Physical, Functional and Neurological Effects of Exercise in Children with CP

主要发现： 我们已关闭入组，并提交了研究的主要结果。在过去的一年里，我们与肯尼迪克里格研究所/约翰霍普金斯的合作者建立了一个新的合作协议，他们将用新的技术重新分析我们的MRI数据，并将这些数据用于一个将疼痛与大脑结构发现相关联的项目。我们目前正在准备一份关于能够完成MRI并且数据质量可接受的儿童子集的脑成像结果的手稿。 已报告的主要发现是，儿童能够进行往复腿部运动的速度发生了显著和显著的变化，其中约三分之一的儿童在步态速度方面也有临床显著改善，椭圆组的结果最积极。然而，该组的步态速度的平均变化并不显著。干预的持续时间可能不够长，不足以将更大的下肢速度显著转移到改善步态功能。 另一项重要的研究是，这组患者的两个感觉运动半球的功能连接比正常情况下要好。在练习之后，我们发现了自主速度的变化和连接性的变化之间的相关性，例如那些速度变化较大的人，连接性的减少更大，这表明大脑通路得到了改善，变得更加互惠，而不是由于训练而同步。目前正在编写一份手稿以供提交。 项目影响声明： 这是首次报道的CP患者的电动辅助自行车和椭圆训练的疗效试验。由于训练改善了相互协调，这些发现值得通过临床试验与现有治疗方法（如BWSTT）进行进一步比较。这也是为数不多的对双侧脑瘫儿童进行干预前后脑成像结果的研究之一。

Major Findings: We have closed enrollment and have submitted the main results of the study. In the past year, we have established a new Collaboration Agreement with our collaborators at Kennedy Krieger Institute/ Johns Hopkins who will reanalyze our MRI data with newer techniques and who will also be using these data for a project relating pain to structural brain findings. We are preparing a manuscript at present on the brain imaging results in the subset of children who were able to complete the MRI and for whom the data quality was acceptable. The major findings which have been reported were a significant and marked change in the speed with which children were able to perform the reciprocal leg exercise with approximately a third of those also having a clinically significant improvement in gait speed with the most positive results seen in the elliptical group. However, the mean change in gait speed for the group was not significant. The duration of the intervention may not have been long enough for significant transfer of greater reciprocal leg speed to improving gait function. Another important funding is that this group of patients showed greater than normal functional connectivity across the two sensorimotor hemispheres. After the exercise we found a correlation between the change in voluntary speed and the change in connectivity, such that those who had a greater change in speed, had a greater reduction of connectivity suggesting that the brain pathways improved and became more reciprocal instead of synchronized as a result of training. A manuscript is currently in preparation for submission. Project Impact Statement: This is the first reported efficacy trial of both motor-assisted cycling and elliptical training in CP. Since reciprocal coordination improved as a result of training,these findings warrant further comparison with existing treatments such as BWSTT through clinical trials. This is also one of the few studies with pre-post intervention brain imaging results in children with bilateral cerebral palsy.