National Pediatric Rehabilitation Resource Center: Techniques Development

项目概要（技术开发） 国家儿科康复资源中心（PedRehab Ctr）将参与技术开发， 我们认为非常有前途，对该领域方法或技术的关键差距作出反应，并可能 在应用中有多种用途。具体来说，我们建议追求的领域有两个研究应用 和临床实践。儿科康复研究将大大受益于更敏感，有效， 可靠的方法来衡量新技能的出现及其在日常功能中的使用。中的许多工具 新的脑瘫通用数据元素（CDE）最初是为典型的发展中国家开发的， 儿童;其他人只适用于有限的年龄范围，但往往是“标签外使用”;和一些指定为 “探索性”或“非常有希望”缺乏对他们的心理测量的确认（以及可能的进一步完善） 特性.儿科康复试验中的另一个主要问题是未能测量 治疗（即，遵守预期的治疗方案）。我们的PedRehab Ctr科学家一直活跃在 开发和验证新颖的评估工具，从复杂的运动学到父报告工具;创建 有史以来第一个用于儿科约束诱导运动治疗和双手治疗的Fidelity of Treatment工具; 并探索各种神经影像学方法的结合，以记录治疗诱导的 神经可塑性我们技术开发的具体目标是： 1.获得功能、技能和行为评估方法的确认性文件， 在实验室和现实世界的环境中。这包括使用运动学和视频，游戏， 机器人和可穿戴设备，以补充传统的标准化测试和系统方法， 建立有临床意义的增益和损失阈值; 2.对当前使用的工具进行标准化修改和汇总评分方法， 特异性和用于在神经运动障碍的年龄、严重程度和病因方面差异很大的儿童 损伤; 3.推进“忠实治疗”措施的制定， 记录实际提供的康复干预措施;以及 4.探索新的神经影像学策略，用作个体生物标志物， 治疗诱导的神经可塑性的指标。

Project Summary (Techniques Development) The National Pediatric Rehabilitation Resource Center (PedRehab Ctr) will engage in development of techniques we consider highly promising, responsive to critical gaps in methods or technology in the field, and potentially multi-purpose in their application. Specifically, the areas we propose to pursue have application for both research and clinical practice. Pediatric rehabilitation research would benefit immensely from more sensitive, valid, and reliable approaches to measuring the emergence of new skills and their use in everyday function. Many tools in the new Common Data Elements (CDEs) for Cerebral Palsy were developed initially for typically developing children; others apply to only limited age ranges but often are used “off label;” and some designated as “exploratory” or “highly promising” lack confirmation (and likely further refinement) of their psychometric properties. Another major problem in pediatric rehabilitation trials has been the failure to measure Fidelity of Treatment (i.e., adherence to intended treatment protocols). Our PedRehab Ctr scientists have been active in developing and validating novel assessment tools from sophisticated kinematics to parent report tools; creating first ever Fidelity of Treatment tools for pediatric Constraint-Induced Movement Therapy and Bimanual treatment; and exploring the incorporation of various neuroimaging approaches to document treatment-induced neuroplasticity. Our specific aims for Techniques Development are: 1. To obtain confirmatory documentation of assessment methods for function, skill, and behaviors that go across laboratory and real-world environments. This includes use of kinematics and video-, game-, robotic-, and wearable-devices to supplement traditional standardized tests and systematic methods for establishing clinically meaningful thresholds for gain and losses; 2. To standardize modifications and summary scoring methods of currently used tools to allow for greater specificity and for use with children who vary widely in age, severity, and etiologies of neuromotor impairments; 3. To advance the development of Fidelity of Treatment measures to provide much-needed documentation of the actual delivery of rehabilitation interventions; and 4. To explore novel neuroimaging strategies for use as individual biomarkers and as valid, reliable indicators of treatment-induced neuroplasticity.