Quantifying and reducing upper extremity impairments in cerebral palsy: Biomechanics, hippotherapy, and participation.

项目总结 脑性瘫痪(CP)是儿童最常见的运动障碍。痉挛，活动范围差， 虚弱和废用是慢性阻塞性肺病患者上肢损害的特征。脑性瘫痪儿童及其父母 报告更好的手臂和手的功能是优先事项。有趣、吸引人、以参与为重点的治疗，以及 以有意义的方式挑战上肢很可能是最成功的减掉上肢 四肢损伤。海马疗法(马背上的物理疗法)可能会提供这样的选择。在这项研究中 生物力学分析提供了一种复杂而客观的方法来量化潜在的时机和 上肢协调障碍；第一，作为儿童脑性瘫痪的重要比较 和典型发展(TD)(目标1)；第二，作为量化 海马区治疗干预(AIM)后上肢损害的减少(和接近TD) 我的毕业论文项目的长期目标是开发一种有针对性的儿科康复治疗 (海马疗法)对患有CP的儿童具有吸引力，减少上肢损伤，防止未来 拒绝。该项目以国际职能分类框架为基础。我们用了 在功能性伸展和抓握任务期间的3D运动捕获，以测量ICF身体结构/功能和 活动域(AIM 1)；儿童和家长报告的ICF活动和参与域的测量(AIM 2)，并应用这些测量来评估海马区治疗干预(AIM 1a，AIM 2a)。最后，我们 建议探讨以ICF个人身份应用患者参与度和享受度的可行性 海马区治疗干预中的因素(AIM 3)。我们预计这些措施可能会打开一个窗口，让我们了解为什么 海马区疗法可能是有效的。我们已经展示了衡量遵守 海马区治疗方案，并对CP和TD患儿执行REACH-AND-GRAPH方案。 通过这些目标，我们将检验1)患有CP的儿童证明的首要假设 与功能任务相比，在功能任务中更慢、更不协调的伸展和把握，以及较差的参与度 他们的TD同龄人和2)这些测量可以评估海马体治疗干预中的变化，以及3)儿童 参与和享受海马体疗法是可以量化的。这项调查的结果将指导 海马区治疗临床试验的未来研究设计。在我的跨学科赞助团队的指导下， 这个项目的准备、制定、分析和传播将使我能够实现以下目标 我的双学位课程，并使我一跃成为一名多产的、独立的临床科学家。

PROJECT SUMMARY Cerebral Palsy (CP) is the most common childhood motor disability. Spasticity, poor range of motion, weakness, and disuse are hallmarks of upper extremity impairment in CP. Children with CP and their parents report better arm and hand function as a priority. Treatments that are fun, engaging, participation-focused, and challenge the upper extremity in meaningful ways are likely to be the most successful in reducing upper extremity impairments. Hippotherapy (physical therapy on horseback) may offer such an option. In this study biomechanical analysis offers a sophisticated and objective measure of quantifying underlying timing and coordination impairments of the upper extremities; first, as an important comparison between children with CP and typical development (TD) (AIM 1) and second, as a potential outcome measure to quantifying the reduction of upper extremity impairments (and approximation to TD) following hippotherapy intervention (AIM 1a).The long-term goal of my dissertation project is to develop a targeted pediatric rehabilitation treatment (hippotherapy) for children with CP that is engaging, reduces upper extremity impairment, and prevents future decline. This project is grounded in the International Classification of Functioning (ICF) framework. We used 3D motion capture during a functional reach-and-grasp task to measure ICF body structures/functions and activity domains (AIM 1); child- and parent-reported measures of ICF activity and participation domains (AIM 2), and the application of these measure to assess a hippotherapy intervention (AIM 1a, AIM 2a). Last, we propose to explore the feasibility of applying measures of patient engagement and enjoyment as ICF personal factors during hippotherapy intervention (AIM 3). We anticipate these measures might cast a window into why hippotherapy is potentially effective. We have demonstrated the ability to measure adherence to a hippotherapy treatment protocol and to execute the reach-and-grasp protocol with children with CP and TD. Through these aims, we will test the overarching hypotheses that 1) children with CP demonstrate slower and less-coordinated reach and grasp in a functional task and poor participation compared to their TD peers and 2) these measures can evaluate change in a hippotherapy intervention, and 3) child engagement and enjoyment of hippotherapy can be quantified. The results of this investigation will guide future study design for hippotherapy clinical trials. With the guidance of my interdisciplinary sponsorship team, the preparation, enactment, analysis, and dissemination of this project will enable me to achieve the goals of my dual-degree program and catapult me to becoming a productive, independent clinician-scientist.