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 发展中的人类神经系统具有显着的脑损伤后重组的能力， 脑瘫（CP）的儿童显然是显而易见的。 CP影响1000个活产中的1.5至4是最常见的 童年的运动障碍，对功能结果具有可变影响。超过一半的孩子 CP经历了吞咽/喂养困难（又称吞咽困难）和/或运动言语障碍（又名A. 构造障碍）具有潜在的有害健康和生活质量的影响。当前可用的治疗 因为这些疾病极为有限，不是基于基本的生理和发展 这些孩子的概况，缺乏疗效。该项目的目的是开始绘制中央和 吞咽和言语的周围神经塑性适应，以及确定的程度 这些领域在CP儿童中相互作用。我们的长期研究目标是使用这个新近获得的 知识以开发基于证据和发展的适当干预措施，以吞咽和 言语利用神经系统的重组潜力。最初的重点将在 检查单方面CP（UCP）儿童中的这些适应性。 UCP，主要一个半球有 受到影响，在结构和功能上提供一个不太复杂的系统，从而成为一个良好的基础 开始理解神经重组。中心假设是这两个功能都有 独立且常见的中央和周围神经塑性适应，预测相应的功能 单方面CP中看到的结果。拟议研究的具体目的是：1）确定中央 （神经影像）相关的相关 UCP儿童的表现，通常是发展同龄人； 2）确定周围 （肌电图）与预测儿童的行为吞咽和语音表现相关 UCP，通常是发展同行； 3）确定每个人的个人和共同贡献 神经控制水平（中央和外围），吞咽和言语，在UCP患者中，通常 发展同行。这项研究将采用新颖的综合方法，包括结构，扩散和静止 状态功能连通性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，并且需要为临床背后的理论提供必要 决策并构成未来探索其他类型的神经重组的基础 双侧受累的患者中的例子。这项研究的贡献将是重要的，因为它将 揭示UCP儿童吞咽和言语的神经重组，并将提供经验 基础开始开发新的独立和/或常见神经生理驱动的治疗方法。在 这一研究的长期，累积知识将增强我们对发展的理解 神经可塑性，改善临床实践，并最大程度地提高这些儿童的健康和生活质量。