Neuromuscular mechanisms of specific trunk interventions in children with cerebral palsy

脑瘫儿童躯干特异性干预的神经肌肉机制

• 批准号: 10582551
• 负责人: Ming Wu
• 金额: $ 32.5万
• 依托单位: REHABILITATION INSTITUTE OF CHICAGO D/B/A SHIRLEY RYAN ABILITYLAB
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10582551
• 关键词: Agonist; Articular Range of Motion; Cerebral Palsy; Chest; Child; Childhood; Clinical; Data; Equilibrium; Exhibits; Exposure to; Extensor; Flexor; Foundations; Frequencies; Functional disorder; Gait; Goals; Head; Impairment; Incidence; Infant; Intervention; Kyphosis deformity of spine; Live Birth; Locomotion; Lordosis; Measures; Motor; Movement; Muscle; Musculoskeletal; Musculoskeletal Equilibrium; Neck; Neuronal Plasticity; Pathway interactions; Pelvis; Postural response; Psychological reinforcement; Robotics; Specificity; Synapses; Therapeutic Effect; Training; Walking; Work; antagonist; autistic children; conventional therapy; effective intervention; functional gain; functional improvement; gait rehabilitation; improved; innovation; motor control; muscle strength; neural; neuromuscular; neuromuscular examination; novel; patient population; peer; physically handicapped; response; robotic system; skills

Abstract Many children with cerebral palsy (CP) show impairments in trunk postural control, which significantly impact their walking capacity and daily activities. For instance, children with severe CP, who have difficulties sitting independently, show poor directional specificity, with antagonists activating before agonists, which is distinct from typically developed children. Compared to typically developed peers, children with CP have a large range of motion for pelvis tilt, thorax, head, and kyphosis and lordosis during gait, even for some high functioning children with CP. While the significance of trunk motor control dysfunction in children with CP has been recognized, effective interventions for this core deficit are still lacking. Children with CP often receive or participate in a wide range of passive and active interventions aimed to improve postural control, but results have shown that current intervention approaches are not often effective in improving postural control in children with CP. For instance, hippotherapy, an intervention strategy that applies rhythmical force perturbations to the pelvis during sitting astride using horseback movement, has been used for improving balance and gait in children with CP for decades. However, while some studies showed improvements in balance and motor function in children with CP after hippotherapy, other studies indicated a mixed result regarding the effect of hippotherapy on Gross Motor Function Measure scores in children with CP. Thus, there is a critical need to improve the efficacy of current interventions for improving trunk postural control and gait in children with CP, which requires a thorough examination of the underlying neuromuscular mechanisms of the interventions. Our long-term goal is to develop rational-based intervention strategies to improve trunk postural control and gait in children with CP. The overall objective of this study is to examine the neuromuscular mechanisms of the trunk muscles to a force perturbation applied to the pelvis during sitting astride, and determine whether repeated exposure to pelvic perturbations during sitting astride using a robotic system will be effective in improving trunk postural control and gait in children with CP. Our central hypothesis is that repetitive activation of specific sensorimotor pathways through applying targeted force perturbations will improve postural control in children with CP, which may be due to the reinforcement in circuits and synapses used for trunk postural control through a use-dependent neuroplasticity mechanism. The rationale for the proposed study is that an understanding of the neuromuscular mechanisms of trunk muscle control in children with CP and determination of the therapeutic effect of targeted force perturbation are likely to provide a strong scientific foundation whereby new force perturbation based intervention strategies can be developed to improve postural control and gait in children with CP. The results from this study may be used to develop innovative clinical therapies aimed at improving trunk postural control and walking function in children with CP.

摘要 许多脑性瘫痪(CP)儿童在躯干姿势控制方面表现出损害，这显著地 影响他们的步行能力和日常活动。例如，患有严重脑瘫的儿童，他们有困难 独立坐着，方向特异性差，拮抗剂先于激动剂激活，这是 有别于一般发育成熟的儿童。与正常发育的同龄人相比，患有CP的儿童有 在步态过程中，骨盆倾斜、胸部、头部、后凸和前凸的大范围运动，即使是一些高位 患有脑瘫的功能正常的儿童。而躯干运动控制功能障碍在慢性阻塞性肺疾病儿童中的意义 虽然已经得到承认，但仍然缺乏对这一核心赤字的有效干预措施。患有脑瘫的儿童通常会收到或 参加一系列旨在改善体位控制的被动和主动干预，但结果 已经表明，目前的干预方法在改善患者的姿势控制方面往往并不有效。 患有脑瘫的儿童。例如，海马体疗法，一种应用节律力的干预策略 利用马背运动在坐姿时对骨盆的扰动，已被用于改善 脑性瘫痪儿童数十年的平衡和步态。然而，尽管一些研究表明， 脑性瘫痪儿童在海马体治疗后的平衡和运动功能，其他研究表明结果喜忧参半 关于海马区治疗对脑性瘫痪儿童粗大运动功能评分的影响。因此，在那里 是改善躯干姿势控制和步态的当前干预措施有效性的迫切需要 儿童脑性瘫痪，这需要彻底检查潜在的神经肌肉机制 干预措施。我们的长期目标是开发基于理性的干预策略来改善躯干姿势 脑性瘫痪儿童的控制和步态。这项研究的总体目标是检查神经肌肉 躯干肌肉对坐姿时施加于骨盆的力扰动的机制，以及 确定在使用机器人系统跨坐时反复暴露于骨盆扰动是否会 能有效改善脑瘫患儿的躯干姿势控制和步态。我们的中心假设是 通过施加靶向力扰动来重复激活特定的感觉运动通路将 改善脑性瘫痪儿童的姿势控制，这可能是由于回路和突触的加强 通过依赖使用的神经可塑性机制用于躯干姿势控制。该计划的基本原理 建议的研究是对儿童躯干肌肉控制的神经肌肉机制的理解 用CP和靶向力测定扰动的治疗效果有可能提供较强的 可以开发新的基于力摄动的干预策略的科学基础 改善脑性瘫痪患儿的姿势控制和步态。这项研究的结果可以用来开发 旨在改善脑瘫儿童躯干姿势控制和行走功能的创新临床疗法。