OPTIMIZING MUSCLE FUNCTION IN CEREBRAL PALSY

优化脑瘫患者的肌肉功能

• 批准号: 6181746
• 负责人: DIANE L. DAMIANO
• 金额: $ 10.32万
• 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: 1997-09-01 至 2002-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6181746
• 关键词: abnormal involuntary movement; ankle; cerebral palsy; child (0-11); clinical research; electromyography; exercise; functional ability; human subject; human therapy evaluation; knee; medical rehabilitation related tag; muscle function; muscle strength; neurophysiology; neurosurgery; orthopedics; outcomes research; quality of life; rehabilitation

Cerebral palsy (CP) is the most prevalent physical disability occurring in childhood, for which no cure is available. All current treatments such a surgery and physical therapy aim solely to alleviate the peripheral effects of this central nervous system disorder, often with limited and inconsistent success. A prevalent clinical system that has long been recognized, but rarely addressed therapeutically in this population is muscle weakness. While strength training is routinely used in the adult orthopaedic population and in athletes to increase force production or alter muscle imbalance, this type of intervention is grossly under- utilized in pediatric rehabilitation, and in particular children with CP. No evidence exists to support the clinical prejudice against strength training and testing in cerebral palsy. In fact, research findings are accumulating toe the contrary, demonstrating that individuals with CP are indeed weak, the degree of weakness has a direct relationship to motor performance, and strengthening programs can produce positive functional outcomes. However, the neurophysiological and biomechanical bases of weakness in CP remain poorly understood. An additional concern is that the two major surgical interventions in ambulatory children with spastic diplegia, muscle-tendon lengthening (orthopaedic surgery) and selective dorsal rhizotomy (neurosurgery), often serve to exacerbate or unmask the symptom of weakness, which can be problematic in children who are already weak. The ultimate goal of this project is to improve motor outcomes in CP by first exploring the mechanisms that lead to diminished force production and defining the relative role of weakness in the functional motor deficit in spastic CP. This will be accomplished by isokinetic and electromyographic evaluation to examine voluntary and involuntary muscle responses in children with CP at the knee and ankle joint throughout the range of motion and at different movement speeds. Muscle performance will then be related to validated pediatric measures of functional status and disability. Lastly, the interaction of strength with surgical interventions will be determined by quantifying the effects of orthopaedic and neurosurgery on strength and functional measures, and assessing whether the addition of a strengthening program enhances surgical outcomes. Strength is an essential component of normal motor control that is deficient in CP, but can be altered through training. Continued research, as proposed here, needs to be conducted to verify and solidify the role of strengthening in the rehabilitation of children with CP.

脑瘫 (CP) 是最常见的身体残疾 童年，无法治愈。 目前所有的治疗方法，例如 手术和物理治疗的目的只是为了缓解周围环境 这种中枢神经系统疾病的影响通常有限且 不一致的成功。 长期以来流行的临床系统 已得到认可，但很少在该人群中进行治疗 肌肉无力。 虽然成人经常使用力量训练 骨科人群和运动员以增加力量产生或 改变肌肉不平衡，这种类型的干预措施严重不足 用于儿科康复，特别是脑瘫儿童。 没有证据支持临床对力量的偏见 脑瘫训练和测试。 事实上，研究结果是 相反，积累脚趾，表明患有 CP 的人 确实很弱，弱的程度和运动有直接关系 表现和强化计划可以产生积极的功能 结果。 然而，神经生理学和生物力学基础 CP 的弱点仍然知之甚少。 另一个问题是 门诊痉挛儿童的两种主要手术干预措施 截瘫、肌腱延长（整形外科）和选择性 背神经根切断术（神经外科），通常用于加剧或揭露 虚弱的症状，这对于已经患有虚弱的儿童来说可能是个问题 虚弱的。 该项目的最终目标是改善运动结果 CP首先探索导致力量减弱的机制 生产并定义功能弱点的相对作用 痉挛性脑瘫的运动缺陷。这将通过等速和 肌电图评估检查随意和不随意肌肉 CP 儿童膝关节和踝关节的反应 运动范围和不同的运动速度。 肌肉表现将 然后与经过验证的儿科功能状态测量相关 残疾。 最后，力量与手术的相互作用 干预措施将通过量化骨科的效果来确定 和神经外科的力量和功能测量，并评估 添加强化计划是否可以增强手术效果 结果。 力量是正常运动控制的重要组成部分 CP 不足，但可以通过训练来改变。 持续 此处提出的研究需要进行验证和巩固 强化在脑瘫儿童康复中的作用。