Augmenting Ankle Plantarflexor Function and Walking Capacity in Children with Cerebral Palsy

项目总结 儿童有效行走的能力对他们的身体健康和总体福祉是至关重要的。不幸的是，许多人 脑性瘫痪(CP)是导致儿童肢体残疾的最常见原因，儿童行走困难 以及完成更高强度的移动任务。这导致患有CP的儿童参与到习惯的水平上 体力活动远低于指导方针和非残疾儿童的体力活动，这反过来又有助于 导致许多继发性疾病，包括代谢功能障碍和心血管疾病。有很广的 临床共识认为，足屈肌功能障碍是导致缓慢、低效和蹲伏行走的主要原因。 CP的模式；CP患者需要更有效的治疗和活动辅助器来治疗趾屈肌功能障碍。 为了满足这一需求，本提案旨在评估一项整体战略，以解决来自 使用轻型、双模式(辅助或阻力)可穿戴机器人设备治疗慢性阻塞性肺病患者的足屈肌功能障碍。 这种策略结合了两种互补的技术：(1)针对神经肌肉步态的踝关节靶向阻力 提供精确治疗的训练，以促进脚踝肌肉功能的长期改善，以及(2) 适应性脚踝辅助，在持续、高强度或具有挑战性的任务中使行走变得更容易。第一 具体目的是量化靶向踝关节术后踝关节肌肉功能和功能活动度的改善。 脑性瘫痪患儿阻力步态训练的临床研究第一个目标的主要假设是有针对性的 踝关节阻力训练将在下肢运动控制、步态力学和 干预后4周和12周评估临床活动能力的测量与标准体格检查的比较 治疗和标准步态训练。第二个具体目标是确定适应性踝关节的疗效。 在持续、高强度和具有挑战性的任务中帮助提高能力和性能 患有脑瘫的门诊儿童。第二个目标的主要假设是适应性踝关节辅助将 在6分钟步行测试和分级跑步机中显著提高容量和性能 与脚踝矫形器走路和只穿鞋子走路相比，阶梯行走方案。两者都是特定的 AIMS将探索参与者的特征(例如，年龄、性别、GMFCS水平、行走速度、痉挛程度) 在提供指导的每次干预后，与结果改善最大相关的 用于未来的临床和家庭实施。拟议的研究将建立关于以下方面的基本知识 与CP患者的护理标准相比，适应性踝关节干预治疗行走障碍的能力。

PROJECT SUMMARY A child’s ability to walk effectively is essential to their physical health and general well-being. Unfortunately, many children with cerebral palsy (CP), the most common cause of pediatric physical disability, have difficulty walking and completing higher-intensity ambulatory tasks. This leads to children with CP engaging in levels of habitual physical activity that are well below guidelines and those of children without disabilities, which in turn contributes to many secondary conditions, including metabolic dysfunction and cardiovascular disease. There is broad clinical consensus that plantarflexor dysfunction is a primary contributor to slow, inefficient, and crouched walking patterns in CP; individuals with CP need more effective treatments and mobility aids for plantarflexor dysfunction. To meet this need, this proposal aims to evaluate a holistic strategy to address impaired mobility from plantarflexor dysfunction in CP using a lightweight, dual-mode (assistive or resistive) wearable robotic device. This strategy combines two complementary techniques: (1) targeted ankle resistance for neuromuscular gait training that provides precision therapy to elicit long-term improvements in ankle muscle function, and (2) adaptive ankle assistance to make walking easier during sustained, high-intensity, or challenging tasks. The first specific aim is to quantify improvement in ankle muscle function and functional mobility following targeted ankle resistance gait training in ambulatory children with CP. The primary hypothesis for the first aim is that targeted ankle resistance training will produce larger improvements in lower-extremity motor control, gait mechanics, and clinical measures of mobility assessed four- and twelve-weeks post intervention compared to standard physical therapy and standard gait training. The second specific aim is to determine the efficacy of adaptive ankle assistance to improve capacity and performance during sustained, high-intensity, and challenging tasks in ambulatory children with CP. The primary hypothesis for the second aim is that adaptive ankle assistance will result in significantly greater capacity and performance during the six-minute-walk-test and graded treadmill and stair stepping protocols compared to walking with ankle foot orthoses and walking with just shoes. Both Specific Aims will explore the participant characteristics (e.g., age, gender, GMFCS level, walking speed, spasticity rating) that are associated with the greatest improvement in outcomes following each intervention to provide guidance for future clinical and at-home implementation. The proposed studies will establish fundamental knowledge on the ability for adaptive ankle interventions to treat walking impairment relative to standard of care in CP.