Optimizing locomotor training for children with severe cerebral palsy

描述（由申请人提供）：脑瘫是儿童中最常见的运动缺陷，发病率为每1000例活产2-3例。一个重要的社会经济问题是，即使采用目前的治疗方法，44%的脑瘫儿童也无法学会独立行走。患有CP的非卧床儿童患髋关节发育不良、脊柱侧凸、骨质疏松、生长迟缓和呼吸系统疾病的风险更高。具有讽刺意味的是，这些儿童获得更好的功能结果的希望减少了，因为他们通常被排除在运动控制研究和临床创新之外。例如，目前的运动干预措施（体重支持的跑步机训练（BWSTT），辅助装置，机器人运动训练）是为已经能够直立控制躯干的高功能儿童设计的。因此，对于那些最需要运动干预的孩子来说，运动干预要么无法实现，要么效率低下。研究人员对发育正常（TD）的婴儿（他们天生对躯干的控制能力较差）进行研究，在跑步机上支撑婴儿时，将他们的躯干向前倾斜，以帮助他们走路。然而，一个特定的倾斜角度并没有被提出，这种姿势的基本原理也没有被阐明或测试。据推测，这种技术减少了对躯干控制的需求，同时减少了婴儿摆动腿和迈步所需的肌肉力量。提出,这项技术也可能为严重CP患儿工作。使用一个定制的树干支撑装置和可调倾角和儿童电动跑步机,一步反应将记录在7月婴儿在年龄范围(目标1)当树干姿势控制正常发展儿童(1 - 7 mo)和30严重CP(粗大运动功能分类系统级III, IV和V)(2 - 4或6 - 8岁)(目标2)。同时评估躯干控制的节段水平将提供必要的信息，以检验最佳躯干倾斜角度与婴儿/儿童可获得的躯干控制水平有关的假设。这是第一个系统评价树干控制对BWSTT步进响应影响的研究。在AIM 1和AIM 2的研究中，将记录躯干和腿部肌肉的表面肌电图（EMG），以验证在跑步机引发的踩踏过程中，提供躯干支撑会减少姿势需求并增强腿部和躯干肌肉的相互激活模式的假设（AIM 3）。本研究的见解将提供特定的信息，以优化那些最需要的CP儿童在运动治疗中的表现。

DESCRIPTION (provided by applicant): Cerebral palsy is the most common motor deficit in children with an incidence of 2-3 per 1000 live births. An important socioeconomic problem is that 44% of children with cerebral palsy (CP) never learn to walk independently even with current treatments. Non-ambulatory children with CP have higher risk of hip dysplasia, scoliosis, osteoporosis, diminished growth and respiratory illness. Ironically, hope for better functional outcome is reduced for these children because they are commonly excluded from motor control research and clinical innovations. For example, current locomotor interventions (body weight supported treadmill training (BWSTT), assistive devices, robotic locomotor training) are designed for higher functioning children who have attained upright control of the trunk. Thus locomotor intervention is either inaccessible or inefficient for those children with the greatest need. Researchers working with young typically developing (TD) infants (who have poor trunk control, naturally), tip the babies' trunks forward when supported on a treadmill to help them step. A specific angle of inclination has not, however, been proposed nor has the rationale for this posture been articulated or tested. It is hypothesized that this technique reduces the demands for trunk control while simultaneously reducing the muscle force required for infants to swing their legs and step. It is proposed that this technique could also work for children with moderate-to-severe CP. Using a custom trunk support device with adjustable forward inclination angle and pediatric motorized treadmill, step responses will be documented monthly in 7 infants (AIM 1) during the age range when trunk postural control normally develops (1-7 mo) and in 30 children with moderate-to-severe CP (Gross Motor Function Classification System Level III, IV and V) (2-4 or 6-8 years of age) (AIM 2). Concurrent assessment of the segmental level of trunk control will provide information necessary to test the hypotheses that the optimal angle of trunk inclination is related to the level of trunk control available to the infant/child. This is the first study to systematically evaluate the influence of trunk control on stepping responses during BWSTT. Surface electromyography (EMG) of trunk and leg muscles will be recorded during studies for AIM 1 and 2, to test the hypothesis that providing trunk support will reduce the postural demands and enhance reciprocal activation patterns for leg and trunk muscles during treadmill-elicited stepping (AIM 3). Insights from this research will provide specific information to optimize performance during locomotor treatment for those children with CP who have the greatest need. PUBLIC HEALTH RELEVANCE: These studies are the first to a) systematically evaluate the contribution of trunk control to BWSTT and b) evaluate methods to compensate for lack of trunk control and increase leg movements in children with moderate-to-severe motor impairment. Together, these studies have the potential to enhance current clinical practice by making BWSTT viable for participants with more severe motor impairment. The inclusion of more involved children as research participants increases the potential to significantly influence rehabilitation practice related to CP; if a child is able to take more steps when practicing on a treadmill, he/she will gain muscle strength, bone density and movement control. This may lead to increased participation in activities with friends and family and reduce health risk factors.