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

主要发现： 本方案的招募始于2010年4月。 已完成20例健康志愿者的采集。迄今为止，已招募了31名CP儿童。 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。我们去年的主要目标是分析大脑成像数据和肌肉成像数据。我们正在与来自霍普金斯的合作者密切合作，研究脑成像数据，其中包括来自rsMRI和DTI的功能连接数据，并已完成对17/20名对照组和16名CP儿童的所有基线数据的处理。去年夏天，我们处理了所有的肌肉超声数据，包括肌肉大小和纹理（回声）数据。我们希望在今年完成目标2，完成数据分析并开始传播。 拟议的工作进程 这项工作的隐含目标是确定下肢的激烈的相互训练是否可以刺激CP的感觉运动通路到足够的程度，以影响运动协调和大脑感觉和运动区域内和之间的皮层连接的变化。 一个问题是，CP中的感觉系统可能会受到损害，因此不是一个有希望的促进运动和皮质变化的途径。 相反，这些长期被剥夺或开发不足的区域可能会对刺激做出更剧烈的反应，而不是更强大。 鉴于我们在器械中进行的依从性监测，我们还可能获得有关运动剂量反应的信息，因为可能并非所有器械都符合方案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，受试者之间经常观察到结局的变异性，并且仍然知之甚少。 我们还预计，我们将获得有关CP中相互协调的性质以及它如何与运动严重性、感觉或运动通路的完整性或小脑等区域（假设我们在样本中获得了足够的大脑区域信息）相关的基本信息。 项目影响声明： 这将是首次报道的CP患者的电动辅助自行车和椭圆训练的有效性试验。如果结果如预期的那样，即相互协调由于训练而得到改善，那么这些发现将值得通过临床试验与现有治疗（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感觉运动通路是否同时发生变化，从而显示出训练后连接性的增加。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柱通路的训练中受益。这是第一个比较CP力量训练前后肌肉完整性的研究。

Major Findings: Recruitment for this protocol started April 2010. Collection of the 20 healthy volunteers has been completed. To date 31 children with CP have been enrolled. Once we complete the exercise portion of the study, we will recruit the additional amount for objective 1. Our major goals this past year was to analyze the brain imaging data and muscle imaging data. We are working closely with our collaborators from Hopkins on the brain imaging data which includes functional connectivity data from rsMRI and DTI and have completed processing all baseline data for 17/20 controls, and 16 children with CP thus far. This past summer we processed all of the muscle ultrasound data including muscle size and texture (echogenicity) data. We are hoping to close out Objective 2 this year, complete data analysis and begin dissemination. 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. It is the first study to compare muscle integrity before and after strength training in CP.