Prone Locomotion in Infants with or at Risk for Disabilities

描述（由申请人提供）：提出的探索性研究的目的是开发和测试一个集成的机器人和传感器技术系统，旨在影响脑瘫婴儿的运动学习。在美国，小儿麻痹症是儿童致残最严重的疾病，运动是最受影响的功能技能。该项目特别关注的是，患有CP的儿童不仅缺乏对运动至关重要的自主运动，而且这些运动随着儿童的成长而减少（学会不使用/不使用）。患有CP的成年人所面临的许多行动不便可以追溯到婴儿期。俯卧运动是婴儿出生后第一年最早的运动，在某些情况下是唯一的运动形式，患有或有CP风险的婴儿很少能做到。俯卧运动不仅与功能独立和学习所必需的其他系统相结合，而且在典型发育的婴儿中，俯卧运动的发展也与大脑中突触形成高度活跃的时期相吻合，使其成为干预的关键门户和目标。没有经过测试的干预措施可以促进婴儿的这项技能。这项研究是我们下一步的工作，即使用自我启动的俯卧进展爬行器（SIPPC）来促进和帮助维持CP婴儿俯卧运动时的肢体和身体运动。它建立在我们早期试验的有希望的结果之上，这些结果表明，使用基于设备的位置输入传感器作为控制信号的第一代SIPPC （SIPPC-1）倾向于奖励较晚而不是较早的努力。拟议的第二代SIPPC （SIPPC-2）将增加基于婴儿的传感器（安装在肢体上的加速度计和称重传感器），这些传感器不仅可以作为控制信号，还可以生成关于患有或有CP风险的婴儿如何在俯卧运动中学习移动的运动学和动力学数据。两项相关研究将用于测试SIPPC-2控制是否会增强运动学习和促进俯卧运动。在第一项研究中，我们将收集信息来创建一个典型肢体和身体运动模式的菜单，这些模式可预测地导致婴儿驱动SIPPC-2的运动。第二项研究将测试设备驱动和婴儿驱动的控制算法，并比较使用活跃和不活跃SIPPC-2系统的婴儿运动策略的发展。将招募30名有或没有CP的婴儿，并在3 - 4个月时进行测试，以确定CP的风险。培训将在4.5 - 6.5个月大时开始。设计方案将包括为期12周的SIPPC-2上15-20分钟的培训。培训课程将被录影。Bayley婴儿发育量表III将用于评估与俯卧运动相关的发育领域。SIPPC-2的设计是独特和创新的，它不仅是一个干预装置，而且可以用来收集有关婴儿学习和行动模式的综合信息。该研究结果将提供有关脑损伤婴儿如何学习新运动技能的信息，为婴儿强化学习的使用提供信息，帮助确定SIPPC-2作为有效干预系统的可行性，并改进一个独立的便携式电池供电的SIPPC-2用于家庭和未来的临床试验。

DESCRIPTION (provided by applicant): The purpose of the proposed exploratory study is to develop and test an integrated robotics and sensor technology system designed to influence movement learning in infants with cerebral palsy (CP). CP is the most disabling condition for children in the United States with locomotion being the most affected functional skill. Of particular concern to the proposed project is that children with CP do not only show paucity of self-initiated movements critical for locomotion, but that these movements diminish as the children grow (learned disuse/non-use). Many of the mobility constraints that confront adults with CP can be traced back to infancy. Prone locomotion is the earliest and, in some cases the only form of locomotion available to infants during the first year of life, that infants with or at risk for CP rarely attain. Not only is prone locomotion integrated with other systems essential for functional independence and learning, its development in infants who are typically developing also coincides with a period of highly active synaptic formation in the brain, making it a critical gateway and target for intervention. No tested interventions exist to promote this skill in infants. The proposed study is the next step in our work on the use of a self-initiated prone progression crawler (SIPPC) to promote and help sustain limb and body movements by infants with CP during prone locomotion. It builds on promising results of our earlier trials that showed that the 1st generation SIPPC (SIPPC-1), which used device-based positional input sensors as control signals, tended to reward later rather than earlier efforts. The proposed 2nd generation SIPPC (SIPPC-2) will add infant-based sensors (limb-mounted accelerometers and load cells) that will not only serve as control signals, but will also generate kinematic and kinetic data about how infants with or at risk for CP learn to move during prone locomotion. Two (2) related studies will be used to test whether the SIPPC-2 controls will enhance motor learning and promote prone locomotion. In the first study we will gather information to create a menu of canonical limb and body movement patterns that predictably result in infant-driven movement of the SIPPC-2. The second study will test the device- and infant-driven control algorithms and compare the development of movement strategies of infants using active and inactive SIPPC-2 systems. Thirty (30) infants with and without CP will be recruited and tested at 3 - 4 months to determine risk for CP. Training will begin at 4.5 - 6.5 months of age. The design protocol will comprise 15-20 minutes of training on the SIPPC-2 for 12 weeks. The training sessions will be videotaped. The Bayley Scales of Infant Development III will be used to assess domains of development that are associated with prone locomotion. The SIPPC-2 design is unique and innovative in that it is not only an intervention device, but can also be used to gather comprehensive information about the infants' learning and mobility patterns. The results will generate information on how infants with brain lesions learn a new motor skill, provide information on the use of reinforced learning in infants, help determine the feasibility of the SIPPC-2 as a valid intervention system, and refine a self-contained portable battery powered SIPPC-2 to be used in homes and in future clinical trials. PUBLIC HEALTH RELEVANCE: The SIPPC-2 system is unique in that it is not only an intervention device that simultaneously generates performance outcomes, but it can also be used to gather comprehensive information about how infants (with and without CP) learn a movement-related task like crawling. The kinematic and kinetic data generated by the SIPPC-2 will allow us to begin to speculate about brain plasticity in infants with brain lesions. We expect that the use of a menu of patterns of limb movement will help deter learned non-use/disuse by challenging infants with a brain insult, such as cerebral palsy, to attain high levels of psychomotor abilities, and minimize the long term deleterious effects that immobility has on other domains of development and functional independence. Because early prone locomotion is associated with emergence of a wide variety of skills, assisting infants with or at risk for CP to attain this skill have far reaching effects.