Robotic_Gait_Training_Improves_Locomotor_Function_in_Children_with_Cerebral_Palsy

描述（由申请人提供）：本研究的目的是通过一种新颖的机器人疗法，在步态摇摆阶段对腿部施加控制力，提高体重支持跑步机训练（BWSTT）对脑瘫（CP）儿童的疗效。CP是儿童期最普遍的身体残疾，发病率为每1000例活产2-3例。清醒速度和耐力下降是两个主要的功能问题。因此，人们渴望开发新技术来改善CP患儿的行走功能。虽然BWSTT已被用于改善CP患儿的运动功能，但这种训练的治疗效果是否最大化尚不清楚，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的参与。目前，机器人辅助的BWSTT在减少运动训练中治疗师的劳动方面显示出有效性，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可控的阻力负荷来提高BWSTT的功效。动物研究的证据表明，步态再训练在需要辅助的情况下比固定轨迹模式更有效。同样，成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性运动恢复的有效方法。我们假设，根据CP儿童的运动表现提供耐受性阻力负荷，将通过增强患者的努力，有效地参与适应性感觉运动过程，从而改善BWSTT的训练结果。因此，我们的具体目标是：证明小儿麻痹症对施加负荷的运动适应。具体来说，我们的目标是评估小儿麻痹症对控制阻力负荷的运动适应。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果。我们期望腿部肌肉活动和肢体运动学将适应施加的载荷，并显示移除后的后遗症。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行走的延续。目标2。使用抵抗作为耐受策略改善CP患儿的步态。我们将评估阻力负荷训练对CP患儿运动功能的改善。具体来说，步态速度、耐力和运动功能的临床测量将在训练前、训练后和随访时获得。与辅助训练组相比，BWSTT结合抵抗有望取得显著改善。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通过机器人辅助的BWSTT改善CP儿童的步态。

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.