Reduce the Risk Factors of Pressure Ulcers in SCI Patients

申请者描述(申请人提供)：申请者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，特别是脊髓损伤(SCI)残疾人士的生活质量。更具体地说，申请者设定了他的目标，通过减少或消除危险因素来预防软组织破坏，软组织破坏是轮椅坐最常见的继发性并发症。在美国，140万依赖轮椅活动的人中，近50%的人在Ischia和大转子等压力点区域发生严重的组织破坏。这对受影响人口的生活质量产生了不利影响，并对卫生保健造成了巨大的经济负担。在这项研究中，申请人专注于发展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位载荷的响应。所提出的有限元模型将模拟实际坐着时的承载情况。预计这些模型不仅将成为更好地了解软组织对坐位负荷的反应的强大工具，而且还将促进针对软组织破裂的改进预防和治疗策略的发展。目的1：发展和完善建立臀部-大腿有限元模型几何模型的方法。该方法实现了实际坐着时臀部-大腿结构的解剖几何的真实表示。将建立这些模型的四个版本，分别代表男性和女性，每个版本包括健全的和慢性脊髓损伤(SCI)的个人。这些模型还将进行校准和验证。目的：将生物软组织(人和实验动物)在健康、创伤和脊髓损伤条件下的力学特性应用到有限元模型中，研究有限元模型对材料特性和组织层间接触行为变化的敏感性，以及完整和脊髓损伤人群臀部组织特性的变化。目的：应用已验证的有限元模型评估慢性脊髓损伤患者坐位时臀部组织的内部力学环境，并将有限元模型的预测结果与健康对照组的预测结果进行比较。与公众健康相关：这项研究将有助于更好地了解轮椅坐着软组织损伤的病因，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.