Investigation of the neuromuscular response and training effects of wearable adaptive resistance in children with cerebral palsy

脑瘫儿童可穿戴自适应阻力神经肌肉反应及训练效果研究

• 批准号: 10371871
• 负责人: Benjamin Charles Conner
• 金额: $ 5.13万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-02 至 2025-03-01
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10371871
• 关键词: Acclimatization; Address; Adult; Advanced Development; Affect; Ankle; Brain; Cerebral Palsy; Child; Childhood; Data; Development; Devices; Educational Intervention; Educational Status; Environment; Evidence based intervention; Flexor; Functional disorder; Future; Gait; Goals; H-Reflex; Impairment; Individual; Intervention; Investigation; Knowledge; Lead; Maintenance; Measures; Metabolic; Modality; Motor; Movement; Movement Disorders; Muscle; Muscle Weakness; Neurosciences; Outcome; Paper; Participant; Physical activity; Physicians; Pilot Projects; Population; Protocols documentation; Reflex action; Rehabilitation therapy; Research; Research Proposals; Resistance; Scheme; Scientist; Secondary to; Soleus Muscle; Specificity; Stimulus; Technology; Testing; Time; Training; Treatment Efficacy; Visit; Walking; Work; career; evidence base; exoskeleton; exoskeleton device; follow up assessment; follow-up; functional decline; functional independence; functional restoration; improved; improved mobility; motor learning; muscle strength; neuromuscular; neuromuscular rehabilitation; neuroregulation; novel; novel therapeutics; patient population; peer; physically handicapped; primary outcome; recruit; response; strength training; stretch reflex; synergism; tool

PROJECT SUMMARY/ABSTRACT Cerebral palsy (CP) is a movement disorder characterized by deficits in strength and coordination. The subsequent gait deficits associated with CP lead to a progressive decline in function due to the secondary effects of having a movement disorder during development. Interventions seeking to mitigate these effects have only been partially successful because they have not addressed both muscle recruitment (i.e. strength) and coordination within one, top-down therapy. Recently, we developed a wearable adaptive resistance therapy that is able to address both of these aspects with promising results for improving neuromuscular control, metabolic efficiency, and functional mobility. To maximize the efficacy of this intervention, two important considerations must be addressed: 1) What is the appropriate level of resistance to prescribe for maximizing neuromuscular response as children acclimate to the intervention? 2) What is the overall trajectory in training effects from this therapy and are these effects maintained after the therapy stops? In addition, there is limited understanding of the underlying mechanisms of observed improvements in neuromuscular control with this novel therapy. The high levels of co-contraction in children with CP have been attributed to deficits in stretch reflex modulation, but whether or not improvements in reflex modulation are responsible for the observed decreases in ankle co- contraction with wearable adaptive resistance has not yet been explored. The main objective of this research proposal is to further investigate a wearable adaptive resistance intervention for children with CP. The first specific aim is to assess the acclimation to adaptive resistance by measuring the neuromuscular response of children with CP, across five visits, as a low, moderate, and high level of resistance is applied while walking. The second specific aim to quantify the time-course and maintenance of training effects for the ten participants by measuring changes in neuromuscular control (i.e., co-contraction about the ankle and the complexity of neural control) and reflex modulation (via H-reflex testing) across five training visits with wearable adaptive resistance, as well as a two-week post-training follow-up visit. Our primary outcome variable for Aim 1 ix plantar flexor activation magnitude, relative to baseline, while walking with resistance. Our primary outcome variables for Aim 2 are ankle co-contraction level, neural control complexity (as determined by a muscle synergy analysis), and reflex modulation (via H-reflex testing) while walking without resistance. The completion of this work will improve our understanding of wearable adaptive resistance, including fundamental knowledge about appropriate training levels and underlying mechanisms, with the ultimate goal of developing an intervention that can enable physical activity for children with CP, allowing them to engage with their peers and environment for healthy development and functional independence.

项目总结/摘要 脑瘫是一种以力量和协调性缺陷为特征的运动障碍。的 与CP相关的后续步态缺陷由于继发性影响导致功能进行性下降 在发育过程中有运动障碍。旨在减轻这些影响的干预措施只会 部分成功，因为他们没有解决肌肉招募（即力量）和 一个内协调，自上而下的治疗。最近，我们开发了一种可穿戴的适应性阻力疗法， 能够解决这两个方面的问题，并在改善神经肌肉控制、代谢 效率和功能流动性。为了最大限度地发挥这种干预的功效，有两个重要的考虑因素 必须解决：1）什么是适当的阻力水平，以最大限度地提高神经肌肉 儿童对干预的适应反应如何？2)从这一点来看， 这些效果在治疗停止后是否仍能维持？此外，人们对 观察到的这种新疗法改善神经肌肉控制的潜在机制。的 CP儿童的高水平共同收缩归因于牵张反射调制的缺陷，但 反射调节的改善是否是观察到的踝关节CO减少的原因， 具有可穿戴的适应性阻力的收缩尚未被探索。 本研究建议的主要目的是进一步研究一种可穿戴的适应性阻力干预方法， CP儿童第一个具体目标是通过测量适应性抗性的适应性来评估适应性抗性。 CP儿童的神经肌肉反应，在五次访视中，表现为低、中、高水平的阻力 在行走时使用。第二个具体目标是量化训练效果的时程和维持 通过测量神经肌肉控制的变化（即，脚踝周围的共同收缩， 神经控制的复杂性）和反射调制（通过H反射测试）， 可穿戴的适应性阻力，以及两周的训练后随访。我们的主要结果变量 对于Aim 1，当有阻力行走时，相对于基线的足底屈肌激活幅度。我们的首要 目标2的结果变量是踝关节共同收缩水平、神经控制复杂性（如由肌肉 协同分析）和反射调节（通过H反射测试），同时无阻力地行走。 这项工作的完成将提高我们对可穿戴自适应电阻的理解，包括 关于适当培训水平和基本机制的基本知识，最终目标是 制定一项干预措施，使CP儿童能够进行体育活动，让他们参与 他们的同龄人和健康发展和功能独立的环境。