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

项目摘要 发育中的人类神经系统在脑损伤后具有惊人的重组能力，就像 在脑性瘫痪(CP)儿童中表现明显。CP影响每1000名活产中的1.5至4名，是最常见的 儿童的运动障碍，对功能结果有不同的影响。超过一半的儿童患有 CP吞咽/喂养困难(又名吞咽困难)和/或运动性言语障碍(又名 构音障碍)可能对健康和生活质量产生不利影响。目前可用的治疗方法 对于这些障碍是极其有限的，都不是建立在潜在的生理和发育基础上的 这些儿童的个人资料，而且缺乏疗效。这个项目的目标是开始绘制中央和 吞咽和说话的外周神经可塑性适应，以及确定 这些区域在患有CP的儿童中相互作用。我们的长期研究目标是利用这一新获得的 开发循证的和适合发展的吞咽干预措施的知识 利用神经系统重组潜力的演讲。最初的重点将是 检查单侧慢性胰腺炎(UCP)儿童的这些适应。UCP，主要是一个半球有 受到影响，提供了一个结构和功能上不那么复杂的系统，从而作为一个良好的基础 开始了解神经重组。中心假设是这两种功能都有 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 单侧CP的转归。拟议研究的具体目标是：1)确定中央 (神经成像)预测外周(肌电)和行为吞咽和言语的相关性 对患有UCP的儿童和典型发育中的同龄人的表现；2)确定外周 (肌电)可预测儿童吞咽行为和言语表现 UCP和典型的发展同行；以及3)确定每个人的个人和共享贡献 UCP儿童吞咽和言语的神经控制水平(中枢和外周) 发展中的同行。这项研究将采用新颖的综合方法，包括结构、扩散和休息- 状态功能连通性MRI、外周肌电方法和功能/行为测试 实现这些目标。这种独特的集成是创新的，也是为临床背后的理论提供信息所必需的 并形成未来探索其他类型的神经重组的基础， 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UCP患儿吞咽和言语的神经重组，为临床提供实验依据。 基金会开始开发新的单独和/或共同的神经生理学驱动的治疗方法。在 来自这一研究领域的长期积累的知识将增强我们对发展的理解 神经可塑性，改善临床实践，并最大限度地提高这些儿童的健康和生活质量。

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.