Robotic_Gait_Training_Improves_Locomotor_Function_in_Children_with_Cerebral_Palsy

描述（由申请方提供）：本拟议研究的目的是使用一种新型机器人疗法（在步态摆动阶段对腿部施加受控力）来改善脑瘫（CP）儿童体重支持跑步机训练（BWSTT）的疗效。脑瘫是最常见的源于儿童的身体残疾，发病率为每1 000名活产2-3人。清醒速度和耐力下降是两个主要的功能问题。因此，人们希望开发新的技术来改善CP儿童的行走功能。虽然BWSTT已被用于改善CP儿童的运动功能，但尚不清楚这种训练的治疗效果是否最大化，需要进一步的证据来支持BWSTT在儿科实践中的应用。此外，BWSTT的一个主要限制是它需要物理治疗师的更多参与。目前的机器人辅助BWSTT证明了在运动训练中减少治疗师劳动的有效性，但在一些患者中显示出有限的功能增益。因此，我们的目标是通过在跑步机训练期间对腿部施加受控的阻力负荷来提高BWSTT的功效。来自动物研究的证据表明，步态再训练在根据需要提供帮助的情况下比固定轨迹范例更有效。同样，成年人中风后手臂研究的结果表明，通过错误增强训练引起适应可能是促进功能运动恢复的有效方法。我们假设，提供耐受的阻力负荷的基础上的运动表现的儿童与CP将提高训练结果的BWSTT通过增强患者的努力，有效地从事自适应感觉运动过程。因此，我们的具体目标是：目标1。证明CP儿童对施加负荷的运动适应性。具体来说，我们的目标是评估运动适应控制阻力负荷的儿童与CP。将记录下肢的肌肉活动和运动学，以量化阻力负荷的运动适应效应。我们预计腿部肌肉活动和肢体运动学将适应所施加的负载，并在移除时显示出后遗症。此外，我们将检查与阻力训练相关的运动适应从跑步机到地上步行的延续。目标二。使用阻力作为耐受策略改善CP儿童的步态。我们将评估CP儿童在阻力负荷训练后运动功能的改善。具体而言，将在训练前、训练后和随访时获得步态速度、耐力和运动功能的临床测量值。与辅助训练组相比，预计BWSTT与阻力相结合会有显着改善。这项研究的结果将导致一种创新的临床治疗，旨在改善CP儿童的运动功能。我们预计，这项技术将有助于改善步态与CP儿童通过机器人辅助BWSTT。 公共卫生相关性：拟议研究的目的是提高体重支持跑步机训练（BWSTT）在脑瘫（CP）儿童中的疗效，使用一种新型机器人疗法，在跑步机行走过程中对腿部施加控制力。这项研究的结果将导致旨在改善CP儿童运动功能的创新临床治疗。我们预计，这项技术将是非常有用的改善步行功能的儿童CP通过机器人辅助BWSTT。

DESCRIPTION (provided by applicant): The goal of this proposed study is to improve the efficacy of body weight supported treadmill training (BWSTT) in children with cerebral palsy (CP) using a novel robotic therapy that applies controlled forces to the leg during the swing phase of gait. CP is the most prevalent physical disability originating in childhood with an incidence of 2-3 per 1,000 live births. Reduced waking speed and endurance are two of the main functional problems. As a consequence, there is a desire to develop new techniques to improve walking function in children with CP. While BWSTT has been used to improve locomotor function in children with CP, it remains unclear whether therapeutic effects of such training are maximized and further evidence is needed to support BWSTT in pediatric practice. In addition, a major limitation of BWSTT is that it requires greater involvement of the physical therapist. Current robot assisted BWSTT demonstrates effectiveness in reducing therapist labor in locomotor training but shows limited functional gains in some patients. Our goal is therefore to improve the efficacy of BWSTT by applying controlled resistance load to the leg during treadmill training. Evidence from animal studies indicates that gait retraining is more effective with assistance as needed than with a fixed trajectory paradigm. Similarly, results from adults post stroke arm study suggested that causing adaptation by using error-augmentation training might be an effective way to promote functional motor recovery. We postulate that providing tolerated resistance load based on the motor performance of the children with CP will improve the training outcomes of BWSTT through enhanced patient effort that effectively engages adaptive sensorimotor processes. Accordingly, our specific aims are: Aim1. Demonstrate motor adaptation to applied loads in children with CP. Specifically, we aim to assess the motor adaptation to controlled resistance load in children with CP. The muscle activities and kinematics of the lower extremities will be recorded to quantify the motor adaptive effects of resistance loads. We expect that leg muscle activity and limb kinematics will adapt to applied loads and show aftereffects when removed. In addition, we will exam the carryover of the motor adaption associated with the resistance training from the treadmill to overground walking. Aim 2. Improve gait in children with CP using a resistance as tolerated strategy. We will assess the locomotor function improvement in children with CP following resistance load training. Specifically, gait speed, endurance, and clinical measurements of motor function will be obtained at pre, post training, and at the follow up. Significant improvements are expected in the BWSTT combined with resistance, compared to the assistance training group. The results from this study will lead to an innovative clinical therapy aimed at improving locomotor function in children with CP. We anticipate that this technique will be useful for improving gait in children with CP through robot-assisted BWSTT. PUBLIC HEALTH RELEVANCE: The purpose of the proposed research is to improve the efficacy of body weight supported treadmill training (BWSTT) in children with cerebral palsy (CP) using a novel robotic therapy that applies controlled force to the leg during treadmill walking. The results from this study will lead to innovative clinical therapies aimed at improving locomotor function in children with CP. We anticipate that this technique will be extremely useful for improving walking function in children with CP through robot-assisted BWSTT.