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

 描述(申请人提供)：脑瘫(CP)是最常见的儿科运动障碍，在美国每1000名儿童中有3.6名受到影响，每年有11,000例新诊断。慢性阻塞性肺病患者的运动和感觉障碍往往随着时间的推移而恶化，导致代价高昂的终生身体、社交和情感残疾。然而，利用依赖活动的大脑可塑性的干预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漠视(DD)。这种形式的忽视始于婴儿期，会损害推断新的有效动作的能力，并导致神经发育轨迹，而这种轨迹很少与典型发育中的儿童相同。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，那时神经可塑性最大，在成年人中得到了很好的研究--约束诱导运动疗法(CIMT)，通过强迫使用和暴露被忽视的肢体来改善上肢功能。这项建议的短期目标是证明CIMT在2岁或2岁之前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，该研究使用了随机对照试验(RCT)设计，在12-24个月患有不对称CP的儿童中进行等待名单对照。CIMT干预包括在受影响较小的手臂上进行为期1个月的软约束佩戴(1/2天疗程，电子监控)，并在常规治疗(目前的标准CP治疗)的基础上，结合有效的父母实施的家庭REACH训练计划和针对受影响较严重的肢体的感觉暴露。患有脑性瘫痪的儿童将在基线、1个月和7个月时进行评估。被分配到对照组的儿童将在随机对照试验结束后接受CIMT，并再次接受评估。典型的发育中(TD)年龄匹配的儿童也将接受测试。试验的RCT阶段将证明CIMT改善了受影响上肢的感觉和运动功能。TD儿童和CP儿童在治疗前的比较将回答有关感觉和运动功能之间的关系如何导致损害的机械性问题。最后，将所有CP儿童与TD儿童联系起来，将为CP的严重程度和CIMT的时机如何改变接受治疗的儿童的神经发育轨迹提供新的信息。这将为未来残疾儿童康复试验的循证设计提供信息。重要的是，CIMT干预本身不涉及广泛的物质和智力资源，而是专注于实施一个受到仔细监控的基于家庭的计划，允许应用程序访问资源有限的环境。因此，这项建议的总体目标是解决儿童脑瘫领域转化性研究连续体中的空白，以增加这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.