Debilitating Contractures in Spinal Cord Injury

描述（由申请人提供）： 本研究的总体目标是制定一个评估、预防和治疗脊髓损伤（SCI）致关节挛缩的总体策略。现有的文献表明，脊髓损伤的挛缩对其他麻痹性损伤可能有效的相同治疗方式没有反应。我们认为这是因为SCI涉及上运动神经元（UMN）和下运动神经元（LMN）损伤的组合，以及广泛变化的随意肌肉力量水平。驱动该项目的基本假设是SCI中的关节挛缩至少有两种不同的病因，如果不更好地了解影响挛缩发展的因素，进一步的治疗尝试将是不成功的。如果没有对关节挛缩、其潜在的生物力学及其功能影响进行全面、系统的分析，我们认为很难制定有效的策略来治疗挛缩并验证成功的治疗结果。因此，我们提出的项目旨在开发改进的评估技术的被动性能的关节，执行这些措施在一个实质性的队列的SCI科目，并使用所获得的信息，以暴露挛缩的病因学在SCI和提出新的治疗模式的基础上理解这一病因。在这个特殊的项目中，我们将专注于挛缩的上肢，基于我们以前的工作显示成功的初步分析的被动属性的手和上臂。这个项目的目的是开发一套工具的被动属性评估，并使用该套件来评估60个慢性颈段SCI受试者的上肢。本研究有两个预期结果：1）制定被动特性测量的临床指南，提供一组简化的数据，最大限度地利用从简单临床试验中获得的信息; 2）制定一系列关于关节挛缩病因和可能的预防和治疗策略的可验证假设。这将有助于指导未来的病因学和干预性研究。

DESCRIPTION (provided by applicant): The overall objective of this research is to develop a general strategy for the assessment, prevention and treatment of debilitating joint contractures in spinal cord injury (SCI). Existing literature indicates that contractures in SCI do not respond to the same treatment modalities that may be effective in other paralyzing injuries. We believe that this is because SCI involves a combination of upper motor neuron(UMN) and lower motor neuron (LMN) damage coupled with widely varying voluntary muscle strength levels. The underlying hypothesis driving this project is that joint contractures in SCI have at least two distinct etiologies, and that further attempts at treatment will be unsuccessful without a better understanding of the factors influencing contracture development. Without a thorough, systematic analysis of joint contractures, their underlying biomechanics and their functional impact, we believe it will be extremely difficult to develop effective strategies to treat contractures and verify successful treatment outcomes. Therefore, our proposed project seeks to develop improved assessment techniques of the passive properties of the joints, perform these measures in a substantial cohort of SCI subjects, and use the information obtained to expose contracture etiology in SCI and to propose new treatment paradigms based on the understanding of this etiology. In this particular project, we will focus on contractures in the upper extremity, based on our previous work showing successful preliminary analysis of the passive properties of the hand and upper arm. The aims of this project are to develop a suite of tools for passive property assessment and to use this suite to evaluate both upper extremities in 60 chronic cervical-level SCI subjects. There are two anticipated outcomes of this study: 1) development of a clinical guide to passive property measurement that presents a streamlined set of data that maximizes the information obtained from simple clinical tests, and 2) development of a series of testable hypotheses regarding the etiology of joint contractures and possible prevention and treatment strategies. This will serve to guide future etiological and interventional research.