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

> **NIH NIH F31** · NORTHWESTERN UNIVERSITY · 2023 · $43,468

## Abstract

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.

## Key facts

- **NIH application ID:** 10741775
- **Project number:** 5F31HD110236-02
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Divya Joshi
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $43,468
- **Award type:** 5
- **Project period:** 2022-09-12 → 2024-09-11

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10741775

## Citation

> US National Institutes of Health, RePORTER application 10741775, Quantification of Musculoskeletal Structural Adaptations Underlying Passive Wrist Joint Properties in Children and Adults with Hemiparetic Cerebral Palsy (5F31HD110236-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10741775. Licensed CC0.

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