Robotic Exoskeleton Gait Training in Transition Aged Persons with Cerebral Palsy

机器人外骨骼对脑瘫过渡期老年人的步态训练

• 批准号: 10752736
• 负责人: Morgan Busboom
• 金额: $ 3.83万
• 依托单位: FATHER FLANAGAN'S BOYS' HOME
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-23 至 2025-08-22
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10752736
• 关键词: Adolescence; Adult; Area; Attention; Biomechanics; Body Weight; Brain; Brain imaging; Cerebral Palsy; Clinical; Clinical Trials; Compensation; Data; Deterioration; Developmental Disabilities; Devices; Direct Costs; Economic Burden; Employment; Exhibits; Experimental Designs; Funding; Gait; H-Reflex; Health; Hoffman' s Reflex; Impairment; Interneurons; Investigation; Joints; Learned Helplessness; Leg; Link; Literature; Locomotion; Lower Extremity; Magnetoencephalography; Measures; Mediation; Metabolic; Motor; Muscle; Nervous System; Neuronal Plasticity; Outcome; Participant; Patients; Perinatal Brain Injury; Persons; Physical therapy; Preparation; Protocols documentation; Research; Societies; Spinal Cord; Surface; Testing; Therapeutic; Therapeutic Intervention; Therapeutic community technique; Time; Training; United States; United States National Institutes of Health; Walking; Well in self; Withdrawal; aged; clinically relevant; cohort; cost; disparity elimination; empowerment; exoskeleton; gait rehabilitation; improved; improved mobility; innovation; interest; kinematics; member; meter; motor learning; neuromuscular activity; neurophysiology; novel; patient population; primary outcome; robot exoskeleton; spatiotemporal; success; tool; treatment strategy; walking speed

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.

项目摘要/摘要 脑性瘫痪（CP）是由围产期脑损伤引起的，是最普遍和最昂贵的疾病之一。 美国的发展障碍。当CP患者从青春期过渡到成年期时， 他们继续面临突出的流动性挑战。尽管人们越来越认识到 随着病情的恶化，NIH对患有CP的过渡期老年人的资助非常低。因此，研究重点 在这个关键的过渡时期，迫切需要加强CP患者的流动性，以帮助缩小 缩小差距，消除这种差距。 在过去的十年中，在治疗中利用机器人外骨骼已经引起了相当大的兴趣。 以改善流动性。这种治疗方法很有趣，因为外骨骼可以用来 当患者练习真实世界的任务（即，楼梯和障碍物协商）。目前的治疗 与这些机器人外骨骼一起使用的方法主要集中于补偿（即，体重 支持，被动腿促进），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， 在运动过程中扰动腿部，以产生增强的肌肉活动和相关的运动 在现实世界的任务中的错误。我们的核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，将导致临床相关的步态改善， 在脊髓和控制腿部运动的关键大脑回路中具有有益的神经可塑性。的 该项目的具体目标是：（1）量化过渡年龄人群（16- 18岁）的流动性变化程度。 25年）与CP谁经历了我们的创新机器人外骨骼步态训练协议，和（2）为了识别 接受我们的机器人外骨骼步态训练方案的患有CP的过渡期老年人是否表现出 在关键的大脑回路和脊髓动力学中， 规划和执行腿部运动动作。简而言之，本项目的实验设计涉及过渡 患有CP的老年人将在佩戴机器人外骨骼的同时接受24次物理治疗， 将在地上治疗步态训练协议期间扰乱时空步态运动学。基线 和治疗后的措施将包括临床活动性评估（功能性步态评估，快速， 可能步行10米，步行1分钟，上下楼梯的时间），脑磁图（MEG）大脑 成像和霍夫曼反射（即，H反射）评估脊髓中间神经元动力学。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新的视角。 外骨骼作为治疗工具，用于改善CP患者的步态。