OPTIMIZING MUSCLE FUNCTION IN CEREBRAL PALSY

脑性瘫痪(CP)是最常见的身体残疾，发生在 童年，没有治愈的方法。所有当前的治疗方法，如 手术和物理治疗的目的仅仅是缓解外周症状。 这种中枢神经系统紊乱的影响，通常是有限和 不稳定的成功。一个流行的临床系统，长期以来一直是 公认的，但很少在这一人群中进行治疗的是 肌肉无力。虽然力量训练是成年人的常规训练 整形外科人口和运动员增加力量生产或 改变肌肉失衡，这种类型的干预严重低于- 用于儿童康复，特别是患有脑瘫的儿童。 没有证据支持临床上对力量的偏见 脑性瘫痪的训练和测试。事实上，研究结果是 相反，积累脚趾，表明患有CP的个体 事实上，疲软的程度与马达有直接的关系 表现，加强计划可以产生积极的功能 结果。然而，其神经生理和生物力学基础 CP的弱点仍然鲜为人知。另一个令人担忧的问题是 非卧床痉挛患儿的两种主要手术干预措施 双瘫、肌腱延长术(骨科手术)和选择性 背根切断术(神经外科)，通常用于加重或揭露 虚弱的症状，这对已经 瘦弱。该项目的最终目标是改善运动成绩 通过首先探索导致力减弱的机制来实现 生产和界定相对薄弱的作用在功能 痉挛型脑瘫患者的运动功能障碍。这将通过等速和等速 肌电检查随意肌和非随意肌的肌电评价 慢性阻塞性肺疾病患儿膝关节和踝关节的反应 运动范围和不同的运动速度。肌肉表现将 然后与经过验证的儿科功能状态测量和 残疾。最后，力量与外科手术的相互作用 干预措施将通过量化骨科的效果来确定 和神经外科关于力量和功能的测量，并评估 加强计划的增加是否会加强外科手术 结果。力量是正常运动控制的重要组成部分， 缺乏CP，但可以通过训练改变。续 如这里所建议的，需要进行研究来验证和巩固 强化在儿童脑性瘫痪康复中的作用。

Cerebral palsy (CP) is the most prevalent physical disability occurring in childhood, for which no cure is available. All current treatments such a surgery and physical therapy aim solely to alleviate the peripheral effects of this central nervous system disorder, often with limited and inconsistent success. A prevalent clinical system that has long been recognized, but rarely addressed therapeutically in this population is muscle weakness. While strength training is routinely used in the adult orthopaedic population and in athletes to increase force production or alter muscle imbalance, this type of intervention is grossly under- utilized in pediatric rehabilitation, and in particular children with CP. No evidence exists to support the clinical prejudice against strength training and testing in cerebral palsy. In fact, research findings are accumulating toe the contrary, demonstrating that individuals with CP are indeed weak, the degree of weakness has a direct relationship to motor performance, and strengthening programs can produce positive functional outcomes. However, the neurophysiological and biomechanical bases of weakness in CP remain poorly understood. An additional concern is that the two major surgical interventions in ambulatory children with spastic diplegia, muscle-tendon lengthening (orthopaedic surgery) and selective dorsal rhizotomy (neurosurgery), often serve to exacerbate or unmask the symptom of weakness, which can be problematic in children who are already weak. The ultimate goal of this project is to improve motor outcomes in CP by first exploring the mechanisms that lead to diminished force production and defining the relative role of weakness in the functional motor deficit in spastic CP. This will be accomplished by isokinetic and electromyographic evaluation to examine voluntary and involuntary muscle responses in children with CP at the knee and ankle joint throughout the range of motion and at different movement speeds. Muscle performance will then be related to validated pediatric measures of functional status and disability. Lastly, the interaction of strength with surgical interventions will be determined by quantifying the effects of orthopaedic and neurosurgery on strength and functional measures, and assessing whether the addition of a strengthening program enhances surgical outcomes. Strength is an essential component of normal motor control that is deficient in CP, but can be altered through training. Continued research, as proposed here, needs to be conducted to verify and solidify the role of strengthening in the rehabilitation of children with CP.