Quantification of Musculoskeletal Structural Adaptations Underlying Passive Wrist Joint Properties in Children and Adults with Hemiparetic Cerebral Palsy

项目摘要 脑性瘫痪是儿童时期最常见的运动障碍，对终生影响深远 肌肉骨骼的发育和功能。患有脑性瘫痪的儿童经常出现抵抗力增强 到受影响肢体的被动活动范围，特别是在远端关节，如手腕，导致 疼痛、不适和行动不便。导致被动变化的潜在结构机制 生物力学特性尚不清楚，但已表明这些损伤是随着时间的推移而逐渐发展的， 导致与脑性瘫痪儿童相比，成人患肢功能恶化。它 已经提出，在脑性瘫痪的最初脑损伤之后，受影响的骨骼肌经历 剧烈的结构变化，从而影响生物力学性能。因此，我建议将一部小说 将创新的活体成像技术与稳健的被动关节力学措施相结合的方法 目的：确定前臂肌肉结构参数对被动腕关节特性的影响。 确定导致被动活动能力恶化的结构性机制有可能 脑性瘫痪儿童和成人功能减退的形态生物标志物，指示靶点 以改善治疗和康复。 拟议项目的目标是1)确定受影响肢体的肌肉结构的适应性， 2)量化偏瘫儿童和成人偏瘫肢体被动属性改变的程度 脑性瘫痪。每个目标都将有一个独立的量化测量模式。在目标1中，磁性 基于磁共振(MR)的扩散张量成像(DTI)技术将用于外推神经束长度和 说明瘫痪前臂肌肉的细胞外基质和肌肉内结缔组织的变化。 在目标2中，测功法将被用来确定偏瘫手腕的被动扭矩角关系，给出 了解被动手腕扭矩(对被动肌肉伸长的阻力)和被动运动范围。 初步工作表明，肌肉结构适应性的衡量标准与 被动生物力学特性，表明拟议的研究具有建立 脑性瘫痪患者进行性运动障碍的肌肉骨骼基础。发现 这项研究将加深我们对继发性、进行性肌肉骨骼损伤的理解 由非进行性神经损伤所致，尤其是脑性瘫痪。此外， 拟议的研究将对未来预防糖尿病的研究和临床治疗起到至关重要的作用 随着脑瘫患者寿命的延长，肌肉骨骼损伤加剧，每天都会得到改善 生活在这样的人口中。

Project Summary Cerebral palsy is the most common movement disorder in childhood and has a profound impact on lifelong musculoskeletal development and function. Children with cerebral palsy often develop an increased resistance to passive range of motion in the affected limbs, particularly prevalent at distal joints such as the wrist, leading to pain, discomfort, and reduced mobility. The underlying structural mechanisms that cause changes in passive biomechanical properties are unknown, but it has been shown that these impairments are progressive over time, resulting in exacerbated function of the affected limbs in adults as compared to children with cerebral palsy. It has been suggested that following the initial brain injury in cerebral palsy, the affected skeletal muscles undergo drastic structural changes that consequently impact biomechanical properties. Thus, I propose to apply a novel approach that integrates innovative in vivo imaging techniques with robust measures of passive joint mechanics to determine the contribution of structural forearm muscle parameters to passive wrist joint properties. Identification of the structural mechanisms underlying deterioration of passive mobility represents the possibility for morphological biomarkers for reduced function in children and adults with cerebral palsy, indicating targets for improved treatment and rehabilitation. The goals of the proposed project are to 1) determine adaptations in muscle structure of the affected limb, and 2) quantify the extent of passive property changes in the paretic limb in children and adults with hemiparetic cerebral palsy. Each aim will have an independent quantitative measurement modality. In Aim 1, magnetic resonance (MR) based diffusion tensor imaging (DTI) techniques will be used to extrapolate fascicle lengths and illustrate changes in the extracellular matrix and intramuscular connective tissue of the paretic forearm muscles. In Aim 2, dynamometry will be used to determine the passive-torque angle relationship at the paretic wrist, giving insight into passive wrist torques (resistance to passive muscle elongation) and passive range of motion. Preliminary work shows that measures of muscle structural adaptations are highly correlated with measures of passive biomechanical properties, indicating promising potential of the proposed research to establish the musculoskeletal underpinnings of progressive motor impairments in individuals with cerebral palsy. Findings from this study will deepen our understanding of the secondary, progressive musculoskeletal impairments that result from a non-progressive neurological injury, specifically evident in cerebral palsy. Furthermore, the proposed research will be critical in informing future research and clinical treatment for the prevention of musculoskeletal impairment exacerbation over the lifespan of individuals with cerebral palsy to improve daily living in this population.