Muscle Performance and Walking in Cerebral Palsy: Short-burst Interval Training

描述(由申请人提供)：患有脑瘫(CP)的活动儿童肌肉力量和力量产生速度降低，这限制了他们行走的活动和参与日常生活的能力。运动跑步机训练(LTT)以增强 患有脑性瘫痪的儿童行走已被证明并不比传统的康复策略更有效。本应用的目的是确定无体重支持的短胸间期LTT对慢性阻塞性肺病儿童步行能力和行走能力的初级结果以及日常参与的次级结果的影响。为了确定这类训练的关键肌肉机制，我们将检查股四头肌的肌肉性能和结构。此外，我们还将收集两个LTT剂量计划的初步数据。这项拟议研究的理论基础是，短爆发式间歇LTT将通过激励和反映典型发育中(TD)青少年的步行和体力活动模式的训练方案，提高肌肉力量产生以及随后的步行性能和能力。我们假设，针对脑瘫儿童的LTT策略以TD儿童的活动模式为模型，而不是成人的活动模式，将积极地影响肌肉力量的产生，并随后改善基于社区的步行活动，并具有积极的参与趋势。这一假设将通过以下具体目标进行检验。目标 #1：研究短爆发间期LTT对慢性阻塞性肺疾病非卧床儿童步行能力、步行能力和日常活动的影响。短猝发间隔LTT将由30秒组成 突发的高速步行和30秒的慢速到中速步行交替进行，朝着总共30分钟的方向努力。将纳入12名患有双侧痉挛脑瘫的6-12岁的流动儿童。分目标#1a：两种短脉冲时间间隔给药方案的初步比较。所有参与者将被随机分配到两种给药方案中的一种，共20次，5次/周，4周或2次/周，10周。目的#2：量化短爆发间期LTT对活体肌肉结构和肌肉性能的影响。肌肉结构将使用超声成像进行测量，肌肉力量、力量和力量发展速度将使用等速测力法进行测量。这个项目是创新的，因为它专注于一种独特的方法来解决脑瘫儿童的步行限制，并实施了StepWatch加速度计，以获得基于社区的步行活动结果。这项拟议的研究意义重大，因为它将是一系列研究的第一步，该研究有望指导儿童残疾人士的运动训练方案和康复策略，并对脑瘫儿童社区步行活动的变化产生积极影响。对脑性瘫痪儿童对高速短脉冲训练作出反应的肌肉机制的理解有望取得进展。这些知识还与终身增强行动能力和体力活动的健康和功能益处有关。

DESCRIPTION (provided by applicant): Ambulatory children with cerebral palsy (CP) have diminished muscle power and rate of force production, which limits their walking activity and ability to physically participate in day to day life. Locomotor treadmill training (LTT) to enhance walking in children with CP has been shown to be no more effective than traditional rehabilitation strategies. The objective of this application is to determine the effect of short-bust interval LTT without body weight support on the primary outcomes of walking performance and capacity, and secondary outcome of daily participation in children with CP. To identify key muscular mechanisms with this type of training, we will examine quadriceps muscle performance and architecture. In addition, we will collect preliminary data on two LTT dosing schedules. The rationale for this proposed research is that short-burst interval LTT will enhance muscle power production and subsequently walking performance and capacity via training protocols that are motivating and mirror the walking and physical activity patterns of typically developing (TD) youth. We hypothesize that LTT strategies for children with CP modeled on activity patterns in TD children, rather than activity patterns of adults, will positively affect muscle power generation and subsequently improve community-based walking activity with a positive trend in participation. This hypothesis will be tested by the following specific aims. Aim #1: examine the effect of short-burst interval LTT on walking performance, capacity, and day-to-day participation in ambulatory children with CP. Short-burst interval LTT will consist of a 30-sec burst of high speed walking alternating with a 30-sec interval of slow to moderate speed walking, working towards a total of 30 minutes. Twelve ambulatory children, 6-12 years old with bilateral spastic CP will be enrolled. Sub-aim #1a: preliminary comparison of two dosing schedules of short-burst interval LTT. All participants will be randomized to one of two dosing schedules of 20 total sessions, 5x/week for 4 weeks or 2x/week for 10 weeks. Aim #2: quantify the effects of short-burst interval LTT on in vivo muscle architecture and muscle performance. Muscle architecture will be measured using ultrasound imaging and muscle power, strength, and rate of force development will be measured with isokinetic dynamometry. This project is innovative because it focuses on a unique approach for addressing walking limitations in children with CP and implements the StepWatch accelerometer for community-based walking activity outcomes. The proposed research is significant because it will be the first step in a continuum of research that is expected to direct locomotor training protocols and rehab strategies across pediatric disabilities and positively effect changes in community-based walking activity for children with CP. Advances in the understanding of the muscular mechanisms by which children with CP respond to high speed short-burst training are expected. Such knowledge also has relevance to the health and functional benefits of enhanced mobility and physical activity across the life span.