Locomotor learning in infants at high risk for cerebral palsy

项目摘要 脑性瘫痪（CP）患者的身体残疾是由于无法学习和/或改善运动控制造成的 在生命的头两年，在运动控制中心神经可塑性的关键时期。尽管如此， 对于CP高危婴儿如何学习（或无法学习）移动和获得早期运动能力知之甚少 这些技能是以后功能性移动的基石。我们工作的长期目标是减少体力劳动， 通过促进循证运动训练策略的发展， 在婴儿期和幼儿期训练和塑造运动学习。该项目的目标是描述 CP高危婴儿在出生后18个月内运动学习的演变。表征 在这一关键时期，运动技能是如何习得（或未习得），我们将联合收割机结合我们已建立的协议 使用强大的，无偏见的机器人和传感器技术，纵向研究婴儿在三个 人类运动控制受损发展过程中的连续阶段-早期自发性 运动、俯卧运动（爬行）和直立运动（行走）。自发腿 60名婴儿的动作将在自然环境中使用可穿戴传感器进行真实的实时捕捉， 生命的前四个月。在4个月大时仍处于CP高风险的婴儿，我们预计 大约50%的参与者将使用机器人技术进行新的运动训练方案 用于爬行（5-9个月大）和行走（9-18个月大）。运动训练方案是 在婴儿运动里程碑出现或未能出现之前引入，并且基于奖励和错误， 允许有足够的机会进行错误学习，同时在即使很小的努力 加强（reinforcement）。训练特征和运动技能的重复测量将量化运动 随着时间的推移，婴儿在高风险的CP学习。关键训练特征，结合神经行为 调节因子，如认知和动机移动，将被确定并用于开发预测模型 运动学习的过程我们假设，经历和应对错误是一个关键机制， 运动学习在CP，学习是由训练以外的神经行为因素介导的，这是至关重要的， 错误阈值和其他训练特征预测运动技能从俯卧到直立的转移 运动我们的团队包括电机控制和开发、计算机科学、机器人技术、 生物力学和解剖学。CP高危婴儿运动学习的特征和预测 将为未来多中心疗效研究的设计和新治疗方法的开发提供信息， 在运动控制发展的关键时期学习，支持Eunice Kennedy Shriver 国家儿童健康和人类发展研究所的使命是所有儿童都有机会实现 充分发挥其健康和生产性生活的潜力，使其免于疾病或残疾，并确保其健康， 通过最佳康复，提高所有人的生产力、独立性和福祉。

PROJECT SUMMARY Physical disability in individuals with cerebral palsy (CP) is caused by a failure to learn and/or refine motor control during the first two years of life, during a critical period for neuroplasticity in motor control centers. Despite this, very little is known about how infants at high risk for CP learn (or fail to learn) to move and acquire early locomotor skills that are building blocks for later functional mobility. The long-term goal of our work is to reduce physical disability in individuals with CP by promoting the development of evidence-based motor training strategies to train and shape motor learning during infancy and toddlerhood. The objective of this project is to characterize the evolution of locomotor learning over the first 18 months of life in infants at high risk for CP. To characterize how locomotor skill is learned (or not learned) during this critical period, we will combine our established protocols using robust, unbiased robotic and sensor technology to longitudinally study infant movement across three consecutive stages during the development of impaired human motor control – early spontaneous movement, prone locomotion (crawling), and upright locomotion (walking). The spontaneous leg movements of sixty infants will be captured in real time using wearable sensors in their natural environment over the first 4 months of life. Infants who remain at high risk for CP at 4 months of age, which we expect to be approximately 50% of those enrolled, will progress to novel locomotor training protocols using robotic technology for crawling (5-9 months of age) and walking (9-18 months of age). The locomotor training protocols are introduced before the infants’ locomotor milestones emerge or fail to emerge, and are reward- and error-based, allowing ample opportunities for error learning while providing assistance to move when even small effort is made (reinforcement). Repeated measures of training characteristics and locomotor skill will quantify locomotor learning over time in infants at high risk for CP. Key training characteristics, combined with neurobehavioral moderators such as cognition and motivation to move, will be identified and used to develop a predictive model of locomotor learning. We hypothesize that experiencing and responding to error is a key mechanism for locomotor learning in CP, that learning is mediated by neurobehavioral factors outside of training, and that critical thresholds of error and other training characteristics predict the transfer of locomotor skill from prone to upright locomotion. Our team includes experts in motor control and development, computer science, robotics, biomechanics and neonatology. Characterizing and predicting locomotor learning in infants at high risk for CP will inform the design of future multi-site efficacy studies and the development of new treatments to shape motor learning during the critical years of the development of motor control, supporting the Eunice Kennedy Shriver National Institute of Child Health and Human Development mission that all children have the chance to achieve their full potential for healthy and productive lives, free from disease or disability, and to ensure the health, productivity, independence, and well-being of all people through optimal rehabilitation.