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Factors Driving Wear and Implant Failure in Total Shoulder Arthroplasty
Polyethylene (PE) wear and implant-related failure remain leading causes of revision in total shoulder arthroplasty (TSA), a procedure which now surpasses the growth rate of hip and knee arthroplasty. Both anatomic (aTSA) and reverse (rTSA) TSA outcomes are heavily influenced by complex interactions between rotator cuff function, scapular motion, implant design, and patient-specific loading—factors not adequately captured in current preclinical implant testing standards. Emerging evidence suggests that PE wear progression in TSA is highly dependent on shoulder kinematics, joint loading, implant positioning, and individual patient factors. Nonetheless, data on in vivo motion and load profiles remain sparse, and few tools exist to link these profiles to clinically relevant wear patterns or associated periprosthetic inflammatory tissue responses. Accordingly, the primary objective of this project is to develop validated, patient-specific models that predict PE wear in TSA and identify modifiable surgical, design, and rehabilitation targets to improve implant longevity and restore patient mobility. Additionally, we will establish histopathological hallmarks that indicate TSA failure caused by PE wear debris. Our central hypothesis is that specific shoulder kinematics and joint loading drive distinct PE wear patterns in TSA associated with mechanical failure or inflammatory-mediated osteolysis, depending on implant design and positioning. To achieve the overall objective of this work, shoulder motions and muscle excitations across 25 activities of daily living will be collected at pre-op and post-op (>6 months) in both aTSA and rTSA patients, with long-term follow-up of patient-reported outcomes via validated surveys (5 years). Unsupervised machine learning will categorize patients into movement-based phenotypes, which will then inform a multi-scale modeling framework to estimate in vivo shoulder joint loads and implant wear across the varying movement strategies. Predicted wear patterns will be validated using state-of-the-art preclinical wear simulators. Simultaneously, we will quantify how patient, surgical, and implant factors contribute to wear in retrieved TSA components (>400 samples), correlating imaging-based wear patterns with clinical outcomes, patient-reported function, inflammatory tissue responses, and radiographic indications of loosening. For that purpose, we will establish benchmarks of TSA wear rates and introduce a new histopathological approach augmented by infrared spectroscopic imaging. This work is innovative because we are linking patient-specific movement patterns following TSA with multi-scale computational models to predict PE wear, breaking the current approaches of using generic motions and loads in existing testing standards. This work will produce the first integrated, publicly available database of TSA kinematics, joint loading, and PE wear patterns and rates, along with validated computational tools to inform implant design, surgical planning, rehabilitation strategies, and personalized risk assessment. Ultimately, these advances will improve functional outcomes and long-term success for TSA patients and enable better preclinical testing methods and standards.
Advancing Brain-Computer Interfaces by adopting a neural population approach
Brain-computer interfaces (BCIs) have afforded paralysed users “mental control” of computer cursors and robots, and even of electrical stimulators that reanimate their own limbs. Most existing BCIs map the activity of hundreds of motor cortical neurons recorded with implanted electrodes into control signals to drive these devices. Despite these impressive advances, the field is facing a number of challenges that need to be overcome in order for BCIs to become widely used during daily living. In this talk, I will focus on two such challenges: 1) having BCIs that allow performing a broad range of actions; and 2) having BCIs whose performance is robust over long time periods. I will present recent studies from our group in which we apply neuroscientific findings to address both issues. This research is based on an emerging view about how the brain works. Our proposal is that brain function is not based on the independent modulation of the activity of single neurons, but rather on specific population-wide activity patters —which mathematically define a “neural manifold”. I will provide evidence in favour of such a neural manifold view of brain function, and illustrate how advances in systems neuroscience may be critical for the clinical success of BCIs.
Leveraging neural manifolds to advance brain-computer interfaces
Brain-computer interfaces (BCIs) have afforded paralysed users “mental control” of computer cursors and robots, and even of electrical stimulators that reanimate their own limbs. Most existing BCIs map the activity of hundreds of motor cortical neurons recorded with implanted electrodes into control signals to drive these devices. Despite these impressive advances, the field is facing a number of challenges that need to be overcome in order for BCIs to become widely used during daily living. In this talk, I will focus on two such challenges: 1) having BCIs that allow performing a broad range of actions; and 2) having BCIs whose performance is robust over long time periods. I will present recent studies from our group in which we apply neuroscientific findings to address both issues. This research is based on an emerging view about how the brain works. Our proposal is that brain function is not based on the independent modulation of the activity of single neurons, but rather on specific population-wide activity patters —which mathematically define a “neural manifold”. I will provide evidence in favour of such a neural manifold view of brain function, and illustrate how advances in systems neuroscience may be critical for the clinical success of BCIs.
Affordable Robots/Computer Systems to Identify, Assess, and Treat Impairment After Brain Injury
Non-traumatic brain injury due to stroke, cerebral palsy and HIV often result in serious long-term disability worldwide, affecting more than 150 million persons globally; with the majority of persons living in low and middle income countries. These diseases often result in varying levels of motor and cognitive impairment due to brain injury which then affects the person’s ability to complete activities of daily living and fully participate in society. Increasingly advanced technologies are being used to support identification, diagnosis, assessment, and therapy for patients with brain injury. Specifically, robot and mechatronic systems can provide patients, physicians and rehabilitation clinical providers with additional support to care for and improve the quality of life of children and adults with motor and cognitive impairment. This talk will provide a brief introduction to the area of rehabilitation robotics and, via case studies, illustrate how computer/technology-assisted rehabilitation systems can be developed and used to assess motor and cognitive impairment, detect early evidence of functional impairment, and augment therapy in high and low-resource settings.
GT-02287, a clinical-stage GCase enhancer, improves activities of daily living and cognitive performance in a preclinical model of GBA1 Parkinson’s disease
FENS Forum 2024
Unveiling the potential of pattern-stimulation in visual prostheses for activities of daily living
FENS Forum 2024
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