Mechanics of overground, dry, and aquatic treadmill walking in children & adolescents with cerebral palsy

摘要 该项目将确定生物力学机制，以优化步行康复， 地面，干跑步机，湿跑步机环境为脑瘫儿童（CP）。 脑性瘫痪是一种神经系统疾病，由早期发育中的脑损伤引起， 损害运动控制和整体移动性。CP儿童常见的步态问题是过度的 膝关节屈曲、髋关节过度屈曲/内收和高肌肉需求。此外，儿童 CP患者下肢肌肉无力，关节活动度（ROM）较低。这些是 推测为降低步行耐力、独立性和生活质量的关键机制。 不太了解的是下肢运动学和肌肉活动是如何在不同的 康复中常用的步行环境。此外，术后耐受性 在患有CP的儿童中，各种步行速度尚未得到严格的检查。通过 描述性研究，我们将扰动步行速度之间的不同步行环境， 表征受试者内时空行走参数的变化，并建立 为设计未来的临床试验提供充足的证据基础。我们假设步行环境 将影响下肢运动学和肌肉活动，由于流体动力学阻力和改变 步行战略此外，我们假设步行环境的影响会有所不同 基于速度。目的1：确定步行速度和环境对下半身的影响 运动学和肌肉需求的儿童CP。目标2：连接地上步行功能 在不同的步行康复条件下的下半身运动学和肌肉需求。目的 3：确定CP儿童行走康复的术后功能差异， 接受股骨远端延长截骨术（DFEO）或股骨远端前部截骨术 半骺固定术（ADFH）。考虑到术后康复的普遍性， 数据驱动的干预措施对脑瘫儿童的重要性很难夸大。

Abstract This project will determine biomechanical mechanisms to optimize walking rehabilitation in overground, dry treadmill, and wet treadmill environments for children with cerebral palsy (CP). Cerebral palsy is a neurological disorder caused by brain damage in early development that impairs motor control and overall mobility. Common gait issues in children with CP are excessive knee flexion, excessive hip flexion/adduction, and high muscular demand. Additionally, children with CP have lower-limb muscle weakness and low joint ranges of motion (ROM). These are speculated as key mechanisms decreasing walking endurance, independence, and quality of life. Less understood is how lower limb kinematics and muscle activity are modified amongst different walking environments commonly used in rehabilitation. In addition, post-operative tolerance to various walking speeds has not been rigorously examined in children with CP. Through descriptive studies, we will perturb walking speed amongst diverse walking environments, characterize within-subject changes to spatiotemporal walking parameters, and establish a fulsome evidence base to design future clinical trials. We hypothesize that walking environment will impact lower limb kinematics and muscle activity due to hydrodynamic drag and altered walking strategies. Furthermore, we hypothesize that the impact of walking environment will vary base on speed. Aim 1: Determine the effects of walking speed and environment on lower body kinematics and muscular demand in children with CP. Aim 2: Link overground walking function with lower body kinematics and muscular demand in diverse walking rehabilitation conditions. Aim 3: Establish post-operative functional differences for walking rehabilitation in children with CP that receive Distal Femoral Extension Osteotomy (DFEO) or Anterior Distal Femoral Hemiepiphysiodesis (ADFH). Considering the ubiquity of post-operative rehabilitation, the clinical importance of data-driven interventions for children with CP is difficult to overstate.