Neuroplastic adaptations of swallowing and speech in children with unilateral cerebral palsy

单侧脑瘫儿童吞咽和言语的神经塑性适应

• 批准号: 9377942
• 负责人: Georgia Malandraki
• 金额: $ 14.98万
• 依托单位: PURDUE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9377942
• 关键词: Adult; Affect; Behavior; Behavioral; Bilateral; Brain; Brain Injuries; Cerebral Palsy; Child; Childhood; Clinical; Clinical Services; Communication impairment; Complex; Data; Deglutition; Deglutition Disorders; Development; Diffusion; Disease; Dysarthria; Exhibits; Foundations; Future; Goals; Health; Health Communication; Human; Individual; Intervention; Knowledge; Lesion; Literature; Live Birth; Magnetic Resonance Imaging; Maps; Measures; Methods; Mission; Modeling; Motor; Nervous system structure; Neuronal Plasticity; Oral; Patients; Pattern; Performance; Peripheral; Physiological; Physiology; Population; Public Health; Quality of life; Recovery; Research; Rest; Severities; Side; Speech; Speech Development; Speech Disorders; Subgroup; Symptoms; System; Treatment Efficacy; Work; base; behavior measurement; behavior test; behavioral outcome; clinical practice; cohesion; design; disability; evidence base; experience; feeding; functional outcomes; improved; indexing; innovation; insight; neuroimaging; neurophysiology; neuroregulation; novel; peer; relating to nervous system; social; somatosensory; theories

Project Summary The developing human nervous system has a remarkable capacity to reorganize after brain injury, as is apparent in children with cerebral palsy (CP). CP affects 1.5 to 4 out of 1000 live births, is the most common motor disability of childhood, and has variable effects on functional outcomes. More than half of children with CP experience swallowing/feeding difficulties (a.k.a. dysphagia) and/or motor speech disorders (a.k.a. dysarthria) with potentially detrimental health and quality of life implications. The treatments currently available for these disorders are extremely limited, are not based on the underlying physiology and developmental profile of these children, and lack efficacy. The objective of this project is to start mapping the central and peripheral neuroplastic adaptations of swallowing and speech, as well as to determine the extent to which these domains interact in children with CP. Our long-term research goal is to use this newly acquired knowledge to develop evidence-based and developmentally appropriate interventions for swallowing and speech that capitalize on the nervous system's potential for reorganization. The initial focus will be on examining these adaptations in children with unilateral CP (UCP). UCP, where primarily one hemisphere has been affected, offers a less complex system structurally and functionally, thereby serving as a good foundation to begin understanding neural reorganization. The central hypothesis is that these two functions have both separate and common central and peripheral neuroplastic adaptations that predict the respective functional outcomes seen in unilateral CP. Specific aims of the proposed study are: 1) To determine the central (neuroimaging) correlates that predict peripheral (electromyographic) and behavioral swallowing and speech performance in children with UCP and typically developing peers; 2) To determine the peripheral (electromyographic) correlates that predict behavioral swallowing and speech performance in children with UCP and typically developing peers; and 3) To determine the individual and shared contributions of each neural control level (central and peripheral) to swallowing and speech in both children with UCP and typically developing peers. This study will employ novel integrative methods, including structural, diffusion, and resting- state functional connectivity MRI, peripheral electromyographic methods, and functional/behavioral testing to achieve these aims. This unique integration is innovative and necessary to inform the theory behind clinical decisions and to form the basis from which to explore other types of neural reorganization in the future, for example in patients with bilateral involvement. The contribution of this study will be significant, because it will reveal the neural reorganization for swallowing and speech in children with UCP, and will provide the empirical foundation to start developing new separate and/or common neurophysiologically-driven treatments. In the long-term, cumulative knowledge from this line of research will enhance our understanding of developmental neuroplasticity, improve clinical practice, and maximize the health and quality of life of these children.

项目摘要 发育中的人类神经系统在脑损伤后具有非凡的重组能力， 小儿脑瘫的治疗方法有哪些？CP影响1.5至4每1000活产，是最常见的 儿童运动残疾，并对功能结果有不同的影响。超过一半的儿童 CP经历吞咽/进食困难（a.k.a.吞咽困难）和/或运动性言语障碍（a.k.a. 构音障碍），具有潜在的有害健康和生活质量的影响。目前可用的治疗方法 对于这些疾病是非常有限的，不是基于潜在的生理和发育 这些孩子的情况，缺乏有效性。该项目的目标是开始绘制中央和 吞咽和言语的外周神经可塑性适应，以及确定 这些结构域在患有CP的儿童中相互作用。我们的长期研究目标是利用这种新获得的 知识，以制定基于证据和发育适当的吞咽干预措施， 利用神经系统重组潜力的演讲。最初的重点将是 检查单侧CP（UCP）儿童的这些适应。UCP，主要是一个半球 受到影响，提供了一个结构和功能不太复杂的系统，从而作为一个良好的基础 来开始理解神经重组。核心假设是，这两种功能都具有 独立和共同的中枢和外周神经可塑性适应，预测各自的功能 在单侧CP中观察到的结果。本研究的具体目标是：1）确定中心 （神经影像学）预测外周（肌电图）和行为吞咽和言语的相关性 在患有UCP的儿童和典型发育的同龄人中的表现; 2）确定外周 （肌电图）相关性，预测行为吞咽和言语表现的儿童， UCP和典型的发展中同行; 3）确定每个人的个人和共同贡献 神经控制水平（中枢和外周），吞咽和言语在两个儿童与UCP和典型 发展同行。这项研究将采用新的综合方法，包括结构，扩散和休息- 陈述功能连接MRI、外周肌电图方法和功能/行为测试， 实现这些目标。这种独特的整合是创新的，也是必要的，以告知临床背后的理论。 决定，并形成基础，从探索其他类型的神经重组在未来， 例如双侧受累的患者。这项研究的贡献将是重大的，因为它将 揭示了UCP儿童吞咽和言语的神经重组，并将提供经验性的 基金会开始开发新的单独和/或共同的神经生理驱动的治疗方法。在 长期的，从这条线的研究积累的知识将提高我们的理解发展 神经可塑性，改善临床实践，并最大限度地提高这些儿童的健康和生活质量。