Investigation of the neuromuscular response and training effects of wearable adaptive resistance in children with cerebral palsy

项目摘要/摘要 脑性瘫痪(CP)是一种以力量和协调能力不足为特征的运动障碍。这个 与CP相关的后续步态缺陷由于次级效应导致功能进行性下降 在发育过程中有运动障碍。寻求缓解这些影响的干预措施只有 部分成功是因为他们没有同时解决肌肉招募(即力量)和 协调一体，自上而下的疗法。最近，我们开发了一种可穿戴的适应性抵抗疗法 能够解决这两个方面，并在改善神经肌肉控制、代谢方面取得了有希望的结果 效率和功能移动性。为了最大限度地发挥这种干预的效果，有两个重要的考虑因素 必须解决的问题是：1)最大限度地增加神经肌肉的适当抵抗力水平是多少？ 儿童适应干预后的反应？2)培训效果的总体轨迹是什么？ 治疗结束后，这些效果还能保持吗？此外，人们对以下问题的理解也有限 通过这种新疗法观察到的神经肌肉控制改善的潜在机制。这个 CP儿童的高水平共收缩被归因于伸展反射调节的缺陷，但 无论反射调制的改善是否导致所观察到的踝关节co-Co. 具有可穿戴适应阻力的收缩还没有被探索过。 本研究建议的主要目的是进一步研究可穿戴式适应性阻力干预。 适用于患有脑瘫的儿童。第一个具体目标是通过测量 CP儿童的神经肌肉反应，在五次访问中，作为低、中、高水平的抵抗力 在行走时使用。第二个具体目标是量化训练的时间进程和维持效果 对于10名参与者，通过测量神经肌肉控制的变化(即脚踝和 神经控制的复杂性)和反射调制(通过H反射测试) 可穿戴的适应性抵抗，以及为期两周的训练后随访。我们的主要结果变量 对于目标1，在阻力行走时，相对于基线，足底屈肌激活幅度为1倍。我们的初选 AIM 2的结果变量是踝关节联合收缩水平、神经控制复杂性(由肌肉决定 协同分析)，以及无阻力行走时的反射调制(通过H反射测试)。 这项工作的完成将提高我们对可穿戴适应阻力的理解，包括 关于适当的培训水平和基本机制的基本知识，最终目标是 开发一种干预措施，使患有CP的儿童能够进行身体活动，使他们能够参与 他们的同龄人和环境才能健康发展和功能独立。

PROJECT SUMMARY/ABSTRACT Cerebral palsy (CP) is a movement disorder characterized by deficits in strength and coordination. The subsequent gait deficits associated with CP lead to a progressive decline in function due to the secondary effects of having a movement disorder during development. Interventions seeking to mitigate these effects have only been partially successful because they have not addressed both muscle recruitment (i.e. strength) and coordination within one, top-down therapy. Recently, we developed a wearable adaptive resistance therapy that is able to address both of these aspects with promising results for improving neuromuscular control, metabolic efficiency, and functional mobility. To maximize the efficacy of this intervention, two important considerations must be addressed: 1) What is the appropriate level of resistance to prescribe for maximizing neuromuscular response as children acclimate to the intervention? 2) What is the overall trajectory in training effects from this therapy and are these effects maintained after the therapy stops? In addition, there is limited understanding of the underlying mechanisms of observed improvements in neuromuscular control with this novel therapy. The high levels of co-contraction in children with CP have been attributed to deficits in stretch reflex modulation, but whether or not improvements in reflex modulation are responsible for the observed decreases in ankle co- contraction with wearable adaptive resistance has not yet been explored. The main objective of this research proposal is to further investigate a wearable adaptive resistance intervention for children with CP. The first specific aim is to assess the acclimation to adaptive resistance by measuring the neuromuscular response of children with CP, across five visits, as a low, moderate, and high level of resistance is applied while walking. The second specific aim to quantify the time-course and maintenance of training effects for the ten participants by measuring changes in neuromuscular control (i.e., co-contraction about the ankle and the complexity of neural control) and reflex modulation (via H-reflex testing) across five training visits with wearable adaptive resistance, as well as a two-week post-training follow-up visit. Our primary outcome variable for Aim 1 ix plantar flexor activation magnitude, relative to baseline, while walking with resistance. Our primary outcome variables for Aim 2 are ankle co-contraction level, neural control complexity (as determined by a muscle synergy analysis), and reflex modulation (via H-reflex testing) while walking without resistance. The completion of this work will improve our understanding of wearable adaptive resistance, including fundamental knowledge about appropriate training levels and underlying mechanisms, with the ultimate goal of developing an intervention that can enable physical activity for children with CP, allowing them to engage with their peers and environment for healthy development and functional independence.