Balance and Posture in Adults with Cerebral Palsy

描述(申请人提供)：脑性瘫痪(CP)患者表现出相当大的功能异质性，并随着年龄的增长表现出明显的功能状态下降，这是由于躯体感觉功能障碍、继发性神经肌肉损伤和躯干肌肉控制不良的发展所致。这些因素会促进平衡不稳定，导致摔倒风险增加，并导致功能性能力丧失。随着脑瘫年龄的增长，神经运动和躯体感觉障碍的进展情况知之甚少，因此，关于成年脑瘫患者的姿势控制和平衡方面的知识差距，特别是与年龄(原发)相关的和与代偿行为相关的知识差距。本研究的目的是探讨成人脑性瘫痪患者姿势控制中运动反应异常的机制。我们假设，躯体感觉依赖以及肌肉的被动和主动属性，随着年龄和功能适应的变化而变化。为了解决我们的中心假说，我们提出了以下具体目标：特定目的1：研究感觉加工和感觉运动整合的中枢障碍，这些障碍是导致青壮年CP患者姿势控制异常的原因。我们将：a)通过视觉依赖测试直接测量成年CP患者的视觉依赖对姿势控制的影响；b)将视觉依赖的存在与成年CP患者的视觉流动场干扰对重心(COM)和压力中心(COP)反应的影响联系起来；以及c)通过标准化的平衡和跌倒风险临床评估来确定感觉加工和感觉运动整合的中枢障碍与功能平衡的关系。具体目的2：研究被动肌腱特性的外周改变可能导致青壮年CP患者的姿势控制异常。我们将使用功能主成分(时间序列)分析来确定支架底部的扰动、对视野的扰动以及两者的联合扰动对成人脑性瘫痪患者关节运动学、COP和COM反应的影响。具体目的3：研究导致青壮年CP患者姿势控制异常的肌肉激活受损和肌肉控制选择性丧失。我们将利用小波分析来确定支撑基座的扰动、视觉流场的扰动以及两者的联合扰动对肢体和躯干肌肉的表面肌电信号活动的影响。在这项研究的结论中，我们将描述成年脑瘫患者在存在躯体感觉和生物力学扰动时所采用的姿势控制策略。我们的创新方法挑战感觉运动系统的所有方面，与我们对数据的时间序列和小波分析的分析方法相结合，将使我们能够将主要动态姿势缺陷与补偿行动分开，这是优化治疗干预的关键区别。

DESCRIPTION (provided by applicant): Individuals with Cerebral Palsy (CP) present with considerable functional heterogeneity, and demonstrate a marked decrease in functional status with age due to the development of disturbances in somatosensory function, secondary neuromuscular impairments, and poor control over the trunk muscles. These factors promote balance instability, result in an increased fall risk, and contribute to lost functional capabilitis. Little is known about the progression of neuromotor and somatosensory impairments as individuals with CP age, thus a knowledge gap exists concerning postural control and balance in the adult with CP, particularly which those associated with aging (primary) and those associated with compensatory behaviors. The objective of this proposal is to explore mechanisms behind abnormal motor response in postural control in the adult with CP. We HYPOTHESIZE that somatosensory reliance, as well as muscle passive and active properties, change with aging and functional adaptation. In order to address our central hypothesis, we propose the following specific aims: SPECIFIC AIM 1: To examine the central disturbances of sensory processing and sensorimotor integration that contribute to abnormal postural control in young adults with CP. We will: a) determine the effect of visual dependence on postural control in the adult with CP as directly measured with a test for visual dependence; and b)relate the presence of visual dependence to the effect of disturbances of the visual flow field on the center of mass (CoM) and center of pressure (CoP) responses in the adult with CP; and c) determine the relationship between central disturbances of sensory processing and sensorimotor integration on functional balance as measured by standardized clinical assessments of balance and fall risk. SPECIFIC AIM 2: To examine the peripheral alterations in passive muscle-tendon properties that could contribute to abnormal postural control in young adults with CP. We will determine the effects of a disturbance of the base of support, a disturbance to the visual flow field, and a combined disturbance of the two on joint kinematics, CoP, and CoM responses in the adult with CP using functional principal component (time-series) analyses. SPECIFIC AIM 3: To examine the impaired muscle activation and loss of selectivity over muscle control that contributes to abnormal postural control in young adults with CP. We will determine the effects of a disturbance of the base of support, a disturbance to the visual flow field, and a combined disturbance of the two on the surface electromyographic (sEMG) activity of lower limb and trunk muscles using wavelet analyses. At the conclusion of this study, we will have characterized postural control strategies employed by adults with CP in the presence of somatosensory and biomechanical perturbations. The combination of our innovative methodology to challenge all aspects of the sensorimotor system, with our analytical approach of both time series and wavelet analysis of the data, will allow us to separate the primary dynamic postural deficits from compensatory actions, a critical distinction for optimizing treatment interventions.