in the real world over 3 years in 60 new MWC users and a matched able-bodied cohort; (Aim 2) define early, preclinical changes on shoulder MRI specific to the MWC users, over 3 years, in comparison to the matched cohort; and (Aim 3) identify specific exposure measures as risk factors for early changes on MRI in the MWC users. Three central and novel aspects of this proposal will pave the way for targeting primary prevention: (1) characterizing the altered shoulder function in new MWC users in the real world with hardware and instrumentation suitable for multiple, day long collections, (2) defining the early, preclinical pattern of disease in users compared to a matched able-bodied cohort, and (3)investigating the combined effect of shoulder motion and loading and its relationship to the incidence of shoulder pathology. Successful completion of this project will define how the shoulder responds to MWC use (Aim 1), identify the MWC-specific pattern of shoulder disease on MRI (Aim 2), and determine how altered shoulder function has contributed to shoulder health decline (Aim 3). This work provides the foundation for understanding the relative impact of shoulder elevation and loading in shoulder health decline. Additionally, this work provides the first building block in defining the complete natural history of shoulder disease in MWC users. We expect the overall impact to be a powerful influence on environmental and assistive technology redesign, post-SCI rehabilitation practices, insurance reimbursement for shoulder health- preserving equipment, and understanding shoulder pathology in the general population.

 描述（由申请人提供）：在美国（US）的170万轮椅使用者中，90%或150万人使用手动轮椅（MWC）。创伤性和非创伤性脊髓损伤（SCI）患者约占MWC使用者的20%，每年发生12，000例新的创伤性SCI。虽然MWC可以立即使用并实现独立性，但63%的MWC使用者在使用WC数十年后会有一个或多个肩袖撕裂，而年龄匹配的健全成年人只有15%。一个关键的知识差距存在于理解MWC用户的肩膀如何从一个几乎永久的坐姿功能作为一个代理的流动性，承重，和手抓;以及如何改变功能转化为纵向肩部健康下降。的目的 应用是通过表征暴露于改变的肩关节功能和肩关节病理早期发作的相关MRI体征，定义新MWC使用者特有的肩关节健康衰退早期阶段（慢性症状发作前）的纵向分量。我们建议：（目的1）在真实的世界中量化60名新MWC使用者和匹配的健全队列在3年内的肩关节运动和载荷;（目的2）与匹配队列相比，定义MWC使用者在3年内特定的肩关节MRI的早期临床前变化;（目的3）将特定暴露指标确定为MWC使用者MRI早期变化的风险因素。这项建议的三个核心和新颖的方面将为针对初级预防铺平道路：（1）使用适合多次、一天收集的硬件和仪器来表征真实的世界中新MWC用户的肩功能改变，（2）定义用户与匹配的健康人群相比的早期、临床前疾病模式，（3）研究肩关节运动和负荷的联合作用及其与肩关节病变发生率的关系。该项目的成功完成将确定肩关节对MWC使用的反应（目标1），确定MRI上肩关节疾病的MWC特异性模式（目标2），并确定肩关节功能改变如何导致肩关节健康下降（目标3）。这项工作提供了基础，了解肩关节抬高和负荷的相对影响，肩关节健康下降。此外，这项工作提供了第一个积木在定义完整的自然历史肩疾病 MWC用户我们预计，总体影响将是一个强大的影响，对环境和辅助技术的重新设计，SCI后康复的做法，保险报销的肩膀健康保护设备，并了解肩关节病理在一般人群。