OPTIMIZING MUSCLE FUNCTION IN CEREBRAL PALSY

优化脑瘫患者的肌肉功能

• 批准号: 2674159
• 负责人: DIANE L. DAMIANO
• 金额: $ 9.6万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-09-01 至 2002-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2674159
• 关键词: abnormal involuntary movement; ankle; cerebral palsy; child (0-11); clinical research; electromyography; exercise; functional ability; human subject; human therapy evaluation; knee; muscle function; muscle strength; neurophysiology; neurosurgery; orthopedics; outcomes research; quality of life; rehabilitation

Cerebral palsy (CP) is the most prevalent physical disability occurring in childhood, for which no cure is available. All current treatments such a surgery and physical therapy aim solely to alleviate the peripheral effects of this central nervous system disorder, often with limited and inconsistent success. A prevalent clinical system that has long been recognized, but rarely addressed therapeutically in this population is muscle weakness. While strength training is routinely used in the adult orthopaedic population and in athletes to increase force production or alter muscle imbalance, this type of intervention is grossly under- utilized in pediatric rehabilitation, and in particular children with CP. No evidence exists to support the clinical prejudice against strength training and testing in cerebral palsy. In fact, research findings are accumulating toe the contrary, demonstrating that individuals with CP are indeed weak, the degree of weakness has a direct relationship to motor performance, and strengthening programs can produce positive functional outcomes. However, the neurophysiological and biomechanical bases of weakness in CP remain poorly understood. An additional concern is that the two major surgical interventions in ambulatory children with spastic diplegia, muscle-tendon lengthening (orthopaedic surgery) and selective dorsal rhizotomy (neurosurgery), often serve to exacerbate or unmask the symptom of weakness, which can be problematic in children who are already weak. The ultimate goal of this project is to improve motor outcomes in CP by first exploring the mechanisms that lead to diminished force production and defining the relative role of weakness in the functional motor deficit in spastic CP. This will be accomplished by isokinetic and electromyographic evaluation to examine voluntary and involuntary muscle responses in children with CP at the knee and ankle joint throughout the range of motion and at different movement speeds. Muscle performance will then be related to validated pediatric measures of functional status and disability. Lastly, the interaction of strength with surgical interventions will be determined by quantifying the effects of orthopaedic and neurosurgery on strength and functional measures, and assessing whether the addition of a strengthening program enhances surgical outcomes. Strength is an essential component of normal motor control that is deficient in CP, but can be altered through training. Continued research, as proposed here, needs to be conducted to verify and solidify the role of strengthening in the rehabilitation of children with CP.

脑性瘫痪（CP）是最常见的身体残疾， 童年，没有治愈的方法。 目前所有的治疗方法， 手术和物理治疗的目的仅仅是为了减轻周围的 这种中枢神经系统疾病的影响，往往是有限的， 不一致的成功。 长期以来， 公认的，但很少在这一人群中治疗解决， 肌肉无力 虽然力量训练通常用于成年人， 在骨科人群和运动员中增加力量产生， 改变肌肉不平衡，这种类型的干预是严重不足- 用于儿科康复，特别是患有CP的儿童。 没有证据支持对规格的临床偏见 脑瘫的治疗方法有哪些 事实上，研究结果 相反，这表明患有CP的个体 确实虚弱，虚弱的程度与运动有直接关系。 性能，并加强方案可以产生积极的功能 结果。 然而，神经生理学和生物力学基础， CP弱点仍然知之甚少。 另一个问题是， 两种主要的手术干预在走动的痉挛性儿童 双瘫，肌肉肌腱延长（骨科手术）和选择性 背根切除术（神经外科），往往有助于加剧或揭露 虚弱的症状，这可能是有问题的儿童谁已经 弱. 该项目的最终目标是改善运动结果， CP首先探索导致力减弱的机制， 生产和定义的相对作用的弱点，在功能 痉挛性脑瘫的运动障碍这将通过等速和 肌电图评估，以检查随意肌和不随意肌 在整个研究期间，CP儿童膝关节和踝关节的反应 运动范围和不同的运动速度。 肌肉性能将 然后与经验证的儿科功能状态指标相关， 残疾。 最后，强度与外科手术的相互作用 干预措施将通过量化骨科的影响来确定， 和神经外科的力量和功能的措施，并评估 是否增加了强化计划， 结果。 力量是正常运动控制的重要组成部分， 缺乏CP，但可以通过训练改变。 继续 这里提出的研究需要进行验证和巩固 强化在脑瘫患儿康复中的作用。