SPASTICITY AND STRENGTH AS INDICATORS FOR RHIZOTOMY

痉挛和力量作为神经根切断术的指标

• 批准号: 6062261
• 负责人: Jack R Engsberg
• 金额: $ 5万
• 依托单位: BARNES-JEWISH HOSPITAL
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-08-15 至 2002-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6062261
• 关键词: adolescence (12-20); ankle; cerebral palsy; clinical research; combination therapy; electromyography; gait; hip; human subject; human therapy evaluation; joint stiffness; knee; middle childhood (6-11); muscle strength; muscle tension; neurosurgery; physical therapy; preschool child (1-5); prognosis; spastic paralysis; spinal nerves

DESCRIPTION (Adapted from the Applicant's Abstract): The long term goal is to improve function in children with cerebral palsy (CP). A selective dorsal rhizotomy (SDR) is performed to improve function by minimizing spasticity. A contraindication and limitation of the SDR is muscle weakness. Muscle weakness is related to reduced function. Thus, determining the degree of spasticity and strength/weakness in a child is a key consideration in the SDR selection process. Objective measures to assess spasticity and strength are not presently used in the process. In this study, objective measures to quantify spasticity and strength will be utilized to determine relationships between pre-surgery spasticity and strength and post-surgery functional measures. Based upon these relationships, an objective clinical tool to improve the selection of SDR candidates will be developed. In addition, comparisons of the measures among 4 different groups of children (n=40/group) will be made, those: 1) undergoing a SDR (SDR group), 2) undergoing physical therapy (PT) identical to the SDR group (PT group), 3) undergoing no change in current intervention (CP controls) and 4) having able bodies (AB controls). Specific Aim 1: Evaluate the importance of pre-surgery spasticity and strength as predictors of functional change due to SDR. Children from the SDR group will be tested on a dynamometer for spasticity and strength, evaluated using the Gross Motor Function Measure, have a gait analysis performed and answer a disability questionnaire. These assessments will be made 6 weeks and again 2 days prior to surgery, and at 8 and 20 months post surgery. Stepwise multiple regression with repeated measures will test the hypothesis that composite pre-surgery spasticity and strength from the ankles, knees, and hips in the SDR group will predict functional changes as a result of the SDR. Specific Aim 2: Compare impairment and functional measures among the SDR group, PT group and CP controls. The same assessments and testing sequence as the SDR group will be followed for these groups, but no surgery will be performed. ANOVA and ANCOVA will test the null hypotheses that the 3 CP groups will not change in impairment and function over all sessions and will not be different from one another. Specific Aim 3: Compare impairment and functional measures from 3 CP groups with those from AB controls. The children with able bodies will be assessed for spasticity, strength, and gait. ANOVA will test the null hypothesis that the CP groups will not be significantly different from the AB controls across all sessions. Descriptive statistics will describe the extent of differences from AP controls. The intent is that this investigation will improve the current methods for selecting SDR patients, thereby improving patient outcomes and reducing costs. It will also compare the efficacy of 3 modes of treatment for CP: SDR with intensive PT, intensive PT without SDR, and standard intervention.

描述（根据申请人的摘要改编）：长期目标是 改善脑瘫儿童（CP）的功能。 选择性 进行背侧根茎切开术（SDR）以通过最小化来提高功能 痉挛。 SDR的禁忌症和限制是肌肉 弱点。 肌肉无力与功能降低有关。 因此， 确定儿童的痉挛程度和力量/劣势是 SDR选择过程中的关键考虑。 客观措施 目前在此过程中不使用评估痉挛和强度。 在 这项研究，量化痉挛和强度的客观措施将是 用于确定手术前痉挛与 力量和手术后功能措施。 基于这些 关系，是改善SDR选择的客观临床工具 候选人将被开发。 另外，对措施的比较 在4个不同的儿童（n = 40/组）中，这些：1） 接受SDR（SDR组），2）进行物理疗法（PT）相同 到SDR组（PT组），3）当前干预没有任何更改 （CP对照）和4）具有能力的身体（AB对照）。 特定目标1：评估手术前痉挛的重要性和 强度是由于SDR引起的功能变化的预测指标。 孩子的孩子 SDR组将在测功机上测试痉挛和强度， 使用总运动功能度量进行评估，进行步态分析 执行并回答残疾问卷。 这些评估将是 在手术前2天进行了6周，并在8和20个月后进行 外科手术。 通过重复测量的逐步多重回归将测试 假设复合术前的痉挛和强度 SDR组中的脚踝，膝盖和臀部将预测功能变化为 SDR的结果。 特定目的2：比较SDR之间的障碍和功能度量 组，PT组和CP对照。 相同的评估和测试顺序 由于这些组将遵循SDR组，但不会进行手术 执行。 ANOVA和ANCOVA将测试3 CP的无效假设 小组不会在所有课程中都不会改变障碍和功能，并且会改变 没有彼此不同。 特定目标3：比较3 CP组的损伤和功能度量 与AB控件的那些。 有能力的孩子将评估 出于痉挛，力量和步态。 方差分析将检验零假设 CP组将与AB对照没有显着差异 在所有会议上。 描述性统计数据将描述 与AP控件的差异。 目的是这项调查将 改善当前选择SDR患者的方法，从而改善 患者的结果和降低成本。 它还将比较3的功效 CP的治疗方式：具有密集PT的SDR，无SDR的密集PT， 和标准干预。