Publications by authors named "Richard Lieber"

It is challenging to obtain in vivo or in situ experimental data from human muscles due to the invasive nature of such measurements. As a result, many investigations of human performance, surgery, or skeletal adaptation are necessarily based on musculoskeletal models. The utility of such models will depend on the question being asked and the extent to which the model is sufficiently accurate to address that question.

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Background: Wearable sensors have been heralded as revolutionary tools for healthcare. However, while data are easily acquired from sensors, users still grapple with questions about how sensors can meaningfully inform everyday clinical practice and research.

Summary: We propose a simple, comprehensive framework for utilizing sensor data in healthcare.

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The intrinsic force production capability of human muscle can be expressed as "Specific Tension," or, the maximum force generated per cross-sectional area of muscle fibers. This value can be used to determine, for example, whether muscle quality changes during exercise, atrophy, disease, or hypertrophy. A value of 22.

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Article Synopsis
  • Progressive functional decline in cancer-associated cachexia is challenging to study due to the lack of appropriate cancer models and reliance on nonspecific measures like grip strength, prompting this study to extend survival in a cancer model for better analysis.
  • Researchers managed to prolong the lifespan of the cancer model to 8-9 weeks using a low dose of cancer cells, enabling the investigation of muscle wasting and other cachexia symptoms in detail.
  • The study found that gait speed is a more accurate indicator of cachexia-related physical function than grip strength, revealing changes in gait speed occurred earlier than grip strength in the model.
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The circadian clock orchestrates vital physiological processes such as metabolism, immune function, and tissue regeneration, aligning them with the optimal time of day. This study identifies an intricate interplay between the circadian clock within muscle stem cells (SCs) and their capacity to modulate the immune microenvironment during muscle regeneration. We uncover that the SC clock provokes time of day-dependent induction of inflammatory response genes following injury, particularly those related to neutrophil activity and chemotaxis.

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Muscle isometric torque fluctuates according to time-of-day with such variation owed to the influence of circadian molecular clock genes. Satellite cells (SCs), the muscle stem cell population, also express molecular clock genes with several contractile-related genes oscillating in a diurnal pattern. Currently, limited evidence exists regarding the relationship between SCs and contractility, although long-term SC ablation alters muscle contractile function.

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Background: After stroke, restoring safe, independent, and efficient walking is a top rehabilitation priority. However, in nearly 70% of stroke survivors asymmetrical walking patterns and reduced walking speed persist. This case series study aims to investigate the effectiveness of transcutaneous spinal cord stimulation (tSCS) in enhancing walking ability of persons with chronic stroke.

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Over the past two decades Biomedical Engineering has emerged as a major discipline that bridges societal needs of human health care with the development of novel technologies. Every medical institution is now equipped at varying degrees of sophistication with the ability to monitor human health in both non-invasive and invasive modes. The multiple scales at which human physiology can be interrogated provide a profound perspective on health and disease.

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A skeletal muscle's peak force production and excursion are based on its architectural properties that are, in turn, determined by its mass, muscle fiber length and physiological cross-sectional area (PCSA). In the classic interspecific study of mammalian muscle scaling, it was demonstrated that muscle mass scales positively allometrically with body mass whereas fiber length scales isometrically with body mass, indicating that larger mammals have stronger leg muscles than they would if they were geometrically similar to smaller ones. Although this relationship is highly significant across species, there has never been a detailed intraspecific architectural scaling study.

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Modern approaches to discovering molecular mechanisms and validating treatments for age-related neuromusculoskeletal dysfunction typically rely on high-throughput transcriptome analysis. Previously harvested and fixed tissues offer an incredible reservoir of untapped molecular information. However, obtaining RNA from such formaldehyde-fixed neuromusculoskeletal tissues, especially fibrotic aged tissues, is technically challenging and often results in RNA degradation, chemical modification and yield reduction, prohibiting further analysis.

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Central and peripheral nervous system lesions may disrupt the intricate balance of the prime movers of the wrist. In spasticity, hyperactive wrist flexors create a flexion moment and, if untreated, can lead to flexion contractures. In patients with C6 spinal cord injury and tetraplegia, the posterior interosseus nerve is typically affected by a complex pattern of upper and/or lower motoneuron lesions causing radial deviation of the wrist due to loss of ulnar deviation actuators.

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Objective: Inpatient rehabilitation represents a critical setting for stroke treatment, providing intensive, targeted therapy and task-specific practice to minimize a patient's functional deficits and facilitate their reintegration into the community. However, impairment and recovery vary greatly after stroke, making it difficult to predict a patient's future outcomes or response to treatment. In this study, the authors examined the value of early-stage wearable sensor data to predict 3 functional outcomes (ambulation, independence, and risk of falling) at rehabilitation discharge.

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Background: Progressive functional decline is a key element of cancer-associated cachexia. No therapies have successfully translated to the clinic due to an inability to measure and improve physical function in cachectic patients. Major barriers to translating pre-clinical therapies to the clinic include lack of cancer models that accurately mimic functional decline and use of non-specific outcome measures of function, like grip strength.

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Traumatic muscle injury represents a collection of skeletal muscle pathologies caused by trauma to the muscle tissue and is defined as damage to the muscle tissue that can result in a functional deficit. Traumatic muscle injury can affect people across the lifespan and can result from high stresses and strains to skeletal muscle tissue, often due to muscle activation while the muscle is lengthening, resulting in indirect and non-contact muscle injuries (strains or ruptures), or from external impact, resulting in direct muscle injuries (contusion or laceration). At a microscopic level, muscle fibres can repair focal damage but must be completely regenerated after full myofibre necrosis.

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Article Synopsis
  • The study investigates the passive mechanical properties of the multifidus muscle fibers in patients undergoing either primary or revision spine surgeries and examines the effects of fatty infiltration.
  • It measures the elastic modulus of single muscle fibers and fiber bundles using tests on excised muscle tissue from patients and assesses various factors including surgery type, gender, and age.
  • Findings reveal that female patients and those with severe fatty infiltration exhibit lower elastic modulus in muscle bundles, indicating that gender significantly influences muscle stiffness at the fiber level, while fatty infiltration impacts stiffness at the fiber bundle level.
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Developing a culture of innovative thinking and one that emphasizes clinician-researcher interaction is critical for the future of rehabilitation. We designed and implemented a strategy to build a culture of interdisciplinary communication and collaboration that facilitates translational research across several disciplines in our inpatient rehabilitation hospital. We colocated clinicians and researchers in workspaces within a new hospital and created the Research Accelerator Program-a collection of team-focused initiatives that promote communication and collaboration among researchers, clinicians, and other staff.

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Introduction: Developmental disabilities and neuromotor delay adversely affect long-term neuromuscular function and quality of life. Current evidence suggests that early therapeutic intervention reduces the severity of motor delay by harnessing neuroplastic potential during infancy. To date, most early therapeutic intervention trials are of limited duration and do not begin soon after birth and thus do not take full advantage of early neuroplasticity.

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Musculoskeletal models are valuable for studying and understanding the human body in a variety of clinical applications that include surgical planning, injury prevention, and prosthetic design. Subject-specific models have proven to be more accurate and useful compared to generic models. Nevertheless, it is important to validate all models when possible.

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  • The study investigates the effectiveness of using gracilis free functioning muscle transfer (FFMT) to restore elbow flexion after pan-brachial plexus injuries, focusing on different tendon insertion options.
  • Cadaveric experiments revealed that the peak instantaneous moment arm for elbow flexion occurs between 83° to 92° at various insertion sites, with distal insertions (FDP/BRD) offering significantly greater strength potential compared to the biceps brachii insertion.
  • The findings support the rationale for choosing distal muscle insertion locations in surgical planning, enhancing the reconstruction of elbow flexion strength based on measurable moment arm curves.
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The vast majority of skeletal muscle biomechanical studies have rightly focused on its active contractile properties. However, skeletal muscle passive biomechanical properties have significant clinical impact in aging and disease and are yet incompletely understood. This review focuses on the passive biomechanical properties of the skeletal muscle extracellular matrix (ECM) and suggests aspects of its structural basis.

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Objective: To evaluate changes in clinicians' use of evidence-based practice (EBP), openness toward EBP, and their acceptance of organizational changes after a rehabilitation hospital transitioned to a new facility designed to accelerate clinician-researcher collaborations.

Design: Three repeated surveys of clinicians before, 7-9 months, and 2.5 years after transition to the new facility.

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Article Synopsis
  • - The study investigates the relationship between single fiber mechanical properties and whole muscle function in the human gracilis muscle, traditionally validated only in small animals, aiming to confirm this in humans.
  • - Researchers used a surgical technique to transfer the gracilis muscle from the thigh to the arm, allowing direct measurement of its force-length relationship in situ and calculating important parameters like optimal fiber length and physiological cross-sectional area (PCSA).
  • - Results showed a human muscle fiber-specific tension of 171 kPa and an average optimal fiber length of 12.9 cm, which is significantly shorter than previous reports (23 cm), suggesting the long gracilis muscle contains shorter fibers acting in parallel.
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Objective: Spinal cord injury (SCI) damages synaptic connections between corticospinal axons and motoneurons of many muscles, resulting in devastating paralysis. We hypothesized that strengthening corticospinal-motoneuronal synapses at multiple spinal cord levels through Hebbian plasticity (i.e.

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There Must Be a Better Way.

J Bone Joint Surg Am

June 2023

The National Institutes of Health (NIH) R01 grant represents the gold standard for research independence across the United States. The barrier to entry for this grant mechanism is extremely high, with <10% of grants being funded. Interestingly, after this tremendously high barrier, there is very little accountability for the grantee to accomplish the aims that were originally proposed.

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Objective: A primary goal of acute stroke rehabilitation is to maximize functional recovery and help patients reintegrate safely in the home and community. However, not all patients have the same potential for recovery, making it difficult to set realistic therapy goals and to anticipate future needs for short- or long-term care. The objective of this study was to test the value of high-resolution data from wireless, wearable motion sensors to predict post-stroke ambulation function following inpatient stroke rehabilitation.

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