Prediction of Shoulder Injury for Disease Prevention in Children and Adults with Spinal Cord Injury Using Advanced Biomechanical Modeling and Diagnostic Imaging

项目摘要/摘要 脊髓损伤(SCI)后保留上肢的临床实践指南 对于患有脊髓损伤的成年人来说，这是一个有前途的工具。然而，遵循这些建议的成年手动轮椅使用者 中风模式和运动策略仍然有高达84%的肩痛发生率。此外，由于这一点 是目前适用于儿童的脊髓损伤患者护理标准的唯一建议。 在没有足够证据证明其终生有效的情况下，患有脊髓损伤。我们的长期目标是 为脊髓损伤儿童建立急需的临床实践指南，同时 为成年人改善这些。我们知道，由于正在进行的肌肉骨骼运动，儿童不仅仅是小成年人 发育和成熟的大脑。患者特定的康复策略，其中包括考虑 患者受伤时的年龄，在整个生命周期内都是有保障的。我们团队发现，成年人 与成人发病的脊髓损伤相比，儿童发病的脊髓损伤患者肩部疼痛较少，尽管 轮椅使用。此外，我们有证据表明，患有脊髓损伤的儿童疼痛较少，而变异性较高。 在中风模式、肩关节力和肩关节力矩方面，运动比成年人更好 手动轮椅活动。然而，我们并不能确切地理解为什么儿童和成人患有 儿童起病的脊髓损伤的继发性疾病的发生率较低，特别是疼痛和可能 病理学。根据我们的初步研究，我们有令人信服的理由相信 推进冲程模式和关节动力学起着关键作用。这使我们能够假设运动 在儿童发病的脊髓损伤患者中，手动轮椅推进的变异性显著大于 成人发病的脊髓损伤，最终减少累积的肩关节需求，肩痛，和 进行性病理学。我们建议通过量化关节动力学、疼痛、 和病理学，使用运动分析和高级生物力学建模、结果测量和 分别进行超声成像。然后我们将确定发病年龄和变异性对 使用个性化肌肉骨骼模拟的基础肩袖和骨力。我们希望能找到一个 脊髓损伤发病年龄对肩关节动力学、卒中类型及肩痛病理的影响 表现为运动变异性降低(过度使用)。这些研究的结果对于 创造创新的康复策略以减轻手动轮椅的肩痛和病理 患有SCI的用户。这些范例对于预防疼痛和随后的肩部疾病至关重要，例如 肌腱病、早发性关节炎和退行性关节疾病。

Project Summary/Abstract Clinical practice guidelines for preservation of the upper limb following spinal cord injury (SCI) are a promising tool for adults with SCI. Yet, adult manual wheelchair users following these recommendations for stroke patterns and movement strategies still have up to 84% occurrence of shoulder pain. Furthermore, as this is the only recommendation for standard of care of individuals with SCI it is currently being applied to children with SCI without sufficient evidence of effectiveness throughout the lifespan. Our long-term objective is to establish the desperately needed clinical practice guidelines for children with SCI while at the same time improving those for adults. We know that children are not just small adults due to ongoing musculoskeletal development and a maturing brain. Patient specific rehabilitation strategies, that incorporate consideration for the age of the patient at onset of injury, are warranted throughout the lifespan. Our group has found that adults with pediatric onset SCI have less shoulder pain than those with adult onset SCI, despite more years of wheelchair use. Furthermore, we have evidence that children with SCI have less pain and higher variability of movement than adults in regards to stroke patterns, shoulder joint forces, and shoulder joint moments during manual wheelchair mobility. However, we do not definitively understand why children and adults with pediatric-onset SCI have a lower incidence of secondary medical conditions, specifically pain and presumably pathology. Based on our preliminary studies, we have a compelling reason to believe that variability of propulsion stroke patterns and joint dynamics play a key role. This allows us to hypothesize that movement variability of manual wheelchair propulsion is significantly greater in persons with pediatric-onset SCI than adult-onset SCI, which ultimately reduces cumulative shoulder joint demands, shoulder pain, and progressive pathology. We propose to test this hypothesis by quantifying glenohumeral joint dynamics, pain, and pathology, using motion analysis with advanced biomechanical modeling, outcomes measures, and ultrasound imaging, respectively. We will then determine the effects of age of onset and variability on the underlying rotator cuff and bony forces using personalized musculoskeletal simulations. We expect to find an effect of age of onset of SCI on shoulder joint dynamics and stroke patterns with shoulder pain and pathology manifesting with decreased movement variability (overuse). The results of these studies are essential for creating innovative rehabilitation strategies to alleviate shoulder pain and pathology in manual wheelchair users with SCI. These paradigms are crucial for preventing pain and subsequent shoulder disease such as tendinopathy, early onset arthritis, and degenerative joint disease.