The Role of Neck Muscle Mechanics in Pediatric Head and Neck Injury

描述（由申请人提供）：创伤性头部和颈部损伤是美国儿童死亡的主要原因（每年15,000名），每年有近150,000名儿童永久残疾。尽管采取了干预措施，如在汽车上安装先进的安全系统，在运动和操场上安装新的安全装置和地面，但这些统计数据仍然存在。不幸的是，这些干预措施在很大程度上是在缺乏儿童头颈部生物力学数据的情况下发展起来的，依赖于成人对儿童的几何比例。这种策略是有缺陷的，特别是头部和颈部，因为它们的异速生长差异- 4岁儿童的头围是成人值的90%，而颈部围直到14岁才接近成人值的90%。因此，我们致力于描述和模拟成熟过程中的头颈部生物力学。通过更好地了解这些变化中的儿童颈部力学，可以在不进一步加剧儿童头颈部损伤的情况下进行紧急医疗服务，如患者提取、转移和诊断。此外，了解儿童头部和颈部对伤害情景的反应将有助于预防这些伤害。本研究的目的是描述颈部肌肉的发育生长轨迹，并将这些数据应用于能够解决儿童紧急医疗服务和伤害预防的头颈部计算模型。具体来说，这项研究工作将从一个人类受试者实验开始，检查整个发育谱（4至23岁）的颈部肌肉力学。峰值和耐力力学将被测量，并与肌肉生物电位（EMG）、受试者人体测量、年龄和性别相关联（具体目标1）。这些数据和我们之前的工作将支持一系列儿童肌肉骨骼模型的开发和验证，以检查影响儿童头颈部损伤的参数问题（具体目标2）。这些模型将能够评估当前的汽车、运动和紧急护理伤害预防策略和暴露改进（具体目标3）。这项工作的临床意义在于对受伤儿童的紧急医疗提取、运输和诊断的改进，以及儿童安全装置的进步，这些都是通过对儿童肌肉骨骼颈部力学的更好理解而提供的。

DESCRIPTION (provided by applicant): Traumatic head and neck injury is the leading cause of death for children in the United States (15,000 each year) and permanently disables close to 150,000 more children annually. These statistics persist in spite of interventions like advanced safety systems in cars and new safety gear and surfaces for sports and playgrounds. Unfortunately, these interventions have been developed largely in the absence of child biomechanical data for the head and neck, relying on geometrical scaling of the adult to child. This strategy is flawed particularly for the head and neck due to their differential allometry-head circumference of a 4- year-old is 90% of its adult value while the neck circumference does not approach 90% of adult until age 14. We have, therefore, engaged in an effort to characterize and simulate head and neck biomechanics during maturation. Through a better understanding of child neck mechanics during these changes, emergency medical services such as patient extraction, transport, and diagnosis can be performed without further exacerbation of child head and neck injuries. Further, knowledge of the response of the child head and neck to injurious scenarios will facilitate the prevention of these injuries. The objective of this research is to characterize the developmental growth trajectories of neck muscles and employ these data in a head and neck computational model able to address emergency medical services and injury prevention in children. Specifically, this research effort will begin with a human subject experiment examining neck muscle mechanics across the developmental spectrum (4-to-23 years). The peak and endurance mechanics will be measured and correlated with muscle biopotentials (EMG), subject anthropometry, age, and sex (specific aim 1). These data and our previous work will support the development and validation of a series of child musculoskeletal models to examine parametric issues affecting child head and neck injury (specific aim 2). These models will be able to assess current automotive, sport, and emergency care injury prevention strategies and expose improvements (specific aim 3). The clinical import of this work lies in modifications for emergency medical extraction, transport, and diagnosis of the injured child and advancements in child safety devices all afforded by an improved understanding of pediatric musculoskeletal neck mechanics.