Optimizing locomotor training for children with severe cerebral palsy

优化重度脑瘫儿童的运动训练

• 批准号: 8408013
• 负责人: SANDRA L SAAVEDRA
• 金额: $ 1.84万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2012-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8408013
• 关键词: 8 year old; Address; Age; Body Weight; Bone Density; Cerebral Palsy; Child; Childhood; Classification; Clinical; Cross-Sectional Studies; Custom; Data; Development; Devices; Dysplasia; Electromyography; Family; Frequencies; Friends; Growth; Health; Hip region structure; Incidence; Infant; Intervention; Lead; Learning; Leg; Live Birth; Lower Extremity; Measures; Methods; Motor; Movement; Muscle; Musculoskeletal Equilibrium; Osteoporosis; Participant; Pattern; Performance; Posture; Protocols documentation; Rehabilitation therapy; Research; Research Design; Research Personnel; Risk Factors; Robotics; Self-Help Devices; Surface; System; Techniques; Testing; Time; Training; Walking; Weight-Bearing state; Work; clinical practice; design; functional outcomes; high risk; improved; innovation; insight; meetings; motor control; motor deficit; motor impairment; muscle strength; respiratory; response; scoliosis; socioeconomics

DESCRIPTION (provided by applicant): Cerebral palsy is the most common motor deficit in children with an incidence of 2-3 per 1000 live births. An important socioeconomic problem is that 44% of children with cerebral palsy (CP) never learn to walk independently even with current treatments. Non-ambulatory children with CP have higher risk of hip dysplasia, scoliosis, osteoporosis, diminished growth and respiratory illness. Ironically, hope for better functional outcome is reduced for these children because they are commonly excluded from motor control research and clinical innovations. For example, current locomotor interventions (body weight supported treadmill training (BWSTT), assistive devices, robotic locomotor training) are designed for higher functioning children who have attained upright control of the trunk. Thus locomotor intervention is either inaccessible or inefficient for those children with the greatest need. Researchers working with young typically developing (TD) infants (who have poor trunk control, naturally), tip the babies' trunks forward when supported on a treadmill to help them step. A specific angle of inclination has not, however, been proposed nor has the rationale for this posture been articulated or tested. It is hypothesized that this technique reduces the demands for trunk control while simultaneously reducing the muscle force required for infants to swing their legs and step. It is proposed that this technique could also work for children with moderate-to-severe CP. Using a custom trunk support device with adjustable forward inclination angle and pediatric motorized treadmill, step responses will be documented monthly in 7 infants (AIM 1) during the age range when trunk postural control normally develops (1-7 mo) and in 30 children with moderate-to-severe CP (Gross Motor Function Classification System Level III, IV and V) (2-4 or 6-8 years of age) (AIM 2). Concurrent assessment of the segmental level of trunk control will provide information necessary to test the hypotheses that the optimal angle of trunk inclination is related to the level of trunk control available to the infant/child. This is the first study to systematically evaluate the influence of trunk control on stepping responses during BWSTT. Surface electromyography (EMG) of trunk and leg muscles will be recorded during studies for AIM 1 and 2, to test the hypothesis that providing trunk support will reduce the postural demands and enhance reciprocal activation patterns for leg and trunk muscles during treadmill-elicited stepping (AIM 3). Insights from this research will provide specific information to optimize performance during locomotor treatment for those children with CP who have the greatest need.

描述(申请人提供)：脑性瘫痪是儿童中最常见的运动缺陷，发病率为每1000名活产儿中有2-3名。一个重要的社会经济问题是，44%的脑瘫(CP)儿童即使在目前的治疗下也从未学会独立行走。患有脑性瘫痪的非卧床儿童患髋关节发育不良、脊柱侧弯、骨质疏松、生长发育减退和呼吸系统疾病的风险较高。具有讽刺意味的是，这些儿童对更好的功能结果的希望降低了，因为他们通常被排除在运动控制研究和临床创新之外。例如，目前的运动干预措施(体重支持的跑步机训练(BWSTT)、辅助设备、机器人运动训练)是为能够直立控制躯干的功能较高的儿童设计的。因此，对于那些最有需要的儿童来说，运动干预要么无法获得，要么效率低下。研究人员对典型发育(TD)婴儿(他们的躯干控制能力自然较差)进行了研究，当他们被支撑在跑步机上时，他们的躯干向前倾斜，以帮助他们前进。然而，还没有提出具体的倾斜角度，也没有阐述或测试这种姿态的理由。据推测，这项技术减少了对躯干控制的需求，同时减少了婴儿摆动腿和步子所需的肌肉力量。这项技术也适用于中重度脑性瘫痪的儿童。使用可调节前倾角的定制躯干支持装置和儿科机动跑步机，在躯干姿势控制正常发育的年龄范围内(1-7mo)，每月将记录7名婴儿(AIM 1)的阶跃反应，以及30名患有中到重度CP(粗大运动功能分类系统III、IV和V级)(2-4或6-8岁)的儿童(AIM 2)。同时评估躯干控制的分段水平将提供必要的信息，以检验以下假设：躯干的最佳倾斜角度与婴儿/儿童可获得的躯干控制水平有关。这是第一次系统地评价躯干控制对BWSTT中步进反应的影响的研究。在AIM 1和AIM 2的研究中，将记录躯干和腿部肌肉的表面肌电(EMG)，以验证在跑步机诱导的踏步(AIM 3)中，提供躯干支撑将减少姿势需求并增强腿部和躯干肌肉的相互激活模式的假设。这项研究的见解将为那些有最大需求的脑瘫儿童在运动治疗过程中优化表现提供具体的信息。