Postural mechanisms in moderate-to-severe cerebral palsy
Postural mechanisms in moderate-to-severe cerebral palsy
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DOI：
10.1152/jn.00549.2020
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发表时间：
2021-05-01
影响因子：
2.5
通讯作者：
Saavedra, Sandra
中科院分区：
文献类型：
--
作者：
Goodworth, Adam;Saavedra, Sandra
中度至重度脑瘫（CP）患者最需要姿势控制研究，但由于坐姿能力不足，通常被排除在研究之外。我们使用的支持系统，使我们能够量化和模型的姿势机制，在瘫痪儿童与CP。一个连续的外部板凳倾斜刺激被用来唤起躯干姿势反应在7个坐着的儿童CP（年龄2.5至13岁）在几个测试会议。还包括8名健康成年人。姿势摇摆分析与均方根（RMS）摇摆和RMS摇摆速度，沿着与频率响应函数（频响函数，增益和相位）和相干函数在两个不同的刺激幅度。一个反馈模型（包括感觉运动噪声，被动，反射和感觉整合机制）被开发来假设姿势控制机制是如何组织和功能的。实验结果表明，大RMS摇摆，频响增益，和变异性与成人相比。建模表明，许多与CP科目采用“简单”的控制与被动和反射机制的主要贡献，只有一个小的贡献，从主动感觉整合。与此相反，成熟的躯干姿势控制包括感觉统合和感觉重新加权的主要贡献。相对于他们的身体大小，与CP的主题表现出显着较低的阻尼，三到五倍大的纠正扭矩，和更高的感觉运动噪声相比，健康的成熟系统。结果是躯干姿势反应的第一个表征，也是中重度脑瘫系统识别的第一次尝试，这是朝着开发和评估更有针对性的干预措施迈出的重要一步。NEW &值得注意的是，脑瘫（CP）是儿童运动障碍的最常见原因。中重度CP患者通常不能行走，躯干姿势控制有严重障碍。我们提出了第一个系统识别研究，调查在这一人群中的外部刺激的姿势反应，并假设在非典型的姿势控制系统的功能与反馈模型的使用。患有中度至重度CP的人可能使用具有显著感觉运动噪声的简单控制系统。
People with moderate-to-severe cerebral palsy (CP) have the greatest need for postural control research yet are usually excluded from research due to deficits in sitting ability. We use a support system that allows us to quantify and model postural mechanisms in nonambulatory children with CP. A continuous external bench tilt stimulus was used to evoke trunk postural responses in seven sitting children with CP (ages 2.5 to 13yr) in several test sessions. Eight healthy adults were also included. Postural sway was analyzed with root mean square (RMS) sway and RMS sway velocity, along with frequency response functions (FRF, gain and phase) and coherence functions across two different stimulus amplitudes. A feedback model (including sensorimotor noise, passive, reflexive, and sensory integration mechanisms) was developed to hypothesize how postural control mechanisms are organized and function. Experimental results showed large RMS sway, FRF gains, and variability compared with adults. Modeling suggested that many subjects with CP adopted "simple" control with major contributions from a passive and reflexive mechanism and only a small contribution from active sensory integration. In contrast, mature trunk postural control includes major contributions from sensory integration and sensory reweighting. Relative to their body size, subjects with CP showed significantly lower damping, three to five times larger corrective torque, and much higher sensorimotor noise compared with the healthy mature system. Results are the first characterization of trunk postural responses and the first attempt at system identification in moderate-to-severe CP, an important step toward developing and evaluating more targeted interventions.NEW & NOTEWORTHY Cerebral palsy (CP) is the most common cause of motor disability in children. People with moderate-tosevere CP are typically nonambulatory and have major impairments in trunk postural control. We present the first systems identification study to investigate postural responses to external stimulus in this population and hypothesize at how the atypical postural control system functions with use of a feedback model. People with moderate-to-severe CP may use a simple control system with significant sensorimotor noise.