Spinal Cord Innovation in Pediatrics to Treat Cerebral Palsy (SCiP Clinical Study)

总结 脑性瘫痪（CP）是儿童时期最常见的运动障碍。基于人口的研究， 《世界报告》的流行率估计为每1 000人1.5至4人。全球约17 100万人有CP。这是一种诊断，包括广泛的症状与异质性病因 神经和心血管的起源。一系列的功能障碍通常在CP中变得明显， 早期发展。例如，大多数儿童被归类为粗大运动功能分类， GMFCS I级患者预计在7-9岁之间达到运动潜能，并在7 - 9岁之后保持稳定。 直到21岁，他们可能会因为疼痛，虚弱和僵硬而下降。而像踏步这样的动作 和姿势是最容易识别的损伤之一，缺乏或异常的感觉，知觉， 认知、沟通能力受损、癫痫、痉挛、精细动作控制不良， 随着时间的推移，可能会出现继发性肌肉骨骼问题。目前，所有现有的干预措施都是 以尽量减少症状的严重程度，而不是纠正神经病因。两种常见的偏好 治疗，选择性背根切断术和重复给予肉毒杆菌毒素A（Botox）直接 针对神经肌肉系统对抗痉挛。虽然这两种策略最大限度地减少了 与痉挛相关的破坏性运动;这些干预措施的长期益处不太清楚， 两者都会对神经肌肉系统造成不可逆的变化，这可能对未来的功能有害。在 目前的建议，我们已经合并的想法和概念，从最近的临床观察CP和 数十年的脊髓损伤研究，以达到由活动驱动的特定主题康复策略- 基于经皮脊髓神经调节过程中的机制。我们神经调节的目标 这些程序是为了增强神经肌肉系统的可塑性，帮助儿童获得表演的能力。 通过活动依赖的可塑性协调运动。我们假设经皮脊髓 基于活动的神经康复治疗（ABNT）期间的神经调节可以改变神经网络， 诊断为痉挛性CP的儿童，以改善自愿姿势和运动活动，如在 GMFM 88评分。这种策略可以提供一个特定的生理目标的根本意义，在 运动控制，可用于改善功能，并为CP儿童提供新的护理途径。

Summary Cerebral Palsy (CP) is the most common motor disability in childhood. Population-based studies from around the world report prevalence estimates ranging from 1.5 to 4 per 1000 individuals. Globally, approximately 17 million people have CP. It is a diagnosis that includes a wide range of symptoms with heterogeneous etiologies of neural and cardiovascular origins. A wide range of functional disorders typically become obvious in CP during early development. For example, the majority of children classified as Gross Motor Functional Classification Scale (GMFCS) Level I are expected to reach their motor potential between 7-9 years and remain stable after that until age 21 where they may decline due to pain, weakness and stiffness. While movements such as stepping and posture are amongst the most recognizable impairments, absence or abnormal sensations, perception, impaired cognition, communication skills, epilepsy, spasticity, poor control of fine movements and marked secondary musculoskeletal problems can emerge with time. Presently, all available interventions are designed to minimize the severity of symptoms rather than correcting the neurological etiology. Two commonly preferred treatments, selective dorsal root rhizotomy and repetitive administration of botulinum toxin A (Botox) directly target the neuromuscular system to counter spasticity. While these two strategies minimize some of the disruptive movements associated with spasticity; the long-term benefits of these interventions are less clear and both cause irreversible changes to the neuromuscular system that may be detrimental to future function. In the present proposal we have merged ideas and concepts derived from both recent clinical observations of CP and decades of studies of spinal cord injury to arrive at a subject-specific rehabilitation strategy driven by activity- based mechanisms during transcutaneous spinal neuromodulation. The objectives of our neuromodulation procedures are to amplify the plasticity of the neuromuscular system and help children gain the ability to perform coordinated movements through activity-dependent plasticity. We hypothesized that transcutaneous spinal neuromodulation during activity-based neurorehabilitation therapy (ABNT) can transform the neural networks in children diagnosed with spastic CP to improve voluntary postural and locomotor activity as captured on the GMFM88 scores. This strategy could provide a specific physiological target of fundamental significance in the control of movement that can be used to improve function and provide new care pathways for children with CP.