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

Award Number: R01HD098698
ORGANIZATION: NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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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.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = $0 )
2024	2023	UNIVERSITY OF WISCONSIN SYSTEM	3203 N DOWNER AVE # 273	MILWAUKEE	WI	53211	MILWAUKEE	USA	Child Health and Human Development Extramural Research	000	4	3/14/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2023 ( Subtotal = $589,760 )
2023	2023	UNIVERSITY OF WISCONSIN SYSTEM	3203 N DOWNER AVE	MILWAUKEE	WI	53211	MILWAUKEE	USA	Child Health and Human Development Extramural Research	000	4	3/17/2023	NON-COMPETING CONTINUATION	$589,760
														Subtotal = $589,760

Issue Date FY: 2022 ( Subtotal = $0 )
2022	2021	UNIVERSITY OF WISCONSIN SYSTEM	3203 N DOWNER AVE STE 273	MILWAUKEE	WI	53211	MILWAUKEE	USA	Child Health and Human Development Extramural Research	000	3	5/20/2022	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2021 ( Subtotal = $602,168 )
2021	2021	UNIVERSITY OF WISCONSIN SYSTEM	3203 N DOWNER AVE STE 273	MILWAUKEE	WI	53211	MILWAUKEE	USA	Child Health and Human Development Extramural Research	000	3	3/25/2021	NON-COMPETING CONTINUATION	$602,168
														Subtotal = $602,168

Issue Date FY: 2020 ( Subtotal = $633,328 )
2020	2020	UNIVERSITY OF WISCONSIN SYSTEM	3203 N DOWNER AVE STE 273	MILWAUKEE	WI	53211	MILWAUKEE	USA	Child Health and Human Development Extramural Research	000	2	4/1/2020	NON-COMPETING CONTINUATION	$633,328
														Subtotal = $633,328

Issue Date FY: 2019 ( Subtotal = $645,457 )
2019	2019	UNIVERSITY OF WISCONSIN SYSTEM	3203 N DOWNER AVE STE 273	MILWAUKEE	WI	53211	MILWAUKEE	USA	Child Health and Human Development Extramural Research	000	1	6/26/2019	NEW	$645,457
														Subtotal = $645,457

Grand Total All Awards = $2,470,713

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

Award Number: R01HD098698

ORGANIZATION: NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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