Physical, Functional and Neurological Effects of Exercise in Children with CP

Major Findings: 该方案的招募工作于2010年4月开始。目前已完成20名健康志愿者的收集。迄今为止，已有 31 名脑瘫儿童入组。 一旦我们完成了研究的运动部分，我们将为目标 1 招募额外的资金。过去一年我们的主要目标是分析大脑成像数据和肌肉成像数据。我们正在与霍普金斯大学的合作者密切合作，研究大脑成像数据，其中包括来自 rsMRI 和 DTI 的功能连接数据，并已完成 17/20 对照组和 16 名 CP 儿童的所有基线数据的处理。去年夏天，我们处理了所有肌肉超声数据，包括肌肉大小和纹理（回声）数据。我们希望今年能够完成目标 2，完成数据分析并开始传播。 拟议的工作进程 这项工作的隐含目标是确定下肢的剧烈交互训练是否可以足够程度地刺激 CP 中的感觉运动通路，从而影响大脑感觉和运动区域内部和之间的运动协调和皮质连接的变化。 一个担忧是脑瘫患者的感觉系统可能受到损害，因此不那么有希望成为促进运动和皮质变化的途径。 相反，这些长期被剥夺或发展较差的区域可能对刺激的反应比它们更加强大时更加剧烈。 鉴于我们在设备中进行合规性监控，我们还可能获得有关运动剂量反应的信息，因为并非所有人都会遵守协议中指定的所有运动或运动持续时间。 我们还能够将患者特征（例如年龄、参与程度、痉挛程度等）与干预措施的反应联系起来。 在 CP 中，不同受试者之间经常观察到结果的差异，但人们对此仍知之甚少。 我们还预计，我们将获得有关 CP 相互协调性质的基本信息，以及它与运动严重程度、感觉或运动通路的完整性或小脑等区域的关系（假设我们获得了样本中该大脑区域的足够信息）。 项目影响报告： 这将是第一个报道的电机辅助自行车和椭圆机训练在脑瘫中的功效试验。如果结果符合预期，即训练后相互协调性得到改善，那么这些发现将有必要通过临床试验与 BWSTT 等现有治疗方法进行进一步比较。 如果协调确实发生了变化，我们也会非常有兴趣确定感觉运动通路是否同时发生变化，显示出训练后连通性的增加。还将探索感觉和运动通路的初始完整性与干预反应的关系，以确定是否可以预测哪些患者最有可能从针对脊柱通路的训练中受益。这是第一项比较 CP 力量训练前后肌肉完整性的研究。

Major Findings: Recruitment for this protocol started April 2010. Collection of the 20 healthy volunteers has been completed. To date 31 children with CP have been enrolled. Once we complete the exercise portion of the study, we will recruit the additional amount for objective 1. Our major goals this past year was to analyze the brain imaging data and muscle imaging data. We are working closely with our collaborators from Hopkins on the brain imaging data which includes functional connectivity data from rsMRI and DTI and have completed processing all baseline data for 17/20 controls, and 16 children with CP thus far. This past summer we processed all of the muscle ultrasound data including muscle size and texture (echogenicity) data. We are hoping to close out Objective 2 this year, complete data analysis and begin dissemination. Proposed course of Work The implicit goal of this work is to determine whether intense reciprocal training of the lower extremities can stimulate sensorimotor pathways in CP to a sufficient degree to effect change in motor coordination and cortical connectivity within and between the sensory and motor areas of the brain. One concern is that the sensory system in CP may be compromised and therefore not as promising an avenue for promoting motor and cortical change. Conversely, it is possible that these areas that have been long deprived or more poorly developed may respond even more dramatically to stimuli than if they were more robust. Given our compliance monitoring in our devices, we may also gain information on dose-response to exercise since it is possible that not all will comply with all exercises or duration of exercises as specified in the protocol. We will also be able to relate patient characteristics such as age, level of involvement, degree of spasticity, etc. to responses from the interventions. In CP, variability in outcomes is often observed across subjects and remains poorly understood. We also anticipate that we will gain fundamental information about the nature of reciprocal coordination in CP and how it relates to motor severity, the integrity of the sensory or motor pathways, or regions such as the cerebellum (assuming we acquire sufficient information on that brain region in our sample). Project Impact Statement: This will be the first reported efficacy trial of both motor-assisted cycling and elliptical training in CP. If results are as anticipated, i.e. reciprocal coordination improves as a result of training, then these findings would warrant further comparison with existing treatments such as BWSTT through clinical trials. If coordination does change, we will also be very interested in determining whether there are concurrent changes in the sensorimotor pathways showing an increase in connectivity as a result of training. The relationship of the initial integrity of sensory and motor pathways to the response from interventions will also be explored to determine whether it may be possible to predict which patients may be most likely to benefit from training that targets the spinal pathways. It is the first study to compare muscle integrity before and after strength training in CP.