EAGER: Advancement of Computational Modeling to Understand Mechanisms of Neonatal Brachial Plexus Injury

新生儿臂丛神经麻痹（NBPP）的发生率为1/1000，其中10-20%的儿童遭受损伤，其中一只手臂的部分或全部肌肉永久性瘫痪。 它发生在供应手臂的神经-臂丛神经-受伤时。 人们普遍认为，绝大多数NBPP本质上是生物力学的，发生在分娩过程中。 为了更好地为临床干预和决策提供信息，减少损伤的发生或严重程度，有必要更好地了解分娩过程中臂丛神经被拉伸的机制。 计算建模提供了了解脆弱人群（如新生儿）损伤机制的最佳方法。 本项目将开发一个先进的计算模型来代表自然生物变异性和整个传递过程，以研究NBPP的机制。 NBPP导致的瘫痪可能导致终身残疾，因为它影响整个上肢的运动神经支配。 在制定新的临床干预和决策建议之前，必须更全面地了解损伤的机制。 一旦开发和验证，该模型将作为未来计算工作的基础，以研究出生过程中发生的其他生物力学损伤的机制-包括潜在的血管损伤（例如脑血管损伤）和骨折。 除了科学影响外，研究小组还将与密歇根州立大学的既定外展计划合作，解释生物力学在理解伤害如何发生方面的重要性，并激发公众对生物力学领域的兴趣。 为推广而开发的模块将以虚拟形式提供，这将扩大这些材料的覆盖范围。为支持本项目的目标，已经建立了两个科学目标：1）开发一个先进的模型，该模型结合了有限元和刚体建模方法，以模拟与NBPP发生有关的适当边界条件和输送力;以及2）利用该模型来参数化地研究影响在分娩过程中发生在臂丛中的拉伸的因素，该拉伸随后增加了损伤的风险。 该模型将整合和推进与生物软组织建模相关的技术，包括复杂几何形状的非线性软组织结构和活动肌肉组织。 它将通过包括母体和新生儿组织的先进建模，大大推进NBPP生物力学科学，这是该领域的一种新方法。该奖项反映了NSF的法定使命，并通过使用基金会的智力价值和更广泛的影响审查标准进行评估，被认为值得支持。

Neonatal brachial plexus palsy (NBPP) occurs at a rate of 1/1000 births, with 10-20% of children who sustain the injury experiencing a permanent paralysis of some or all of the muscles in one of their arms. It occurs when the nerves that supply the arm – the brachial plexus – is injured. It is widely accepted that the vast majority of NBPP are biomechanical in nature and occur during the birth process. An improved understanding of the mechanisms through which the brachial plexus is stretched during the birth process is necessary in order to better inform clinical interventions and decision making that may reduce the occurrence or severity of the injury. Computational modeling provides the best approach to understand the mechanism of injury in a vulnerable population, such as newborns. This project will develop an advanced computational model to represent natural biological variability and the full process of delivery in order to investigate the mechanism of NBPP. The paralysis that results from NBPP can result in a lifelong disability, as it affects motor innervation of the entire upper extremity. Before new recommendations for clinical interventions and decision making can be developed, it is imperative that the mechanism of injury is more completely understood. Once developed and validated, this model will serve as a foundation for future computational work to investigate the mechanisms of other biomechanical injuries that occur during the birth process – including potentially vascular injuries (e.g. cerebral hemorrhages) and bony fractures. In addition to the scientific impact, the research team will work with established outreach programs at Michigan State to explain the importance of biomechanics in understanding how injuries occur and to excite the public about the field of biomechanics. Modules developed for outreach will be made available in virtual formats, which will broaden the reach of these materials.Two scientific objectives have been established to support the goal of this project: 1) to develop an advanced model that combines finite element and rigid body modeling methods to mimic the appropriate boundary conditions and delivery forces involved with the occurrence of NBPP; and 2) to utilize the model to parametrically investigate the factors that affect the stretch that occurs in the brachial plexus during the birth process, which subsequently increases the risk of injury. The model will integrate and advance techniques related to modeling of biological soft tissues, including non-linear soft tissue structures of complex geometries and active muscle tissue. It will significantly advance the science of NBPP biomechanics by including advanced modeling for both maternal and neonatal tissues, a novel approach within the field.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.