Early Childhood Constraint Therapy for Sensory/Motor Impairment in Cerebral Palsy

 描述（由申请人提供）：脑瘫（CP）是最常见的儿科运动障碍，在美国影响3.6/1000的儿童，每年有11，000例新诊断。CP的运动和感觉功能障碍往往会随着时间的推移而恶化，导致昂贵的终身身体，社会和情感残疾。然而，利用活动依赖性大脑可塑性的干预措施可以导致运动执行和肢体使用的持久改善，从而优化成年后的运动和社会功能。CP儿童康复的最大挑战之一是克服发展忽视（DD）。这种形式的忽视始于婴儿期，削弱了推断新的有效运动的能力，并导致神经发育轨迹很少与正常发育的儿童相同。治疗越早克服DD，对以后的神经发育的影响就越大，特别是如果它可以在3岁之前开始，当神经可塑性最大时，约束诱导运动疗法（CIMT）在成人中得到了充分的研究，通过强迫使用和被忽视的肢体的感觉暴露来改善上肢功能。本提案的短期目标是证明2岁或2岁之前的CIMT可以改善上肢感觉和运动功能，从而减轻DD。为了实现这一点，该研究采用了随机对照试验（RCT）设计，在12-24个月的儿童不对称CP中进行了等待列表对照。CIMT干预包括在受影响较小的手臂上进行1个月的软约束性穿戴（1/2天的疗程，电子监测），结合经验证的父母实施的家庭计划，即针对受影响较大的肢体进行伸展训练和感觉暴露，以及常规治疗疗程（当前标准CP治疗）。将在基线、1个月和7个月时对CP儿童进行评估。随机对照试验结束后，对照组儿童将接受CIMT治疗，并再次进行评估。通常发育（TD）年龄匹配的儿童也将进行测试。该试验的RCT阶段将证明CIMT可改善受累上肢的感觉和运动功能。治疗前TD儿童和CP儿童的比较将回答关于感觉和运动功能之间的关系如何导致损伤的机械问题。最后，参考所有CP儿童TD儿童将提供新的信息，CP的严重程度和CIMT的时间可能会改变治疗儿童的神经发育轨迹。这将为未来发展中残疾儿童康复试验的循证设计提供信息。重要的是，CIMT干预本身并不涉及广泛的物质和智力资源，而是侧重于实施一个仔细监测的家庭计划，允许应用程序设置有限的资源访问。因此，该提案的总体目标是解决小儿脑瘫领域连续转化研究中的差距，以增加此类康复研究的临床和社会相关性。

 DESCRIPTION (provided by applicant): Cerebral palsy (CP) is the most common pediatric movement disorder, affecting 3.6/1000 children in the US, with 11,000 new diagnoses every year. Motor and sensory dysfunction in CP often worsen over time, leading to costly lifelong physical, social and emotional disabilities. However, interventions that take advantage of activity-dependent brain plasticity can result in lasting improvements of movement execution and extremity use that optimize motor and social function into adulthood. Among the greatest challenges in the rehabilitation of children with CP is overcoming developmental disregard (DD). This form of neglect starts in infancy impairs the ability to infer new and effective movements and contributes to neurodevelopmental trajectories that rarely equal those of typically developing children. The sooner a therapy can overcome DD, the greater its impact on later neurodevelopment, especially if it can start before 3 years old, when neural plasticity is greatest Constraint-induced movement therapy (CIMT), well-studied in adults, improves upper extremity function through forced-use and sensory exposure of a neglected extremity. The short-term objective of this proposal is to show that CIMT at or before 2 years old can improve upper extremity sensory and motor function and thereby mitigate DD. To accomplish this, the study uses a randomized controlled trial (RCT) design with a wait- list control, in children 12-24 months with asymmetric CP. The CIMT intervention includes 1 month of soft constraint wear on the less affected arm (1/2 day sessions, electronically-monitored) combined with a validated parent-implemented home-based program of reach training and sensory exposures for the more affected extremity, in addition to routine therapy sessions (current standard CP treatment). Children with CP will be assessed at baseline, and at 1 and 7 months. Children assigned to the control group will receive CIMT after the RCT is finished and be assessed again. Typically developing (TD) age-matched children will also be tested. The RCT phase of the trial will demonstrate that CIMT improves the sensory and motor function of an affected upper extremity. The comparison of TD children and CP children before treatment will answer mechanistic questions about how the relationship between sensory and motor function contributes to impairments. Finally, referencing all CP children to TD children will provide new information on how the severity of CP and the timing of CIMT may change the neurodevelopmental trajectories of treated children. This will inform the evidence-based design of future trials of rehabilitation n developing children with disabilities. Importantly, the CIMT intervention itself does not involve extensive material and intellectual resources and focuses instead on implementing a carefully monitored home-based program, allowing an application to settings with limited access to resources. The overarching goals of this proposal are therefore to address gaps in the continuum of translational research in the field of pediatric cerebral palsy in order to increase the clinical and societal relevance of this type of rehabilitation research.