Quantification of head and trunk control for children with neuromotor and neuromuscular disorders

患有神经运动和神经肌肉疾病的儿童的头部和躯干控制的量化

• 批准号: MR/T002034/1
• 负责人: Ian Loram
• 金额: $ 98.69万
• 依托单位: Manchester Metropolitan University
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2020
• 资助国家: 英国
• 起止时间: 2020 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FT002034%2F1
• 关键词: Quantification; head; trunk; control; children

Head and trunk control (trunk control) is mandatory for effective performance of everyday functional activities such as use of vision, sitting or any upper limb activity. Children with cerebral palsy (CP), spinal muscular atrophy (SMA) and inherited neuromuscular disorders (NMD) experience impairments in trunk control which are a fundamental component of their condition.Children with CP show a direct relationship between poor trunk control (orienting the head, sitting balance) and compromised function including communication by eye gaze, use of both hands for learning, play and social development, mobility and urinary incontinence. Children with more severe CP regress in their functional abilities from age 7 years. Accurate diagnosis of trunk control can enable individualised physiotherapy, when combined with treatment as usual, to improve general motor function even in severe CP (preprint). An accurate, objective tool is needed to provide evidence encompassing multiple therapies and centres.Infants with SMA1 have similar difficulty acquiring trunk control as do children with severe CP. Using Nusinersen, these children now survive, but this drug is expensive. An accurate, objective test is needed to monitor effectiveness of this and alternative drugs.The increasing muscle weakness in children with NMD (SMA2, congenital myopathy, congenital muscular dystrophy, Duchenne muscular dystrophy) leads to deterioration in trunk control with subsequent scoliosis. Objective measurement sensitive enough to detect changes in trunk control, pre-scoliosis, would enable appropriate treatment such as physiotherapy at the optimal time. Our hypothesis is that segmental trunk control can be measured objectively and efficiently, classified to seven segmental levels. This objective measurement would promote benefits in terms of new understanding of the mechanisms of trunk control, monitoring treatment and providing evidence to inform practice for all therapy strategies that aim to improve postural control and associated motor function. All current assessments suitable for use in a clinic are validated but rely on clinical judgement that must be maintained over time and between therapists, and many cannot be used for children unable to sit by themselves. They also consider the trunk as a single unit, thus losing the accurate and detailed assessment required for specialised therapy. We anticipate this objective assessment tool could lead to interventions to enhance trunk control, and thus improvement of functional skills, for thousands of children worldwide including those with greater severity of CP.Our project will i) develop live imaging analysis technology to automate the assessment of trunk control in sitting, ii) provide a cost effective and accessible tool usable within any clinic without increasing assessment time and iii) publish an online interactive database disseminating a public standard, a reference and a training resource for measuring trunk control, increasing understanding and enhancing expertise. Assessments of trunk control of children in sitting (400 CP, 20 SMA1, 40 typically developing (TD), 40 NMD) will be recorded using 3D cameras available for the home market. This dataset will include examples of all trunk control problems, body morphology and height that the clinical tool would be required to meet. Machine learning methods will be used to train and validate the automated diagnosis. The tool will be validated against expert clinical assessment and deployed as a laptop, software and two cameras, suitable for use by clinical staff in a routine clinical environment. To prepare power calculations necessary to plan clinical trials, we will collect a longitudinal dataset of 20 children with CP and 5 infants with SMA 1 during a twelve-month period.

头部和躯干控制（躯干控制）是有效执行日常功能活动（如使用视觉、坐姿或任何上肢活动）的强制性要求。脑性瘫痪（CP）、脊髓性肌萎缩症（SMA）和遗传性神经肌肉疾病（NMD）患儿的躯干控制能力受损，而躯干控制能力受损是其病情的基本组成部分。（定向头部，坐姿平衡）和受损的功能，包括通过眼睛凝视进行交流，使用双手进行学习，玩耍和社会发展，活动性和尿失禁。患有更严重CP的儿童从7岁起功能能力退化。躯干控制的准确诊断可以使个体化的物理治疗，当与常规治疗相结合时，即使在严重的CP中也可以改善一般运动功能。需要一个准确、客观的工具来提供包括多种治疗和中心的证据。SMA1婴儿与重度CP儿童在获得躯干控制方面有类似的困难。使用Nusinersen，这些儿童现在存活下来，但这种药物很昂贵。NMD（SMA2，先天性肌病，先天性肌营养不良，杜氏肌营养不良）患儿的肌无力增加，导致躯干控制能力下降，随后出现脊柱侧凸。客观的测量灵敏度足以检测躯干控制的变化，脊柱侧凸前，将使适当的治疗，如物理治疗在最佳时间。我们的假设是，节段性躯干控制可以客观有效地测量，分为七个节段性水平。这种客观测量将促进对躯干控制机制的新理解、监测治疗并提供证据以告知旨在改善姿势控制和相关运动功能的所有治疗策略的实践方面的受益。目前所有适合在诊所使用的评估都是经过验证的，但依赖于临床判断，必须随着时间的推移和治疗师之间的保持，许多不能用于不能自己坐着的儿童。他们还认为躯干是一个单一的单位，从而失去了专业治疗所需的准确和详细的评估。我们预计这种客观的评估工具可以导致干预措施，以加强躯干控制，从而改善功能技能，为世界各地的数千名儿童，包括那些更严重的CP。我们的项目将i）开发实时成像分析技术，以自动评估躯干控制坐着，ii）提供在任何诊所内可用的成本有效且可获得的工具，而不增加评估时间，以及iii）发布传播公共标准的在线交互式数据库，一个参考和培训资源，用于测量躯干控制，增加理解和提高专业知识。将使用国内市场可用的3D摄像机记录坐姿儿童（400 CP、20 SMA1、40典型发育（TD）、40 NMD）躯干控制的评估。该数据集将包括临床工具需要满足的所有躯干控制问题、身体形态和身高的示例。机器学习方法将用于训练和验证自动诊断。该工具将根据专家临床评估进行验证，并部署为笔记本电脑、软件和两个摄像头，适合临床工作人员在常规临床环境中使用。为了准备计划临床试验所需的把握度计算，我们将收集一个12个月期间20名CP儿童和5名SMA 1婴儿的纵向数据集。