Neuromuscular mechanisms of specific trunk interventions in children with cerebral palsy

摘要 许多脑瘫患儿的躯干姿势控制能力受损， 影响他们的行走能力和日常活动。例如，患有严重CP的儿童， 单独使用时，方向特异性较差，拮抗剂先于激动剂激活， 与正常发育的儿童不同。与正常发育的同龄人相比，CP儿童有一个 步态中骨盆倾斜、胸部、头部、脊柱后凸和脊柱前凸的大范围运动，即使对于一些高 患有脑瘫的儿童而CP患儿躯干运动控制功能障碍的意义 尽管人们认识到这一点，但仍然缺乏对这一核心赤字的有效干预。患有CP的儿童经常接受或 参与广泛的被动和主动干预，旨在改善姿势控制，但结果 已经表明，目前的干预方法往往不能有效地改善姿势控制， 儿童CP例如，间歇性治疗，一种干预策略， 在使用马背运动跨坐期间对骨盆的扰动，已经用于改善 数十年来，CP儿童的平衡和步态。然而，虽然一些研究表明， 其他研究表明，CP儿童在接受维生素C治疗后的平衡和运动功能， 关于康复治疗对CP儿童粗大运动功能测量评分的影响。因此 是一个迫切需要提高目前的干预措施，以改善躯干姿势控制和步态， 儿童CP，这需要彻底检查的潜在神经肌肉机制， 干预措施。我们的长期目标是制定基于合理的干预策略，以改善躯干姿势 CP患儿的控制和步态。本研究的总体目标是检查神经肌肉 在跨坐期间躯干肌肉对施加到骨盆的力扰动的机制，以及 确定在使用机器人系统跨坐期间反复暴露于骨盆扰动是否会 有效改善CP儿童的躯干姿势控制和步态。我们的核心假设是， 通过施加有针对性的力扰动来重复激活特定的感觉运动通路， 改善CP儿童的姿势控制，这可能是由于回路和突触的强化 通过使用依赖性神经可塑性机制用于躯干姿势控制。的理由 建议的研究是了解儿童躯干肌肉控制的神经肌肉机制 与CP和确定有针对性的力扰动的治疗效果可能会提供一个强大的 科学基础，从而可以开发新的基于力扰动的干预战略， 改善CP患儿姿势控制和步态。这项研究的结果可以用来开发 创新的临床疗法，旨在改善CP儿童的躯干姿势控制和行走功能。

Abstract Many children with cerebral palsy (CP) show impairments in trunk postural control, which significantly impact their walking capacity and daily activities. For instance, children with severe CP, who have difficulties sitting independently, show poor directional specificity, with antagonists activating before agonists, which is distinct from typically developed children. Compared to typically developed peers, children with CP have a large range of motion for pelvis tilt, thorax, head, and kyphosis and lordosis during gait, even for some high functioning children with CP. While the significance of trunk motor control dysfunction in children with CP has been recognized, effective interventions for this core deficit are still lacking. Children with CP often receive or participate in a wide range of passive and active interventions aimed to improve postural control, but results have shown that current intervention approaches are not often effective in improving postural control in children with CP. For instance, hippotherapy, an intervention strategy that applies rhythmical force perturbations to the pelvis during sitting astride using horseback movement, has been used for improving balance and gait in children with CP for decades. However, while some studies showed improvements in balance and motor function in children with CP after hippotherapy, other studies indicated a mixed result regarding the effect of hippotherapy on Gross Motor Function Measure scores in children with CP. Thus, there is a critical need to improve the efficacy of current interventions for improving trunk postural control and gait in children with CP, which requires a thorough examination of the underlying neuromuscular mechanisms of the interventions. Our long-term goal is to develop rational-based intervention strategies to improve trunk postural control and gait in children with CP. The overall objective of this study is to examine the neuromuscular mechanisms of the trunk muscles to a force perturbation applied to the pelvis during sitting astride, and determine whether repeated exposure to pelvic perturbations during sitting astride using a robotic system will be effective in improving trunk postural control and gait in children with CP. Our central hypothesis is that repetitive activation of specific sensorimotor pathways through applying targeted force perturbations will improve postural control in children with CP, which may be due to the reinforcement in circuits and synapses used for trunk postural control through a use-dependent neuroplasticity mechanism. The rationale for the proposed study is that an understanding of the neuromuscular mechanisms of trunk muscle control in children with CP and determination of the therapeutic effect of targeted force perturbation are likely to provide a strong scientific foundation whereby new force perturbation based intervention strategies can be developed to improve postural control and gait in children with CP. The results from this study may be used to develop innovative clinical therapies aimed at improving trunk postural control and walking function in children with CP.