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

项目摘要 脑性瘫痪（CP）是最常见的儿童运动障碍。痉挛，活动范围小， 虚弱和废用是CP患者上肢损伤的标志。CP患儿及其父母 优先报告更好的手臂和手功能。治疗是有趣的，吸引人的，以参与为中心的， 以有意义的方式挑战上肢可能是最成功的减少上肢 肢体损伤Hippotherapy（马背上的物理治疗）可以提供这样的选择。本研究 生物力学分析提供了一个复杂的和客观的措施，量化潜在的时间和 上肢协调障碍;首先，作为CP儿童之间的重要比较 和典型发展（TD）（AIM 1），第二，作为一个潜在的结果衡量量化 减少上肢损伤（和接近TD）后，康复治疗干预（AIM 1a）.我的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方法， （康复治疗）用于患有CP的儿童，可减少上肢损伤，并防止未来 下降该项目以国际功能分类框架为基础。我们使用 在功能性伸手抓握任务期间进行3D运动捕捉，以测量ICF身体结构/功能， 活动领域（AIM 1）;儿童和父母报告的ICF活动和参与领域（AIM）测量 2），以及这些措施的应用，以评估一个治疗干预（AIM 1a，AIM 2a）。最后我们 建议探讨将患者参与和享受措施作为ICF个人的可行性 治疗干预期间的因素（AIM 3）。我们预计这些措施可能会让我们了解为什么 药物治疗可能有效。我们已经证明了衡量遵守一个 对CP和TD儿童进行手握式治疗方案。 通过这些目标，我们将测试以下总体假设：1）CP儿童表现出 在功能性任务中，与 2）这些措施可以评估治疗干预的变化，以及3）儿童 参与和享受康复治疗可以量化。这次调查的结果将指导 未来的研究设计，用于药物治疗的临床试验。在我的跨学科赞助团队的指导下， 该项目的准备、实施、分析和传播将使我能够实现以下目标： 我的双学位课程，使我成为一个多产的，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.