Marking the spot: Collaboration aims to develop clinically useful tool to shed light on birth injury

February 28, 2013 by Diane Kukich, University of Delaware
The Richards research team works with Lindsay Adler, a patient at Shriners Hospital in Philadelphia. Pictured are (from left) Kristen Thomas, Tyler Richardson and Stephanie Russo.

University of Delaware researcher Jim Richards has successfully used motion analysis technology to allow elite figure skaters to explore "what-if" scenarios about their jumping technique. Now he hopes that he and his research team can use a similar approach to guide clinicians in treating children with a birth injury called brachial plexus birth palsy (BPBP).

BPBP, which occurs in about four out of every 1,000 births, affects in the , impacting muscle function in the shoulder and the arm. Most children recover on their own, but about 30 percent are left with lifelong deficits in that require therapy or surgery. The most severe brachial plexus injuries can cause complete paralysis of the arm.

But the answer to a key question has eluded researchers trying to understand exactly what is going on in the musculoskeletal systems of children with BPBP: Where is the shoulder blade at any given moment, and what is it doing? This information would provide valuable insight into a child's specific defects and enable treatments to be tailored to individual patients, as the location and extent of damage to the nerves and muscles vary from one person to another.

Richards, who is Distinguished Professor in UD's Department of Kinesiology and Applied Physiology, explains that the movements of the scapula, commonly known as the shoulder blade, are incredibly difficult to measure. 

Researchers discuss a collaborative effort between UD and Shriners Hospital for Children to shed light on an injury called brachial plexus birth palsy. Credit: Andrea Boyle Tippett

"Our motion capture cameras provide us with reasonable data for the lower extremities," Richards says, "but the same approach applied to the upper body fails to tell us much about the movement of the scapula."

He and his team of doctoral students in UD's BIOMS ( and Movement Science) program have taken a systematic approach to filling this gap.  If they're successful, it may someday be possible for surgeons to use the UD simulation to explore what will happen if they move a tendon from one point to another in an individual patient.

Feeling their way

The team is working with clinicians at Shriners Hospital for Children in Philadelphia on the first stage of the project.  Two of Richards' students, Kristen Thomas and Stephanie Russo, have collected data on 65 children with BPBP using a system. 

"We're fairly confident that we can get accurate scapular measurements under static conditions," Thomas explains. "The question then is, 'If we put the kids in enough static positions, can we draw conclusions about what happens when they're moving?'"

"There are 11 specific positions that have clinical relevance," she continues. "The problem is that right now we're identifying these positions through palpation, or feel, and the accuracy of this approach has not been established in living patients. So our plan is to use static fluoroscopic imaging data to build a 3D model for comparison with the palpation method. If the model validates the palpation measures, then we can move forward with testing a larger pool of subjects without the need for expensive imaging equipment."

Doing the math

Once the researchers have determined whether the positional measurements are repeatable, they can develop a set of equations to tell them how the scapula moves from one position to another. Results from the equations will be compared with data collected using 3D motion fluoroscopy, an imaging technique that produces a video X-ray.

"If it all works," Richards says, "we'll be able to go into a clinical setting like Shriners, drop 11 markers onto a patient to find out what's happening, and then do the same after surgery to see what the effects are."

Seeing the big picture

Tyler Richardson, another graduate student in Richards' group, is adapting a freely available program called OpenSim for use on the project.

"With motion data input from a patient, the program will use mathematical optimization to find all of the possible muscle combinations that could produce that motion," he says. "We can gain lots of information about the , both pre- and post-surgically, of an individual this way."

Ultimately, Richardson envisions clinicians being able to explore what-if scenarios that would enable them to determine how a specific surgical technique will affect a specific patient. And eventually the technique could be broadened beyond BPBP to other injuries.

The academic researcher has high praise for his clinical partners on the project as well as his for his team of talented students. 

"Shriners is the go-to place for families who have a child with this injury," he says. "We're very fortunate to be working with these experts, and none of this would be possible without my grad students."

Russo, who is simultaneously working on a Ph.D. at UD and an M.D. at Drexel University, is co-advised by two physicians at Shriners, Scott Kozin and Dan Zlotolow.

"They have been fabulous to work with," she says. "It's wonderful to see the collaboration between the science side through UD's BIOMS program and the clinical side through the physicians at the hospital. We're all working together to make treatment more effective for these kids."

Explore further: New tool to measure outcomes could help improve arm surgery for devastating nerve injury

Related Stories

New tool to measure outcomes could help improve arm surgery for devastating nerve injury

May 20, 2011
The way that clinicians report outcomes of surgery for a traumatic nerve injury involving the arm is not standardized, and it is thus difficult to compare the efficacy of different surgical treatments, according to a study ...

JAAOS study highlights success of nerve transfer surgery

August 1, 2012
Because many physicians are unaware of nerve transfer surgery, some patients suffer long-term impairment from nerve injuries that could have been fixed.

Recommended for you

Best of Last Year—The top Medical Xpress articles of 2017

December 20, 2017
It was a good year for medical research as a team at the German center for Neurodegenerative Diseases, Magdeburg, found that dancing can reverse the signs of aging in the brain. Any exercise helps, the team found, but dancing ...

Pickled in 'cognac', Chopin's heart gives up its secrets

November 26, 2017
The heart of Frederic Chopin, among the world's most cherished musical virtuosos, may finally have given up the cause of his untimely death.

Sugar industry withheld evidence of sucrose's health effects nearly 50 years ago

November 21, 2017
A U.S. sugar industry trade group appears to have pulled the plug on a study that was producing animal evidence linking sucrose to disease nearly 50 years ago, researchers argue in a paper publishing on November 21 in the ...

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.