Balance and Posture in Adults with Cerebral Palsy

描述（由申请人提供）：脑瘫（CP）患者表现出相当大的功能异质性，并且由于躯体感觉功能障碍的发展，继发性神经肌肉损伤和躯干肌肉控制不良，随着年龄的增长，功能状态显着下降。这些因素促进平衡不稳定，导致跌倒风险增加，并导致功能丧失。随着CP年龄的增长，神经运动和体感障碍的进展情况知之甚少，因此，对于成年CP患者的姿势控制和平衡，特别是与年龄（原发性）和代偿行为相关的认知存在空白。本研究的目的是探讨成年CP患者姿势控制异常运动反应的机制。我们假设体感依赖以及肌肉的被动和主动特性会随着年龄和功能适应而改变。为了解决我们的中心假设，我们提出了以下具体目标：具体目标1：检查导致年轻CP患者异常姿势控制的感觉加工和感觉运动整合的中枢障碍。我们将：a)通过视觉依赖测试直接测量视觉依赖对成年CP患者姿势控制的影响；b)将视觉依赖的存在与视觉流场干扰对CP成人质心（CoM）和压力中心（CoP）反应的影响联系起来；c)通过平衡和跌倒风险的标准化临床评估，确定感觉加工中枢障碍和感觉运动整合对功能平衡的影响。具体目的2：研究被动肌肉肌腱特性的外周改变，这些改变可能导致年轻CP患者异常的姿势控制。我们将使用功能主成分（时间序列）分析来确定支撑基础的干扰、视觉流场的干扰以及两者对成年CP患者关节运动学、CoP和CoM反应的综合干扰的影响。具体目标3：研究导致年轻CP患者异常姿势控制的肌肉激活受损和肌肉控制选择性丧失。我们将使用小波分析确定支撑基础干扰、视觉流场干扰以及两者联合干扰对下肢和躯干肌肉表面肌电图（sEMG）活动的影响。在本研究的结论中，我们将描述成人CP患者在体感和生物力学扰动下采用的姿势控制策略。结合我们的创新方法来挑战感觉运动系统的各个方面，以及我们对数据的时间序列和小波分析的分析方法，将使我们能够从代偿行为中分离出主要的动态姿势缺陷，这是优化治疗干预措施的关键区别。

DESCRIPTION (provided by applicant): Individuals with Cerebral Palsy (CP) present with considerable functional heterogeneity, and demonstrate a marked decrease in functional status with age due to the development of disturbances in somatosensory function, secondary neuromuscular impairments, and poor control over the trunk muscles. These factors promote balance instability, result in an increased fall risk, and contribute to lost functional capabilitis. Little is known about the progression of neuromotor and somatosensory impairments as individuals with CP age, thus a knowledge gap exists concerning postural control and balance in the adult with CP, particularly which those associated with aging (primary) and those associated with compensatory behaviors. The objective of this proposal is to explore mechanisms behind abnormal motor response in postural control in the adult with CP. We HYPOTHESIZE that somatosensory reliance, as well as muscle passive and active properties, change with aging and functional adaptation. In order to address our central hypothesis, we propose the following specific aims: SPECIFIC AIM 1: To examine the central disturbances of sensory processing and sensorimotor integration that contribute to abnormal postural control in young adults with CP. We will: a) determine the effect of visual dependence on postural control in the adult with CP as directly measured with a test for visual dependence; and b)relate the presence of visual dependence to the effect of disturbances of the visual flow field on the center of mass (CoM) and center of pressure (CoP) responses in the adult with CP; and c) determine the relationship between central disturbances of sensory processing and sensorimotor integration on functional balance as measured by standardized clinical assessments of balance and fall risk. SPECIFIC AIM 2: To examine the peripheral alterations in passive muscle-tendon properties that could contribute to abnormal postural control in young adults with CP. We will determine the effects of a disturbance of the base of support, a disturbance to the visual flow field, and a combined disturbance of the two on joint kinematics, CoP, and CoM responses in the adult with CP using functional principal component (time-series) analyses. SPECIFIC AIM 3: To examine the impaired muscle activation and loss of selectivity over muscle control that contributes to abnormal postural control in young adults with CP. We will determine the effects of a disturbance of the base of support, a disturbance to the visual flow field, and a combined disturbance of the two on the surface electromyographic (sEMG) activity of lower limb and trunk muscles using wavelet analyses. At the conclusion of this study, we will have characterized postural control strategies employed by adults with CP in the presence of somatosensory and biomechanical perturbations. The combination of our innovative methodology to challenge all aspects of the sensorimotor system, with our analytical approach of both time series and wavelet analysis of the data, will allow us to separate the primary dynamic postural deficits from compensatory actions, a critical distinction for optimizing treatment interventions. PUBLIC HEALTH RELEVANCE: The results of this study will have an impact upon public heath policy as adults with cerebral palsy (CP) present a growing and underserved population in the United States. At the conclusion of this study, we will have identified the means by which the adult with CP maintains their upright position, which is essential for activities of daily living ad for movement. With this knowledge, it will be possible to develop clinical and rehabilitation interventions that will improve their arm and leg function, and reduce the risk of falls for the adlt with CP.