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

> **NIH NIH R01** · UNIVERSITY OF WISCONSIN MILWAUKEE · 2021 · $602,168

## Abstract

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.

## Key facts

- **NIH application ID:** 10136652
- **Project number:** 5R01HD098698-03
- **Recipient organization:** UNIVERSITY OF WISCONSIN MILWAUKEE
- **Principal Investigator:** Brooke A Slavens
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $602,168
- **Award type:** 5
- **Project period:** 2019-07-01 → 2024-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10136652

## Citation

> US National Institutes of Health, RePORTER application 10136652, Prediction of Shoulder Injury for Disease Prevention in Children and Adults with Spinal Cord Injury Using Advanced Biomechanical Modeling and Diagnostic Imaging (5R01HD098698-03). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10136652. Licensed CC0.

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