Sensorimotor Learning in Children with Cerebral Palsy

 描述(由申请人提供)：脑性瘫痪(CP)是在美国诊断出的最普遍和最昂贵的儿科神经疾病之一。尽管多年来的研究已经对脑瘫儿童的运动障碍进行了分类，但创新和有效的干预措施尚未出现。至少部分问题是，大多数治疗方法(如手术、拉伸、加强)强调可能影响运动模式执行的肌肉骨骼损伤，而忽视了感觉运动皮质活动的异常，这是CP儿童用于执行和学习运动任务的运动规划和编程的基础。解决这一重大差距是最重要的，也是我们开发创新治疗策略的长期研究目标的核心，这些策略最有可能教授患有脑瘫的儿童新的运动技能。为了实现这一目标，我们实施了一种创新的科学方法，使用高密度脑磁图(MEG)、扩散张量成像和先进的人体运动分析方法来识别影响脑瘫儿童运动能力的神经生理因素。这项建议的具体目标将(1)确定如何通过密集练习目标导向的运动任务来调节阶段性β和伽马感觉运动皮质振荡，(2)量化躯体感觉皮质内的活动如何影响学习目标指导的运动任务所必需的感觉运动整合过程，以及(3)量化感觉运动皮质内的激活程度、运动行为改善与丘脑皮质和皮质脊髓束中纤维的完整性和数量之间的关系。简而言之，我们的研究将通过量化在练习等长踝趾屈目标匹配任务后发生的神经生理和运动行为变化来解决这些目标。我们将重点放在踝关节运动任务上，因为踝关节的控制在脑瘫儿童的活动和姿势限制中起着关键作用。我们的研究设计包括收集训练前(基线)、强化训练后3天和训练结束后一周的脑磁图和运动行为测量。参与者将包括一组患有不同程度运动障碍的脑瘫儿童(例如，GMFCS I-IV)，以及一组年龄匹配的典型发育儿童。拟议的实验结果将对挑战和潜在地改变目前用于教授患有脑瘫儿童新的运动技能的康复方法具有开创性的意义。此外，我们期待这项建议中建立的新的运动学习神经指数将提供关键的洞察，为什么一些患有CP的儿童在治疗后表现出巨大的改善，而另一些儿童则被归类为无反应。了解可能限制无反应者进展的神经机制将使我们和其他研究小组能够开发新的个体化治疗策略，使所有CP儿童都有最好的机会学习新的运动技能。

 DESCRIPTION (provided by applicant): Cerebral palsy (CP) is one of the most prevalent and costly pediatric neurologic conditions diagnosed in the United States. Despite years of studies that have catalogued the motor impairments seen in children with CP, innovative and effective interventions have not emerged. At least part of the problem is that the majority of treatment approaches (e.g., surgical, stretching, strengthening) emphasize the musculoskeletal impairments that may affect the execution of the movement pattern, without attention to the abnormalities in sensorimotor cortical activity, which underlie the motor planning and programming that children with CP use to perform and learn motor tasks. Addressing this substantial gap is paramount, and central to our long-term research goals of developing innovative treatment strategies that have the highest probability of teaching children with CP new motor skills. To meet this goal, we have implemented an innovative scientific approach that uses high-density magnetoencephalography (MEG), diffusion-tensor imaging, and advanced human movement analysis methods to identify the neurophysiological factors that influence a child with CP's motor performance. The Specific Aims of this proposal will (1) determine how the stage-like beta and gamma sensorimotor cortical oscillations are modulated by intensively practicing a goal-directed motor task, (2) quantify how activity within the somatosensory cortices affects the sensorimotor integration processes that are necessary for learning a goal-directed motor task, and (3) quantify the relationships between the extent of activation within the sensorimotor cortices, motor behavioral improvements, and the integrity and quantity of fibers in the thalamocortical and corticospinal tracts. Briefly, our study will address these aims by quantifying the neurophysiological and motor behavioral changes that occur after practicing an isometric ankle plantarflexion target matching task. We will focus on an ankle motor task because control of the ankle joint is well recognized as playing a key role in the mobility and postural limitations seen in children with CP. Our study design consists of the collection of MEG and motor behavioral measures prior to training (baseline), after 3- days of intensive training, and a week after cessation of the training. Participants will include a cross-section of children with CP that have various levels of motor impairments (e.g., GMFCS I-IV), and a cohort of age- matched typically-developing children. Outcomes from the proposed experiments will be seminal for challenging and potentially redirecting the current rehabilitation methods that are used to teach children with CP new motor skills. Furthermore, we expect that the new neural indices of motor learning established in this proposal will provide critical insight on why some children with CP show vast improvements after therapy, whereas others are classified as non-responders. Understanding the neural mechanisms that may limit the progress of non-responders will enable us and other research groups to develop new individualized treatment strategies that will allow for all children with CP to have the best chance of learning new motor skills.