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.

项目概要/摘要 肩部疼痛和关节疾病对手动轮椅使用者的健康和行动能力构成严重威胁 脊髓损伤会对功能独立性、生活质量、照顾者产生后续影响。 特别是，肩袖撕裂对这些人来说是毁灭性的。 通常的临床过程（修复）通常是不可行的。 因此，肩关节健康至关重要。 为这一人群保留，以应对预防肩部疾病的主要挑战和 对于手动轮椅使用者的功能障碍进展，我们需要评估各种影响和需求 除了关节扭矩的逆动态计算之外，还对肩袖相对软组织健康进行干预。 或肌电图测量，测量干预措施对肩袖软组织压缩的影响 我们的建议将结合机械理解和结果评估的重要进步。 明尼苏达大学的现有数据集（20 个精确的 3D 肩部重建，包括软组织） 和 Mayo Clinic（10 名参与者在轮椅推进过程中的精确 3D 肩部运动学）进行测量 Aim 1 将提供 200 种独特的肩部几何形状和运动学组合的肩袖压缩。 “描述解剖学特征和运动模式对肩袖肌腱压缩的​​影响 临床医生和变革科学家需要了解相关信息。 轮椅推进过程中运动和解剖/几何形状对肩袖应力的影响。 这项调查的结果将为机械调查和评估预防性的临床试验提供信息 此外，直接评估软组织影响的方法是劳动力和技术密集型的。 提出的目标 2 将“确定低保真模型预测体内肌腱压缩的​​能力” 手动轮椅推进”通过直接比较高保真度和低保真度技术成功完成。 该项目的进展将决定劳动密集型、特定主题模型的必要性或益处 研究肩袖肌腱损伤机制和预防结果的保真度较低的替代方案。 我们的团队和其他人可以将这些知识广泛应用于未来的工作中，包括评估 还可以与未来工作计划适当的样本量。 通过该拟议项目获得的知识提供了独特的合作机会。 经验丰富的研究人员之间并结合现有数据来确定各种方法的相对效用 我们的方法响应 NICHD 特别通知。 兴趣（NOT-HD-20-200）在于它利用有价值的现有数据来增进对肩部软组织的理解 组织疾病以及我们的多学科小组和其他人对未来研究的规划。