Mechanisms of Rotator Cuff Injury During Manual Wheelchair Propulsion

手动轮椅推进过程中肩袖损伤的机制

• 批准号: 10572578
• 负责人: PAULA Marie LUDEWIG
• 金额: $ 7.44万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10572578
• 关键词: 3-Dimensional; Address; Affect; Algorithms; Anatomy; Applications Grants; Articular Range of Motion; Caregiver Burden; Clinic; Clinical; Clinical Trials; Collaborations; Custom; Data; Data Set; Development; Dimensions; Disease; Electromyography; Functional disorder; Future; Genetic Models; Geometry; Head; Health; Immobilization; Individual; Institution; Intervention; Investigation; Joint structure of shoulder region; Joints; Knowledge; Manual wheelchair; Measures; Methods; Minnesota; Modeling; Motion; Movement; Muscle; Musculoskeletal; National Institute of Child Health and Human Development; Outcome; Outcome Assessment; Pain; Participant; Pathology; Pattern; Persons; Population; Positioning Attribute; Public Health; Quality of life; Reporting; Research; Research Personnel; Resolution; Resources; Risk; Rotator Cuff; Sample Size; Scanning; Scientist; Severities; Shoulder; Shoulder Pain; Site; Soft Tissue Disorder; Spinal cord injury; Statistical Data Interpretation; Stress; Structure; Techniques; Technology; Tendon Injuries; Tendon structure; Time; Torque; Transportation; United States; Universities; Upper Extremity; Weight-Bearing state; Wheelchair propulsion; Work; arthropathies; bone; clinical application; design; experience; functional independence; health care service utilization; improved; in vivo; injured; interest; kinematics; multidisciplinary; preservation; pressure; prevent; preventive intervention; reconstruction; repaired; rotator cuff injury; rotator cuff tear; scapula; secondary analysis; skeletal; soft tissue

Project Summary/Abstract Shoulder pain and joint disease is a serious threat to health and mobility for manual wheelchair users living with spinal cord injury. There are subsequent implications for functional independence, quality of life, caregiver burden, and healthcare utilization. In particular, rotator cuff tears are devastating for these individuals as the usual clinical course (repair) is not typically viable. Their upper extremities have become their primary means of mobility, and post-surgical shoulder immobilization is impractical. As such, it is critical that shoulder joint health is preserved for this population. In order to address the major challenges of preventing shoulder disease and dysfunction progression for manual wheelchair users, we need to assess the impact of and need for various interventions relative to rotator cuff soft tissue health. In addition to inverse dynamic calculations of joint torques or electromyographic measures, measuring the impact of interventions on rotator cuff soft tissue compression is an important advancement in mechanistic understanding and outcomes assessment. Our proposal will combine existing data sets from the University of Minnesota (20 precise 3D shoulder reconstructions including soft tissue) and Mayo Clinic (10 participants’ precise 3D shoulder kinematics during wheelchair propulsion) to measure rotator cuff compression for 200 unique combinations of shoulder geometry and kinematics. Aim 1 will “Characterize the effect of anatomical features and movement patterns on rotator cuff tendon compression during manual wheelchair propulsion”. Clinicians and transformational scientists need to know the relative impacts of motion and anatomy/geometry on rotator cuff stresses during wheelchair propulsion. Outcomes of this investigation will inform both mechanistic investigations and clinical trials assessing preventive interventions. In addition, methods to directly assess soft tissue impact are labor- and technology-intensive. Our proposed Aim 2 will “Determine the capability of low-fidelity models to predict in vivo tendon compression during manual wheelchair propulsion” by directly comparing high- and low-fidelity techniques. Successful completion of this project will determine the necessity or benefit of labor-intensive, subject-specific models over lower fidelity alternatives in studying rotator cuff tendon injury mechanisms, and preventative outcomes. This knowledge can then be applied extensively in future work by our group and others, including assessment of transfers and other functional activities. Appropriate sample sizes for future work can also be planned with the knowledge gained through this proposed project. This project provides a unique opportunity for collaboration between experienced investigators and to combine existing data to determine relative utility of various approaches for larger scale investigation planning. Our approach is responsive to the NICHD Notice of Special Interest (NOT-HD-20-200) in that it leverages valuable existing data to advance understanding of shoulder soft tissue disease and planning for future investigations by our multidisciplinary groups and others.

项目摘要/摘要 肩部疼痛和关节疾病是对拥有的手动轮椅使用者的健康和机动性的严重威胁 脊髓损伤。随后对职能独立性，生活质量，照顾者有影响 负担和医疗保健利用。特别是，肩袖撕裂对这些人来说是毁灭性的 通常的临床课程（维修）通常不可行。他们的上肢已成为他们的主要手段 流动性和手术后的肩膀固定是不切实际的。因此，至关重要的是肩部关节健康 保留给这个人群。为了解决预防肩部疾病和的主要挑战 手动轮椅使用者的功能障碍进展，我们需要评估各种的影响和需求 相对于肩袖软组织健康的干预措施。除了关节扭矩的反向动态计算 或肌电图测量，测量干预措施对肩袖软组织压缩的影响是 机械理解和结果评估方面的重要进步。我们的建议将结合在一起 明尼苏达大学的现有数据集（20个精度3D肩部重建，包括软组织） 和Mayo诊所（轮椅推进期间10个参与者的精确的3D肩运动学） 肩袖压缩，用于200种独特的肩部几何形状和运动学组合。目标1意志 “表征解剖特征和运动模式对肩袖肌腱压缩的​​影响 在手动轮椅推进期间”。临床医生和变革型科学家需要了解亲戚 运动和几何形状对轮椅推进期间肩袖应力的影响。 这项投资的成果将为机械投资和临床试验提供信息，以评估预防性 干预措施。此外，直接评估软组织影响的方法是劳动力和技术密集型。我们的 拟议的AIM 2将“确定低保真模型在预测体内肌腱压缩过程中的能力 手动轮椅推进”直接比较高保真技术。成功完成 这个项目将确定劳动密集型，特定于主题的模型的必要或好处 在研究肩袖肌腱损伤机制和预防结果方面，较低的保真度替代方案。 然后，这些知识可以由我们的小组和其他人广泛应用于未来的工作，包括评估 转移和其他功能活动。适当的样本量也可以通过 通过这个建议的项目获得的知识。该项目为合作提供了独特的机会 在经验丰富的研究人员之间并结合现有数据以确定各种的相对效用 大规模调查计划的方法。我们的方法是对特殊的NICHD通知的响应 兴趣（非HD-20-200），因为它利用有价值的现有数据来提高对肩部软的了解 组织疾病和计划对我们的跨学科群体和其他人进行调查。