Robotic Exoskeleton Gait Training in Transition Aged Persons with Cerebral Palsy

项目摘要/摘要 脑性瘫痪(CP)是由围产期脑损伤引起的，是最常见和最昂贵的疾病之一 美国的发育性残疾。CP患者从青春期过渡到成年期 他们继续面临着突出的移动性挑战。尽管人们对移动性的认可度越来越高 随着病情恶化，国立卫生研究院为患有慢性阻塞性肺病的过渡期老年人提供的资金非常少。因此，研究集中在 在这一关键的过渡时期加强脑瘫患者的流动性是非常必要的，以帮助缩小 缩小差距，消除这种差距。 在过去的十年里，人们对利用机器人外骨骼进行治疗非常感兴趣 为提高移动性而设置。这种治疗方法很有趣，因为外骨骼可以用来 当病人练习现实世界的任务(即，楼梯和障碍穿越)时。然而，目前的治疗方法 使用这些机器人外骨骼的方法主要集中在补偿(即体重 支持，被动的腿部促进)，这可能会抑制运动学习，因为它可以脱离神经系统。 这项建议反对这种治疗策略，因为我们将使用外骨骼作为治疗工具 在运动过程中扰乱腿部，以产生高度的肌肉活动和相关的运动 现实世界任务环境中的错误。我们的中心假设是神经肌肉活动的增强 在我们的外骨骼步态训练期间，将导致临床上相关步态的改善，这将是密切相关的 在脊髓中具有有益的神经可塑性，以及控制腿部运动动作的关键大脑回路。这个 该项目的具体目标是：(1)量化过渡期老年人(16-16岁)的流动性变化程度 25年)与CP一起接受我们创新的机器人外骨骼步态训练方案，以及(2)识别 接受我们的机器人外骨骼步态训练方案的患有脑瘫的过渡老年患者是否表现出 在关键的大脑回路和脊髓动力学中涉及到更大的神经生理学变化 计划和执行腿部运动动作。简而言之，这个项目的实验设计涉及到过渡 患有脑性瘫痪的老年患者将接受24次物理治疗，同时穿着机器人外骨骼 将在地面治疗步态训练方案期间扰乱时空步态运动学。基线 治疗后的措施将包括临床活动能力评估(功能性步态评估，FAST-AS-AS- 可能步行10米，步行1分钟，上下楼梯的时间)，脑磁图(脑磁图) 成像和霍夫曼反射(即H反射)对脊髓间神经元动力学的评估。临床 结果将与接受标准步态训练而不使用 外骨骼。这项临床试验的有益结果将为机器人的使用创造一个新的视角 外骨骼作为改善CP患者步态的治疗工具。

PROJECT SUMMARY/ABSTRACT Cerebral palsy (CP) results from a perinatal brain injury and is one of the most prevalent and costly developmental disabilities in the United States. As persons with CP transition from adolescence into adulthood they continue to be faced with prominent mobility challenges. Despite the increased recognition of the mobility deteriorations, NIH funding related to transition aged persons with CP is remarkably low. Thus, research focused on enhancing the mobility of persons with CP during this critical transition period is sorely needed to help narrow the gap and eliminate this disparity. Over the last decade, there has been considerable interest in utilizing robotic exoskeletons in a therapeutic setting for improved mobility. This therapeutic approach is interesting because the exoskeleton can be used while the patient practices real-world tasks (i.e., stair and obstacle negotiation). However, the current therapeutic approaches used with these robotic exoskeletons are primarily focused on compensation (i.e., body weight support, passive leg facilitation), which might dampen motor learning since it can disengage the nervous system. This proposal opposes this treatment strategy in that we will use the exoskeleton as a treatment tool for perturbing the legs during locomotion, in order to generate heightened muscular activity and relevant motor errors in the context of real-world tasks. Our central hypothesis is that the heightened neuromuscular activity during our exoskeleton gait training will result in clinically relevant gait improvements that will be tightly connected with beneficial neuroplasticity in the spinal cord and key brain circuits that govern the leg motor actions. The Specific Aims of this project are: (1) To quantify the degree of mobility changes in transition aged persons (16- 25 years) with CP who undergo our innovative robotic exoskeleton gait training protocol, and (2) To identify whether transition aged persons with CP who undergo our robotic exoskeleton gait training protocol exhibit greater neurophysiological alterations in the key brain circuits and spinal cord dynamics that are involved in planning and executing leg motor actions. In brevity, the experimental design of this project involves transition aged persons with CP who will undergo 24 physical therapy sessions while wearing a robotic exoskeleton that will perturb the spatiotemporal gait kinematics during an overground therapeutic gait training protocol. Baseline and post-therapy measures will include clinical mobility assessments (Functional Gait Assessment, fast-as- possible 10-meter walk, 1-minute walk, time up and down stairs), magnetoencephalographic (MEG) brain imaging, and Hoffman reflex (i.e., H-reflex) assessments of the spinal cord interneuron dynamics. Clinical outcomes will be compared with a cohort of persons with CP that undergo standard gait training without using the exoskeleton. Beneficial outcomes from this clinical trial will create a new perspective on the use of robotic exoskeletons as a therapeutic tool for improving the gait of persons with CP.