Effects of Motor-Assisted Cycling in Cerebral Palsy

描述（由申请人提供）：通过适当的刺激和练习，可以在人类中访问和训练脊髓运动回路。跑步机训练和FES-自行车方案正越来越多地用于CMS损伤的人，以利用这种潜力，努力改善协调性，并在可能的情况下恢复或促进运动能力。脊髓回路的激活也可以驱动皮质重组并进一步增强运动恢复。脑性瘫痪（CP）是儿童时期最常见的身体残疾，其特征在于由于发育中的神经系统中的静态脑损伤而导致的运动控制异常。由此产生的不适当的下行输入的后果是，促进下肢协调的相互运动的脊柱机制通常未得到充分利用，因此可能会异常发育。这对运动发育有直接的负面影响，并引发级联反应，从而限制运动的量和类型限制神经系统中运动通路的强化或发育，进一步降低运动潜力。我们的具体目标是在这个初步调查是进行为期三个月的电机辅助（被动）骑自行车计划，使用一个特殊的计算机化电机驱动的周期在20个走动和非走动的儿童与CP的主要目标，以训练脊髓运动回路，从而提高运动协调和功能。次要目标是调节痉挛和肌肉僵硬，并增强皮质可塑性。骑自行车是一种运动形式，具有与步行相似的时间和相位以及共享神经回路的证据，并且可以为治疗师辅助的跑步机训练方案提供更有效和可行的家庭替代方案。快速（50 RPM）电机驱动的自行车在正常人中产生相互的肌肉激活，这可能在spasiticy患者中甚至更大。如果发现骑自行车刺激CP的神经和运动恢复，则本前瞻性观察性研究中获得的数据将用于支持CP被动和主动辅助骑自行车的RCT。

DESCRIPTION (provided by applicant): Spinal locomotor circuits can be accessed and trained in humans with appropriate stimuli and practice. Treadmill training and FES-cycling protocols are being increasingly utilized for persons with CMS injuries to exploit this potential in an effort to improve coordination and, if possible, to restore or promote ambulation. Activation of spinal circuits may also drive cortical reorganization and further augment motor recovery. Cerebral palsy (CP), the most prevalent physical disability originating in childhood, is characterized by abnormal motor control as a result of a static brain lesion in a developing nervous system. A consequence of the resultant inappropriate descending input is that spinal mechanisms that promote coordinated reciprocal movements in the lower extremities are often underutilized and therefore may develop abnormally. This has a direct negative effect on motor development and initiates a cascade whereby restricted amounts and types of movements limit the reinforcement or development of motor pathways in the nervous system, further reducing motor potential. Our specific aim in this initial investigation is to conduct a three month motor-assisted (passive) cycling program using a special computerized motor-driven cycle in 20 ambulatory and non-ambulatory children with CP with the primary goal to train spinal locomotor circuits and thereby improve motor coordination and function. Secondary goals are to modulate spasticity and muscle stiffness, and enhance cortical plasticity. Cycling is a form of locomotion shown to have similar timing and phasing to walking and evidence of shared neural circuitry, and could provide a more effective and feasible in-home alternative to therapist-assisted supported treadmill training regimens. Fast (50RPM) motor-driven cycling produces reciprocal muscle activation in normals that may be even greater in persons with spasiticy. If it is found that cycling stimulates neural and motor recovery in CP, the data obtained in this prospective observational study will be used to support a RCT of passive and perhaps active-assisted cycling in CP.