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

项目摘要 儿童有效行走的能力对他们的身体健康和整体福祉至关重要。不幸的是很多 脑性瘫痪（CP）儿童是儿童身体残疾的最常见原因，他们行走困难 完成高强度的行走任务。这导致患有CP的儿童参与习惯性的 身体活动远远低于指导方针和那些没有残疾的儿童，这反过来又有助于 许多继发性疾病，包括代谢功能障碍和心血管疾病。有广泛 临床共识是跖屈肌功能障碍是缓慢、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辅助活动来治疗跖屈肌功能障碍。 为了满足这一需求，本提案旨在评估一项整体战略，以解决行动不便， 使用轻便的双模式（辅助或阻力）可穿戴机器人设备治疗CP中的跖屈肌功能障碍。 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阻力 提供精确治疗的训练，以引起踝关节肌肉功能的长期改善，以及（2） 自适应踝关节辅助，使步行更容易在持续，高强度，或具有挑战性的任务。第一 具体目标是量化踝关节靶向治疗后踝关节肌肉功能和功能活动性的改善 能走动的脑瘫儿童的阻力步态训练。第一个目标的主要假设是， 踝关节阻力训练将在下肢运动控制、步态力学和 与标准体格检查相比，干预后4周和12周评估的活动性临床指标 治疗和标准步态训练。第二个具体目的是确定自适应踝关节的疗效 在持续、高强度和具有挑战性的任务中，帮助提高能力和绩效， 患有CP的非卧床儿童。第二个目标的主要假设是自适应踝关节辅助将 在六分钟步行测试和分级跑步机中， 与踝足矫形器行走和仅穿鞋行走相比，特异性 目标将探索参与者的特征（例如，年龄、性别、GMFCS水平、步行速度、痉挛状态评级） 与每次干预后结局的最大改善相关， 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标准治疗相比，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.