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

描述（由申请人提供）：患有脑瘫（CP）的非卧床儿童的肌肉力量和力量产生率下降，这限制了他们的步行活动和参与日常生活的能力。运动跑步机训练（LTT），以提高 已经证明，患有CP的儿童行走并不比传统的康复策略更有效。本申请的目的是确定无体重支撑的短胸围间隔LTT对CP儿童行走能力和能力的主要结局以及日常参与的次要结局的影响。为了确定这种类型的训练的关键肌肉机制，我们将检查四头肌肌肉的性能和结构。此外，我们将收集两种LTT给药方案的初步数据。这项拟议研究的基本原理是，短爆发间隔LTT将通过激励和反映典型发育（TD）青少年的步行和身体活动模式的训练方案来增强肌肉力量的产生以及随后的步行性能和能力。我们假设，LTT策略为CP儿童的TD儿童的活动模式，而不是活动模式的成年人，将积极影响肌肉发电，并随后改善社区为基础的步行活动的积极趋势参与。这一假设将通过以下具体目标进行检验。目的 #1：检查短爆发间期LTT对非卧床CP儿童步行能力、能力和日常参与的影响。短脉冲间隔LTT将包括30秒 快速步行与间隔30秒的慢速至中速步行交替进行，总共持续30分钟。将入组12名患有双侧痉挛性CP的6-12岁非卧床儿童。子目标#1a：短爆发间期LTT的两种给药方案的初步比较。所有受试者将被随机分配至两个给药方案之一，共20次，每周5次，持续4周或每周2次，持续10周。目标#2：量化短爆发间隔LTT对体内肌肉结构和肌肉性能的影响。将使用超声成像测量肌肉结构，并使用等速测力法测量肌肉力量、力量和力量发展速率。该项目具有创新性，因为它专注于解决CP儿童行走限制的独特方法，并实施StepWatch加速计，以实现基于社区的步行活动结果。这项研究意义重大，因为它将是一系列研究的第一步，这些研究有望指导儿科残疾儿童的运动训练方案和康复策略，并对CP儿童基于社区的步行活动产生积极影响。在理解CP儿童对高速短爆发训练的肌肉机制方面取得了进展。这些知识也与增强整个生命周期的活动能力和身体活动对健康和功能的好处有关。

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.