Quantifying patient-specific changes in neuromuscular control in cerebral palsy

量化脑瘫患者神经肌肉控制的特定变化

• 批准号: 10442902
• 负责人: Michael Hart Schwartz
• 金额: $ 40.27万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-30 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10442902
• 关键词: Aftercare; Age; Ankle; Bilateral; Birth; Brain Injuries; Caring; Cerebral Palsy; Characteristics; Child; Data; Diagnosis; Dorsal; Europe; Exhibits; Exposure to; Feedback; Flexor; Foundations; Impairment; Individual; Intervention; Joints; Knowledge; Learning; Leg; Length; Life; Measures; Methods; Modality; Motor; Movement; Muscle; Nervous System Trauma; Operative Surgical Procedures; Orthopedic Surgery; Orthotic Devices; Outcome; Participant; Patients; Pattern; Performance; Persons; Process; Quality of life; Randomized; Research; Resistance; Rhizotomy procedure; Robot; Soleus Muscle; Speed; Symptoms; System; Time; Training; Treatment outcome; Visual; Walking; Weight; Work; design; experimental analysis; experimental study; gait examination; gait rehabilitation; improved; improved functioning; light weight; motor control; motor impairment; motor learning; multimodality; neuromuscular; peer; rate of change; recruit; response; robotic device; sex; synergism; treadmill; treatment response; walking speed

Project Summary Walking enables independence and exploration in daily life. For people with cerebral palsy (CP), a brain injury near the time of birth alters their ability to move and participate in daily activities. Treatments seek to improve walking function, but the processes by which people with CP adapt and learn new movement patterns are poorly understood. Our prior research demonstrated that patient-specific measures of motor control (i.e., how an individual recruits and coordinates their muscles) are important indicators of walking function and treatment outcomes. Children with more impaired motor control compared to nondisabled peers have worse function and worse outcomes after treatments like orthopedic surgery or selective dorsal rhizotomy. The premise of our proposed research is that patient-specific measures of adaptation are equally important to understand and inform care, but we lack methods to quantify adaptation or effectively induce motor learning. Whether adaptation is altered in CP and whether targeted training can amplify adaptation to improve walking function remains unknown. Multimodal feedback training is a promising approach to support adaptation and motor learning, but few studies have evaluated adaptation with real-time feedback training during walking or its impacts on walking function. The proposed research seeks to fill these gaps by completing the systematic experimental analyses necessary to quantify walking adaption rates (Aim-1) and determine whether repeated exposure to multimodal feedback training can alter adaptation rates (Aim-2) to induce motor learning and improve walking function (Aim-3). Specifically, we examine adaptation rates in response to multimodal feedback training that targets plantarflexor function, a key muscle group for walking that is nearly universally impaired in CP. We provide multimodal feedback using (1) sensorimotor feedback from adaptive ankle resistance delivered via a light-weight, wearable robot and (2) audiovisual feedback of plantar flexor activity from EMG recordings. By evaluating responses of children with CP to this feedback training – both individually and combined – this research will establish the scientific basis to quantify and understand adaptation and motor learning in CP.

项目摘要 步行可以在日常生活中实现独立和探索。对于脑瘫（CP）患者来说， 在接近出生的时候改变他们的移动和参与日常活动的能力。治疗寻求改善 步行功能，但CP患者适应和学习新运动模式的过程是 不太了解。我们先前的研究表明，运动控制的患者特异性措施（即，如何 个体招募并协调其肌肉）是行走功能的重要指标， 治疗结果。与非残疾同龄人相比，运动控制受损的儿童更严重， 矫形手术或选择性脊神经背根切断术等治疗后的功能和预后更差。的 我们提出的研究的前提是，患者特定的适应措施同样重要， 了解和告知护理，但我们缺乏量化适应或有效诱导运动学习的方法。 CP中的适应是否改变，以及有针对性的训练是否可以放大适应以改善行走 功能仍然未知。多模式反馈培训是支持适应的一种有前途的方法， 运动学习，但很少有研究评估适应与实时反馈训练，在步行或 对行走功能的影响。拟议的研究旨在通过完成系统的 量化步行适应率（Aim-1）并确定是否重复 暴露于多模态反馈训练可以改变适应率（Aim-2），以诱导运动学习， 改善行走功能（目标3）。具体来说，我们研究了适应率，以应对多模态 反馈训练，目标跖屈肌功能，一个关键的肌肉群步行，几乎普遍 CP受损。我们提供多模态反馈使用（1）感觉运动反馈自适应踝关节 通过一个重量轻，可穿戴机器人和（2）足底屈肌活动的视听反馈传递阻力 肌电图记录。通过评估CP儿童对这种反馈训练的反应-无论是单独的 这项研究将为量化和理解适应建立科学基础， CP中的运动学习