Sensorimotor Learning in Children with Cerebral Palsy

脑瘫儿童的感觉运动学习

• 批准号: 9009029
• 负责人: Max J Kurz
• 金额: $ 54.38万
• 依托单位: UNIVERSITY OF NEBRASKA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-24 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9009029
• 关键词: Address; Affect; Age; Ankle; Attention; Behavioral; Biological Neural Networks; Biomechanics; Brain; Brain imaging; Cataloging; Catalogs; Cerebral Palsy; Child; Childhood; Collection; Corticospinal Tracts; Development; Diagnosis; Diffusion Magnetic Resonance Imaging; Educational process of instructing; Exhibits; Fiber; Foundations; Frequencies; Future; Goals; Human; Impairment; Isometric Exercise; Joints; Knowledge; Learning; Location; Logic; Lower Extremity; Magnetoencephalography; Measures; Methods; Modeling; Motor; Motor Activity; Motor Cortex; Motor Skills; Movement; Muscle; Musculoskeletal; Musculoskeletal System; Neurologic; Neurons; Operative Surgical Procedures; Outcome; Participant; Pattern; Performance; Perinatal; Peripheral; Physical therapy; Play; Posture; Probability; Process; Rehabilitation therapy; Reporting; Research; Research Design; Resolution; Seminal; Sensory; Solid; Somatosensory Cortex; Staging; Stretching; Therapeutic; Time; Training; Treatment Protocols; United States; Update; Work; ankle joint; base; behavior measurement; cohort; cooking; density; effective intervention; feeding; improved; indexing; individualized medicine; innovation; insight; meetings; motor impairment; motor learning; movement analysis; neuromechanism; neurophysiology; programs; public health relevance; relating to nervous system; research study; sensory feedback; strength training; success; thalamocortical tract; treatment strategy; trend

 DESCRIPTION (provided by applicant): Cerebral palsy (CP) is one of the most prevalent and costly pediatric neurologic conditions diagnosed in the United States. Despite years of studies that have catalogued the motor impairments seen in children with CP, innovative and effective interventions have not emerged. At least part of the problem is that the majority of treatment approaches (e.g., surgical, stretching, strengthening) emphasize the musculoskeletal impairments that may affect the execution of the movement pattern, without attention to the abnormalities in sensorimotor cortical activity, which underlie the motor planning and programming that children with CP use to perform and learn motor tasks. Addressing this substantial gap is paramount, and central to our long-term research goals of developing innovative treatment strategies that have the highest probability of teaching children with CP new motor skills. To meet this goal, we have implemented an innovative scientific approach that uses high-density magnetoencephalography (MEG), diffusion-tensor imaging, and advanced human movement analysis methods to identify the neurophysiological factors that influence a child with CP's motor performance. The Specific Aims of this proposal will (1) determine how the stage-like beta and gamma sensorimotor cortical oscillations are modulated by intensively practicing a goal-directed motor task, (2) quantify how activity within the somatosensory cortices affects the sensorimotor integration processes that are necessary for learning a goal-directed motor task, and (3) quantify the relationships between the extent of activation within the sensorimotor cortices, motor behavioral improvements, and the integrity and quantity of fibers in the thalamocortical and corticospinal tracts. Briefly, our study will address these aims by quantifying the neurophysiological and motor behavioral changes that occur after practicing an isometric ankle plantarflexion target matching task. We will focus on an ankle motor task because control of the ankle joint is well recognized as playing a key role in the mobility and postural limitations seen in children with CP. Our study design consists of the collection of MEG and motor behavioral measures prior to training (baseline), after 3- days of intensive training, and a week after cessation of the training. Participants will include a cross-section of children with CP that have various levels of motor impairments (e.g., GMFCS I-IV), and a cohort of age- matched typically-developing children. Outcomes from the proposed experiments will be seminal for challenging and potentially redirecting the current rehabilitation methods that are used to teach children with CP new motor skills. Furthermore, we expect that the new neural indices of motor learning established in this proposal will provide critical insight on why some children with CP show vast improvements after therapy, whereas others are classified as non-responders. Understanding the neural mechanisms that may limit the progress of non-responders will enable us and other research groups to develop new individualized treatment strategies that will allow for all children with CP to have the best chance of learning new motor skills.

 描述（由适用提供）：脑瘫（CP）是美国诊断出的最普遍，最昂贵的儿科神经系统疾病之一。尽管多年的研究已经分类了CP儿童中看到的运动障碍，但尚未出现创新和有效的干预措施。至少部分问题是，大多数治疗方法（例如，手术，伸展，增强）强调可能影响运动模式执行的肌肉骨骼障碍，而无需关注感觉运动皮质活动的异常，这是CP的运动和编程CP使用CP进行和学习运动的儿童的基础。解决这一巨大差距至关重要，这是我们的长期研究目标，即制定创新的治疗策略，这些策略的可能性最高的是教授CP新运动技能的儿童。为了实现这一目标，我们实施了一种创新的科学方法，该方法使用了高密度磁摄影（MEG），扩散诱变成像和先进的人类运动分析方法来识别影响CP运动表现的孩子的神经生理因素。该提案的具体目的（1）确定如何通过强烈练习目标指导的运动任务来调节类似舞台的β和γ型皮层振荡，（2）量化体感感官内部的活动如何量化在范围内，在学习范围内的范围内部范围内的范围量化范围的运动范围和（3）范围内的运动范围，并且（3）范围内的范围是指向范围的动态任务，并且（3）范围的关系（3）范围（3）范围（3）范围（3）范围（3）范围（3）范围（3）范围（3）的关系（3）。皮质，运动行为改善以及丘脑皮质和皮质脊髓束中纤维的完整性和数量。简而言之，我们的研究将通过量化练习等轴测踝部plotalarflexion目标匹配任务后发生的神经生理和运动行为变化来解决这些目标。我们将重点关注踝关节运动任务，因为对踝关节的控制被广泛认为是在CP儿童中看到的移动性和姿势限制中起着关键作用。我们的研究设计包括训练前的MEG和运动行为措施，经过3天的强化培训后以及训练后一周。参与者将包括具有不同水平运动障碍（例如GMFCS I-IV）的CP儿童的横截面，以及一系列年龄匹配的通常是成熟的儿童。拟议实验的结果将是挑战的第二，并可能重定向当前的康复方法，这些方法用于教授CP新运动技能的儿童。此外，我们预计本提案中建立的运动学习的新神经指标将对某些CP后的儿童进行治疗后的改善提供批判性见解，而其他人则将其归类为非反应者。了解可能限制非反应者进步的神经元机制，将使我们和其他研究小组制定新的个性化治疗策略，这将使所有CP儿童都有最佳机会学习新的运动技能。