Effects of Motor-Assisted Cycling in Cerebral Palsy

描述(申请人提供)：在适当的刺激和练习下，脊椎运动回路可以在人体内获得和训练。跑步机训练和FES-自行车方案正越来越多地被用于CMS损伤的人，以开发这一潜力，以努力改善协调，并在可能的情况下，恢复或促进行走。脊髓回路的激活也可能驱动皮质重组，进一步增强运动恢复。脑性瘫痪(CP)是最常见的起源于儿童的身体残疾，其特征是由于发育中的神经系统的静止性大脑损害而导致运动控制异常。由此产生的不适当的下行输入的后果是，促进腿部协调相互运动的脊髓机制往往没有得到充分利用，因此可能会发育异常。这对运动发育有直接的负面影响，并引发级联反应，限制运动量和运动类型，限制神经系统运动通路的强化或发育，进一步降低运动潜力。在这项初步研究中，我们的具体目标是对20名患有脑性瘫痪的儿童进行为期三个月的运动辅助(被动)自行车计划，该计划使用一种特殊的计算机化摩托车驱动的自行车，主要目的是训练脊髓运动回路，从而改善运动协调和功能。次要目标是调节痉挛和肌肉僵硬，并增强皮质的可塑性。骑自行车是一种运动形式，被证明具有与步行相似的时间和阶段，并有证据表明共享神经回路，并且可以提供一种更有效、更可行的家庭替代方案，以取代由治疗师辅助的跑步机训练方案。快速(50RPM)电动自行车在正常人中产生相互的肌肉激活，在痉挛患者中可能更强。如果发现骑车刺激脑瘫患者的神经和运动恢复，在这项前瞻性观察研究中获得的数据将被用于支持脑瘫患者被动或主动辅助骑行的随机对照试验。

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.