Quantifying patient-specific changes in neuromuscular control in cerebral palsy

项目摘要 走路使人们能够在日常生活中独立和探索。对于脑瘫(CP)患者来说，这是一种脑损伤 接近出生时会改变他们的活动和参与日常活动的能力。治疗寻求改善 行走功能，但患有CP的人适应和学习新运动模式的过程是 人们对此知之甚少。我们之前的研究表明，患者特定的运动控制措施(即如何 个人新兵和协调他们的肌肉)是行走功能和 治疗结果。与非残疾同龄人相比，运动控制受损的儿童情况更差 功能和较差的治疗结果，如骨科手术或选择性脊神经后根切断术。这个 我们提议的研究的前提是，针对患者的适应措施对 理解并告知护理，但我们缺乏量化适应或有效诱导运动学习的方法。 脑性瘫痪患者的适应是否发生了改变，靶向训练是否能放大适应以改善行走 功能仍不清楚。多模式反馈训练是一种很有前途的支持适应和 运动学习，但很少有研究评估行走或运动过程中实时反馈训练的适应 它对行走功能的影响。拟议的研究试图通过完成系统化的 量化步行适应率(AIM-1)并确定是否重复行走所需的实验分析 暴露在多模式反馈训练中可以改变适应率(AIM-2)以诱导运动学习和 改善步行功能(Aim-3)。具体地说，我们检查了多模式响应的适应率 针对足屈肌功能的反馈训练，这是一种几乎普遍存在的行走关键肌肉群 脑性瘫痪。我们使用(1)自适应踝关节的感觉运动反馈来提供多模式反馈 阻力通过轻便、可穿戴的机器人传递，以及(2)足底屈肌活动的视听反馈 从肌电记录中。通过评估患有CP的儿童对这种反馈训练的反应--两者都是单独的 并结合--这项研究将为量化和理解适应和 脑瘫患者的运动学习。

Project Summary Walking enables independence and exploration in daily life. For people with cerebral palsy (CP), a brain injury near the time of birth alters their ability to move and participate in daily activities. Treatments seek to improve walking function, but the processes by which people with CP adapt and learn new movement patterns are poorly understood. Our prior research demonstrated that patient-specific measures of motor control (i.e., how an individual recruits and coordinates their muscles) are important indicators of walking function and treatment outcomes. Children with more impaired motor control compared to nondisabled peers have worse function and worse outcomes after treatments like orthopedic surgery or selective dorsal rhizotomy. The premise of our proposed research is that patient-specific measures of adaptation are equally important to understand and inform care, but we lack methods to quantify adaptation or effectively induce motor learning. Whether adaptation is altered in CP and whether targeted training can amplify adaptation to improve walking function remains unknown. Multimodal feedback training is a promising approach to support adaptation and motor learning, but few studies have evaluated adaptation with real-time feedback training during walking or its impacts on walking function. The proposed research seeks to fill these gaps by completing the systematic experimental analyses necessary to quantify walking adaption rates (Aim-1) and determine whether repeated exposure to multimodal feedback training can alter adaptation rates (Aim-2) to induce motor learning and improve walking function (Aim-3). Specifically, we examine adaptation rates in response to multimodal feedback training that targets plantarflexor function, a key muscle group for walking that is nearly universally impaired in CP. We provide multimodal feedback using (1) sensorimotor feedback from adaptive ankle resistance delivered via a light-weight, wearable robot and (2) audiovisual feedback of plantar flexor activity from EMG recordings. By evaluating responses of children with CP to this feedback training – both individually and combined – this research will establish the scientific basis to quantify and understand adaptation and motor learning in CP.