Sensorimotor Learning in Children with Cerebral Palsy

 描述（由申请人提供）：脑瘫（CP）是在美国诊断的最普遍和最昂贵的儿科神经系统疾病之一。尽管多年的研究已经对CP儿童的运动障碍进行了分类，但尚未出现创新和有效的干预措施。至少部分问题是大多数治疗方法（例如，手术、伸展、强化）强调可能影响运动模式执行的肌肉骨骼损伤，而不关注感觉运动皮层活动的异常，这是CP儿童用于执行和学习运动任务的运动规划和编程的基础。解决这一巨大的差距是至关重要的，也是我们长期研究目标的核心，即开发创新的治疗策略，最有可能教会CP儿童新的运动技能。为了实现这一目标，我们实施了一种创新的科学方法，使用高密度脑磁图（MEG），扩散张量成像和先进的人体运动分析方法来确定影响CP儿童运动表现的神经生理因素。本提案的具体目标是：（1）确定如何通过强化练习目标导向运动任务来调节阶段性β和γ感觉运动皮层振荡，（2）量化躯体感觉皮层内的活动如何影响学习目标导向运动任务所必需的感觉运动整合过程，以及（3）量化感觉运动皮质内的激活程度、运动行为改善以及丘脑皮质和皮质脊髓束中纤维的完整性和数量之间的关系。简而言之，我们的研究将通过量化练习等长踝跖屈目标匹配任务后发生的神经生理和运动行为变化来解决这些目标。我们将重点放在踝关节运动任务，因为踝关节的控制是公认的在CP儿童的活动和姿势限制中起着关键作用。我们的研究设计包括在训练前（基线）、3天强化训练后和停止训练后一周收集MEG和运动行为测量。参与者将包括具有不同程度运动障碍的CP儿童的横截面（例如，GMFCS I-IV）和年龄匹配的典型发育儿童的队列。从拟议的实验结果将是开创性的挑战，并可能重新定向目前的康复方法，用于教CP儿童新的运动技能。此外，我们预计，在这项建议中建立的新的运动学习神经指标将提供关键的见解，为什么一些患有CP的儿童在治疗后表现出巨大的改善，而其他儿童则被归类为无反应者。了解可能限制无应答者进展的神经机制将使我们和其他研究小组能够开发新的个性化治疗策略，使所有CP儿童有最好的机会学习新的运动技能。

 DESCRIPTION (provided by applicant): Cerebral palsy (CP) is one of the most prevalent and costly pediatric neurologic conditions diagnosed in the United States. Despite years of studies that have catalogued the motor impairments seen in children with CP, innovative and effective interventions have not emerged. At least part of the problem is that the majority of treatment approaches (e.g., surgical, stretching, strengthening) emphasize the musculoskeletal impairments that may affect the execution of the movement pattern, without attention to the abnormalities in sensorimotor cortical activity, which underlie the motor planning and programming that children with CP use to perform and learn motor tasks. Addressing this substantial gap is paramount, and central to our long-term research goals of developing innovative treatment strategies that have the highest probability of teaching children with CP new motor skills. To meet this goal, we have implemented an innovative scientific approach that uses high-density magnetoencephalography (MEG), diffusion-tensor imaging, and advanced human movement analysis methods to identify the neurophysiological factors that influence a child with CP's motor performance. The Specific Aims of this proposal will (1) determine how the stage-like beta and gamma sensorimotor cortical oscillations are modulated by intensively practicing a goal-directed motor task, (2) quantify how activity within the somatosensory cortices affects the sensorimotor integration processes that are necessary for learning a goal-directed motor task, and (3) quantify the relationships between the extent of activation within the sensorimotor cortices, motor behavioral improvements, and the integrity and quantity of fibers in the thalamocortical and corticospinal tracts. Briefly, our study will address these aims by quantifying the neurophysiological and motor behavioral changes that occur after practicing an isometric ankle plantarflexion target matching task. We will focus on an ankle motor task because control of the ankle joint is well recognized as playing a key role in the mobility and postural limitations seen in children with CP. Our study design consists of the collection of MEG and motor behavioral measures prior to training (baseline), after 3- days of intensive training, and a week after cessation of the training. Participants will include a cross-section of children with CP that have various levels of motor impairments (e.g., GMFCS I-IV), and a cohort of age- matched typically-developing children. Outcomes from the proposed experiments will be seminal for challenging and potentially redirecting the current rehabilitation methods that are used to teach children with CP new motor skills. Furthermore, we expect that the new neural indices of motor learning established in this proposal will provide critical insight on why some children with CP show vast improvements after therapy, whereas others are classified as non-responders. Understanding the neural mechanisms that may limit the progress of non-responders will enable us and other research groups to develop new individualized treatment strategies that will allow for all children with CP to have the best chance of learning new motor skills.