Investigation of the neuromuscular response and training effects of wearable adaptive resistance in children with cerebral palsy

脑瘫儿童可穿戴自适应阻力神经肌肉反应及训练效果研究

• 批准号: 10581663
• 负责人: Benjamin Charles Conner
• 金额: $ 5.27万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-02 至 2025-03-01
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10581663
• 关键词: Acclimatization; Address; Adult; Advanced Development; Affect; Ankle; Brain; Cerebral Palsy; Child; Childhood; Data; Development; Devices; Educational Intervention; Educational Status; Environment; Evidence based intervention; Flexor; Functional disorder; Future; Gait; Goals; H-Reflex; Impairment; Individual; Intervention; Investigation; Knowledge; Lead; Maintenance; Measures; Metabolic; Modality; Motor; Movement; Movement Disorders; Muscle; Muscle Weakness; Neurosciences; Outcome; Paper; Participant; Physical activity; Physicians; Pilot Projects; Population; Protocols documentation; Reflex action; Rehabilitation therapy; Research; Research Proposals; Resistance; Scheme; Scientist; Secondary to; Soleus Muscle; Specificity; Stimulus; Technology; Testing; Time; Training; Treatment Efficacy; Visit; Walking; Work; career; evidence base; exoskeleton; exoskeleton device; follow up assessment; follow-up; functional decline; functional independence; functional restoration; improved; improved mobility; motor learning; muscle strength; neuromuscular; neuromuscular rehabilitation; neuroregulation; novel; novel therapeutics; patient population; peer; physically handicapped; primary outcome; recruit; resistance exercise; response; stretch reflex; synergism; tool

PROJECT SUMMARY/ABSTRACT Cerebral palsy (CP) is a movement disorder characterized by deficits in strength and coordination. The subsequent gait deficits associated with CP lead to a progressive decline in function due to the secondary effects of having a movement disorder during development. Interventions seeking to mitigate these effects have only been partially successful because they have not addressed both muscle recruitment (i.e. strength) and coordination within one, top-down therapy. Recently, we developed a wearable adaptive resistance therapy that is able to address both of these aspects with promising results for improving neuromuscular control, metabolic efficiency, and functional mobility. To maximize the efficacy of this intervention, two important considerations must be addressed: 1) What is the appropriate level of resistance to prescribe for maximizing neuromuscular response as children acclimate to the intervention? 2) What is the overall trajectory in training effects from this therapy and are these effects maintained after the therapy stops? In addition, there is limited understanding of the underlying mechanisms of observed improvements in neuromuscular control with this novel therapy. The high levels of co-contraction in children with CP have been attributed to deficits in stretch reflex modulation, but whether or not improvements in reflex modulation are responsible for the observed decreases in ankle co- contraction with wearable adaptive resistance has not yet been explored. The main objective of this research proposal is to further investigate a wearable adaptive resistance intervention for children with CP. The first specific aim is to assess the acclimation to adaptive resistance by measuring the neuromuscular response of children with CP, across five visits, as a low, moderate, and high level of resistance is applied while walking. The second specific aim to quantify the time-course and maintenance of training effects for the ten participants by measuring changes in neuromuscular control (i.e., co-contraction about the ankle and the complexity of neural control) and reflex modulation (via H-reflex testing) across five training visits with wearable adaptive resistance, as well as a two-week post-training follow-up visit. Our primary outcome variable for Aim 1 ix plantar flexor activation magnitude, relative to baseline, while walking with resistance. Our primary outcome variables for Aim 2 are ankle co-contraction level, neural control complexity (as determined by a muscle synergy analysis), and reflex modulation (via H-reflex testing) while walking without resistance. The completion of this work will improve our understanding of wearable adaptive resistance, including fundamental knowledge about appropriate training levels and underlying mechanisms, with the ultimate goal of developing an intervention that can enable physical activity for children with CP, allowing them to engage with their peers and environment for healthy development and functional independence.

项目摘要/摘要 脑瘫（CP）是一种运动障碍，其特征是强度和协调的缺陷。这 随后与CP相关的步态缺陷导致次要效应的功能逐渐下降 在发展过程中患有运动障碍。寻求减轻这些影响的干预措施只有 之所以成功，是因为他们尚未解决肌肉招募（即力量）和 一项自上而下的治疗范围内的协调。最近，我们开发了一种可穿戴的自适应抗性疗法 能够以有希望的结果来解决这两个方面，以改善神经肌肉控制，代谢 效率和功能活动性。为了最大化这种干预的疗效，两个重要的考虑因素 必须解决：1）开处方以最大化神经肌肉的适当阻力是多少 儿童适应干预时的回应？ 2）训练效果的总体轨迹是什么 治疗后，这些作用是否在治疗停止后保持？此外，对 通过这种新型疗法，观察到神经肌肉控制改善的基本机制。这 CP儿童的高度共同收集归因于拉伸反射调制的缺陷，但 反射调制的改进是否导致踝关节共同观察到的减少 尚未探索具有可穿戴自适应抗性的收缩。 该研究建议的主要目的是进一步研究可穿戴的自适应耐药性干预 适用于CP的儿童。第一个具体目的是通过测量来评估适应自适应抗性的适应 CP儿童在五次访问中的神经肌肉反应，较低，中度和高阻力 步行时被应用。量化时间课程和维护培训效果的第二个特定目的 对于十个参与者，通过衡量神经肌肉对照的变化（即，关于踝关节的共同收缩 神经控制的复杂性）和反射调制（通过H反射测试）在五次训练访问中 可穿戴的自适应阻力以及两周的训练后随访。我们的主要结果变量 对于AIM 1 IX植物屈肌激活幅度，相对于基线，在具有电阻时行走。我们的主要 目标2的结果变量是踝关节收缩水平，神经控制复杂性（由肌肉确定 协同分析）和反射调制（通过H反射测试）在没有阻力的情况下行走时。 这项工作的完成将提高我们对可穿戴适应性抗性的理解，包括 关于适当培训水平和基本机制的基本知识，其最终目标是 开发一种干预措施，可以为患有CP的儿童进行体育锻炼，使他们能够与 他们的同龄人和环境健康发展和功能独立性。