Mechanical Intervention in Children with Cerebral Palsy

描述(申请人提供)：峰值骨量，这是在性发育结束后不久，是最重要的决定因素的骨量和骨质疏松症在以后的生活。残疾儿童，如脑瘫儿童，由于活动能力和负重能力降低，降低了骨骼的机械负荷，特别容易出现骨量增加不足的情况。此外，这些儿童的肌肉力量和功能较差，这导致缺乏建立骨量所需的机械刺激。物理疗法可以增加骨量和改善肌肉功能，但这种疗法耗时耗力，而且可能不会像需要的那样频繁。 全身振动已经显示出作为一种替代方法的前景，既可以刺激骨量增加，也可以改善肌肉性能。在全身振动干预中，受试者站在上下振动或摇摆运动的平台上。这项建议的主要目的是测试高频、低幅度振动作为干预脑瘫儿童骨量减少和肌肉功能低下的疗效。具体地说，本研究将检验以下假设：(1)相对于对照组，振动干预将增加轴向和附件骨密度以及长骨的横截面性质；(2)相对于对照组，振动干预将增加肌肉质量、肌肉力量和姿势稳定性；(3)相对于对照组，振动干预将减少骨吸收标志，增加骨形成标志。 在振动干预中，受试者接受机械刺激10次/天，7天/周，为期6个月。这些受试者将按照相同的时间表额外接受6个月的无振动负重训练，作为内部对照。另一组匹配的儿童将不会接受任何干预。将测量腰椎和胫骨近端松质骨密度、胫骨中段横断面特性、骨转换标志、小腿肌肉横截面积和力量以及姿势稳定性指数的变化，以确定振动干预是否有效地改善骨量和肌肉功能。以CP为模型，本研究将有助于验证或否定低强度机械刺激作为骨质疏松症干预措施的普遍有用性。这项研究还将深入了解肌肉适应和骨转换在增加骨量方面的潜在作用，以回应这种简单、非侵入性、非药理学的干预。

DESCRIPTION (provided by applicant): Peak bone mass, which is achieved soon after the end of sexual development, is the most important determinant of bone mass and osteoporosis later in life. Disabled children, such as children with cerebral palsy, are particularly vulnerable to deficits in bone mass accretion due to decreased mobility and weight-bearing which reduces mechanical loading of the skeleton. In addition, these children have poor muscle strength and function which contributes to the lack of mechanical stimulation needed to build bone mass. Physical therapy can increase bone mass and improve muscle function, but the therapy is time and labor intensive and may not be available as frequently as needed. Whole body vibration has shown promise as an alternative method for stimulating both increases in bone mass and improvements in muscle performance. In whole body vibration interventions, the subject stands on a platform that vibrates either up and down or in a rocking motion. The main purpose of this proposal is to test the efficacy of high frequency, low magnitude vibration as an intervention for low bone mass and poor muscle function in children with cerebral palsy. Specifically, this study will test the following hypotheses: (1) The vibration intervention will increase axial and appendicular bone density and long bone cross-sectional properties relative to controls; (2) The vibration intervention will increase muscle mass, muscle strength, and postural stability relative to controls; (3) The vibration intervention will decrease markers of bone resorption and increase markers of bone formation relative to controls. In the vibration intervention, subjects will receive mechanical stimulation for 10 rain/day, 7 days/wk for 6 months. These subjects will undergo an additional 6 months of weight bearing without vibration following the same schedule to serve as an internal control. An additional control group of matched children will receive no intervention. Changes in lumbar spine and proximal tibia cancellous bone density, cross-sectional properties of the midshaft of the tibia, markers of bone turnover, calf muscle cross-sectional area and strength, and indices of postural stability will be measured to determine whether or not the vibration intervention is effective in improving bone mass and muscle function. Using CP as a model, this study will help to validate or invalidate the general usefulness of low magnitude mechanical stimulation as an intervention for osteoporosis. This study will also provide insight into the potential role of muscle adaptation and bone turnover in increasing bone mass in response to this simple, non-invasive, non-pharmacalogical intervention.