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

偏瘫脑瘫儿童和成人被动腕关节特性下的肌肉骨骼结构适应性的量化

• 批准号: 10538153
• 负责人: Divya Joshi
• 金额: $ 4.2万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-12 至 2024-09-11
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10538153
• 关键词: 18 year old; Adult; Affect; Algorithms; Anatomy; Anisotropy; Articular Range of Motion; Biological Markers; Biomechanics; Birth; Brain; Brain Injuries; Cerebral Palsy; Child; Childhood; Clinical; Clinical Treatment; Collagen; Connective Tissue; Contracture; Deformity; Deterioration; Development; Devices; Diffusion; Diffusion Magnetic Resonance Imaging; Distal; Ensure; Extensor; Extracellular Matrix; Fascicle; Fellowship; Fiber; Fibrosis; Fingers; Flexor; Forearm; Goals; Hand functions; Imaging Techniques; Impairment; Individual; Intramuscular; Joints; Knowledge; Lead; Length; Limb structure; Link; Longevity; Magnetic Resonance; Measurement; Measures; Mechanics; Methods; Modality; Morphology; Motor; Movement Disorders; Muscle; Muscle Fibers; Musculoskeletal; Musculoskeletal Development; Nervous System Trauma; Operative Surgical Procedures; Pain; Paresis; Passive Range of Motion function; Patients; Pharmacological Treatment; Physical therapy; Population; Positioning Attribute; Prevention; Production; Property; Quality of life; Rehabilitation therapy; Research; Resistance; Secondary to; Side; Skeletal Muscle; Structure; Techniques; Testing; Time; Tissues; Torque; Work; Wrist; Wrist joint; arm; arm paresis; base; biomechanical test; bone; clinically relevant; cohort; effective therapy; hemiparesis; imaging biomarker; improved; in vivo; in vivo imaging; innovation; insight; model development; motor impairment; multimodality; muscular structure; novel; novel strategies; portability; prevent; relating to nervous system; response; spasticity; targeted treatment; therapeutic target; tractography; water diffusion

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.

项目摘要 脑瘫是儿童时期最常见的运动障碍，对终身影响有深远的影响 肌肉骨骼发育和功能。患有脑瘫的儿童通常会增加阻力增加 在受影响的肢体中被动运动范围，尤其是在远端关节（如手腕）中流行的。 疼痛，不适和降低活动能力。导致被动变化的基本结构机制 生物力学特性尚不清楚，但已经表明这些障碍会随着时间的流逝而渐进 与脑瘫儿童相比，成年人的肢体的功能加剧了。它 有人建议在脑瘫最初的脑损伤之后，受影响的骨骼肌肉发生 急剧的结构变化，从而影响生物力学特性。因此，我建议应用小说 将创新的体内成像技术与被动关节力学衡量的方法相结合 确定结构前臂肌肉参数对被动腕关节特性的贡献。 鉴定被动迁移率恶化的结构机制代表了可能性 用于脑瘫儿童和成人功能降低功能的形态生物标志物，指示靶标 用于改善治疗和康复。 拟议项目的目标是1）确定受影响肢体的肌肉结构的适应 和2）量化偏瘫儿童和成年人的偏肢被动特性变化的程度 脑瘫。每个目标都将具有独立的定量测量方式。在AIM 1中，磁性 共振（MR）的扩散张量成像（DTI）技术将用于推断束长度和 说明了前臂肌肉的细胞外基质和肌内结缔组织的变化。 在AIM 2中，将使用发元计来确定右手腕的被动扭转角关系，从而给予 深入了解被动腕带（对被动肌肉伸长的抵抗力）和被动运动范围。 初步工作表明，肌肉结构适应的度量与措施高度相关 被动生物力学特性，表明拟议的研究具有有希望的潜力 脑瘫患者进行性运动障碍的肌肉骨骼基础。发现 从这项研究中，我们将加深我们对次要进行性肌肉骨骼障碍的理解 由非促进神经损伤引起的，在脑瘫中特别明显。此外， 拟议的研究对于告知未来的研究和临床治疗至关重要 在脑瘫患者的寿命中，肌肉骨骼障碍加剧了每天改善 生活在这个人群中。