Robotic_Gait_Training_Improves_Locomotor_Function_in_Children_with_Cerebral_Palsy

描述(申请人提供)：这项拟议的研究的目标是使用一种新型的机器人疗法来提高脑瘫儿童的体重支持跑步机训练(BWSTT)的有效性，这种疗法在步态的摆动阶段对腿部施加可控力。脑性瘫痪是最普遍的起源于儿童的身体残疾，发病率为每1000名活产儿中有2-3名。唤醒速度和耐力降低是两个主要的功能问题。因此，人们渴望开发新的技术来改善患有CP的儿童的行走功能。虽然BWSTT已被用于改善CP儿童的运动功能，但目前尚不清楚这种训练的治疗效果是否最大化，还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更多的物理治疗师参与。目前的机器人辅助BWSTT在减少治疗师在运动训练中的劳动方面表现出了有效性，但在一些患者中显示出有限的功能收益。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阻力负荷来提高BWSTT的疗效。来自动物研究的证据表明，步态再训练在需要帮助的情况下比在固定轨迹模式下更有效。同样，成人中风后手臂研究的结果表明，通过使用错误强化训练来导致适应可能是促进功能运动恢复的有效方式。我们推测，根据脑瘫儿童的运动表现提供耐受阻力负荷，将通过增强患者的努力有效地参与适应性感觉运动过程来改善BWSTT的训练结果。因此，我们的具体目标是：Aim1。展示患有脑性瘫痪的儿童对外加负荷的运动适应。具体地说，我们的目标是评估CP儿童对受控阻力负荷的运动适应。将记录下肢体的肌肉活动和运动学，以量化阻力负荷对运动适应的影响。我们预计，腿部肌肉活动和肢体运动学将适应施加的负荷，并在移除时显示出后遗症。此外，我们将测试与阻力训练相关的运动适应从跑步机到地面行走的延续情况。目的2.采用抵抗作为耐受策略，改善脑性瘫痪儿童的步态。我们将评估阻力负荷训练后脑性瘫痪患儿的运动功能改善情况。具体地说，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。与援助训练组相比，预计BWSTT与阻力相结合的情况将有显著改善。这项研究的结果将导致一种旨在改善CP儿童运动功能的创新临床治疗方法。我们期望这项技术将有助于通过机器人辅助的BWSTT来改善CP儿童的步态。 公共卫生相关性：拟议研究的目的是改善脑瘫(CP)儿童的体重支持跑步机训练(BWSTT)的疗效，使用一种在跑步机行走过程中对腿部施加受控力量的新型机器人疗法。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疗法。我们预计，通过机器人辅助的BWSTT，这项技术将对改善脑性瘫痪儿童的步行功能非常有用。

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.