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）是最普遍的身体残疾，起源于儿童时期，痉挛和无力是主要的临床体征。 在过去的二十年中，该人群中的痉挛管理发生了巨大变化，首先是随着选择性背侧根茎切开术（SDR）的引入，最近是在引入鞘内巴芬（ITB）泵植入的过程中。 ITB对脊柱痉挛的人有效；但是，CP的临床结果虽然通常为正，但较不公平，痉挛的降低通常标记较低，功能增长令人印象深刻甚至均衡。 报告的ITB的积极作用包括痉挛和痉挛的放松，这可能会减少相关的不适感并提高运动的易度性。 一个尚未解决的主要问题是，肌肉无力是ITB的直接作用，还是仅由于SDR后看到的，由于消除了痉挛而出现明显的弱点。 在这些已经明显疲软的患者中，弱点加剧可能会出现问题。 该项目的具体目的是：（1）量化ITB的自愿产生，痉挛和选择性控制的变化； （2）确定功能运动结果上这些临床变化的相互作用，以改善该疗法在CP中的临床应用。 将测试以下假设：a）ITB对八（8）个主要下肢的等距和偏心峰值产生产生负面影响，并以剂量​​依赖性方式对八（2）个代表性的上肢肌肉群产生负面影响； b）在运动任务和步态过程中，反对痉挛性激动剂的肌肉的孤立控制将以剂量依赖的方式得到改善； c）功能增长，包括步态时间空间参数的变化和PODCI的全局函数量表，将不与剂量相关。 另外，这些将取决于个人的潜在运动能力，ITB产生的痉挛和强度的变化量以及这些变化如何相互作用以改变功能性能。 我们的长期目标是通过更精确的患者选择和剂量调整来改善CP中的痉挛性管理，并在术后进行辅助疗法，例如术后力量训练等辅助疗法。