Effects of Baclofen on Muscle Strength in Cerebral Palsy

巴氯芬对脑瘫患者肌肉力量的影响

• 批准号: 6837248
• 负责人: DIANE L. DAMIANO
• 金额: $ 25.24万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-07-15 至 2005-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6837248
• 关键词: body movement; cerebral palsy; computer data analysis; dosage; drug adverse effect; electromyography; functional ability; gait; human subject; human therapy evaluation; implant; injection /infusion; joint stiffness; limb movement; medical implant science; muscle function; muscle relaxants; muscle strength; nervous system disorder chemotherapy; neuropharmacology; pain; patient oriented research; psychomotor function; questionnaires; spasm

Cerebral palsy (CP) is the most prevalent physical disability originating in childhood of which spasticity and weakness are primary clinical signs. Spasticity management in this population has changed dramatically in the past two decades, first with the introduction of selective dorsal rhizotomy (SDR) and most recently with the introduction of intrathecal baclofen (ITB) pump implantation. ITB is efficacious for persons with spasticity of spinal origin; however, the clinical results in CP, while generally positive, are less well-established, reduction in spasticity is typically less marked, and functional gains are less impressive or even equivocal. Reported positive effects of ITB include a relaxation in spasms and spasticity which may reduce associated discomfort and improve ease of movement. A major unresolved question is whether muscle weakness is a direct effect of ITB or whether only an apparent weakness occurs due to elimination of spasticity, as seen after SDR. Exacerbation of weakness could prove problematic in these patients who are already significantly weak. The Specific Aims of this project are to:(1) quantify the changes in voluntary torque production, spasticity and selective control as a result of ITB; and (2) determine the interplay of these clinical changes on functional motor outcomes so as to improve clinical application of this therapy in CP. The following hypotheses will be tested: a) ITB will have a negative effect on isometric and eccentric peak torque production of eight (8) major lower extremity and two (2) representative upper extremity muscle groups in a dose-dependent manner; b) Isolated control of muscles opposing spastic agonists during movement tasks and gait will be conversely improved in a dose-dependent manner; c) Functional gains, including changes in gait temporal-spatial parameters and the Global Function Scale of the PODCI, will not be dose-related. Alternatively, these will depend on the individual's underlying motor capabilities, the amount of change in spasticity and strength produced by ITB, and how these changes interact to alter functional performance. Our long term goal is to improve spasticity management in CP by more precise patient selection and dosage adjustment, and greater consideration of adjunct therapies such as strength training post-operatively.

脑瘫（CP）是起源于儿童期的最常见的身体残疾，其主要临床症状是痉挛和虚弱。 在过去二十年中，该人群的痉挛治疗发生了巨大变化，首先是选择性背神经根切断术（SDR）的引入，最近是鞘内巴氯芬（ITB）泵植入的引入。 ITB 对脊髓痉挛患者有效；然而，脑瘫的临床结果虽然总体上是积极的，但还不太确定，痉挛的减轻通常不太明显，功能的改善也不那么令人印象深刻，甚至是模棱两可的。 据报道，ITB 的积极作用包括缓解痉挛和痉挛，这可能会减少相关的不适并改善运动的自如性。 一个尚未解决的主要问题是肌肉无力是否是 ITB 的直接影响，或者是否只是由于痉挛消除而出现明显的无力，如 SDR 后所见。 对于这些已经非常虚弱的患者来说，虚弱的加剧可能会带来问题。 该项目的具体目标是：(1) 量化 ITB 导致的自愿扭矩产生、痉挛和选择性控制的变化； (2) 确定这些临床变化对功能性运动结果的相互作用，以改善该疗法在脑瘫中的临床应用。 将测试以下假设： a) ITB 将以剂量依赖性方式对八 (8) 个主要下肢和两 (2) 个代表性上肢肌肉群的等长和偏心峰值扭矩产生产生负面影响； b) 在运动任务和步态中对抗痉挛激动剂的肌肉的孤立控制将以剂量依赖的方式反过来得到改善； c) 功能增益，包括步态时空参数和 PODCI 整体功能量表的变化，与剂量无关。 或者，这些将取决于个人的潜在运动能力、ITB 产生的痉挛和力量的变化量，以及这些变化如何相互作用以改变功能表现。 我们的长期目标是通过更精确的患者选择和剂量调整以及更多地考虑术后力量训练等辅助治疗来改善脑瘫的痉挛管理。