Physical, Functional and Neurological Effects of Exercise in Children with CP

主要发现： 该议定书的招募工作于2010年4月开始。所有20名健康志愿者的收集工作已经完成。到目前为止，已经登记了26名患有脑瘫的儿童。初步数据显示，所有结果都发生了积极的变化，椭圆形组步态速度的变化最大。一旦我们完成了研究的练习部分，我们将为目标1招募额外的数量。今年我们的另一个主要目标是分析大脑成像数据。 建议的工作进程 这项工作的隐含目标是确定高强度的下肢相互训练是否可以刺激CP中的感觉运动通路到足够的程度，从而影响大脑感觉和运动区内和之间的运动协调性和皮质连接的变化。一个令人担忧的问题是，CP的感觉系统可能受到损害，因此不是促进运动和皮质变化的有希望的途径。相反，这些长期被剥夺或更不发达的地区对刺激的反应可能比它们更强健的情况下更剧烈。考虑到我们的设备中的遵从性监测，我们还可能获得关于运动的剂量反应的信息，因为可能不是所有人都会遵守协议中规定的所有运动或运动持续时间。我们还将能够将患者的特征，如年龄、参与程度、痉挛程度等与干预措施的反应联系起来。在CP中，结果的可变性经常在不同的受试者中观察到，并且仍然知之甚少。 我们还预计，我们将获得关于CP相互协调的性质以及它如何与运动严重程度、感觉或运动通路的完整性或小脑等区域相关的基本信息(假设我们在样本中获得了关于该大脑区域的足够信息)。 项目影响说明书： 这将是首次报道的运动辅助自行车和椭圆训练对脑瘫的疗效试验。如果结果如预期的那样，即训练后相互协调能力得到改善，那么这些发现将值得通过临床试验与现有的治疗方法(如BWSTT)进行进一步比较。如果协调性确实发生了变化，我们也将非常有兴趣确定是否存在感觉运动通路的同时变化，表明由于训练而增加了连接性。还将探索感觉和运动通路的初始完整性与干预反应的关系，以确定是否有可能预测哪些患者最有可能从针对脊髓通路的训练中受益。

Major Findings: Recruitment for this protocol started April 2010. Collection of all 20 healthy volunnteers has been completed. To date 26 children with CP have been enrolled. Preliminary data show positive changes on all outcomes with the elliptical group showing the largest change on gait speed. Once we complete the exercise portion of the study, we will recruit the additional amount for objective 1. One of our other major goals this year is to analyze the brain imaging data. Proposed course of Work The implicit goal of this work is to determine whether intense reciprocal training of the lower extremities can stimulate sensorimotor pathways in CP to a sufficient degree to effect change in motor coordination and cortical connectivity within and between the sensory and motor areas of the brain. One concern is that the sensory system in CP may be compromised and therefore not as promising an avenue for promoting motor and cortical change. Conversely, it is possible that these areas that have been long deprived or more poorly developed may respond even more dramatically to stimuli than if they were more robust. Given our compliance monitoring in our devices, we may also gain information on dose-response to exercise since it is possible that not all will comply with all exercises or duration of exercises as specified in the protocol. We will also be able to relate patient characteristics such as age, level of involvement, degree of spasticity, etc. to responses from the interventions. In CP, variability in outcomes is often observed across subjects and remains poorly understood. We also anticipate that we will gain fundamental information about the nature of reciprocal coordination in CP and how it relates to motor severity, the integrity of the sensory or motor pathways, or regions such as the cerebellum (assuming we acquire sufficient information on that brain region in our sample). Project Impact Statement: This will be the first reported efficacy trial of both motor-assisted cycling and elliptical training in CP. If results are as anticipated, i.e. reciprocal coordination improves as a result of training, then these findings would warrant further comparison with existing treatments such as BWSTT through clinical trials. If coordination does change, we will also be very interested in determining whether there are concurrent changes in the sensorimotor pathways showing an increase in connectivity as a result of training. The relationship of the initial integrity of sensory and motor pathways to the response from interventions will also be explored to determine whether it may be possible to predict which patients may be most likely to benefit from training that targets the spinal pathways.