Effects of Motor-Assisted Cycling in Cerebral Palsy

电机辅助自行车对脑瘫的影响

• 批准号: 7140538
• 负责人: DIANE L. DAMIANO
• 金额: $ 16.06万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-08-05 至 2008-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7140538
• 关键词: assistive device /technology; cerebral palsy; children; chordate locomotion; clinical research; electromyography; energy source; functional ability; human subject; human therapy evaluation; medical rehabilitation related tag; muscle tone; nervous system disorder therapy; neural plasticity; neuroanatomy; patient oriented research; rehabilitation

DESCRIPTION (provided by applicant): Spinal locomotor circuits can be accessed and trained in humans with appropriate stimuli and practice. Treadmill training and FES-cycling protocols are being increasingly utilized for persons with CMS injuries to exploit this potential in an effort to improve coordination and, if possible, to restore or promote ambulation. Activation of spinal circuits may also drive cortical reorganization and further augment motor recovery. Cerebral palsy (CP), the most prevalent physical disability originating in childhood, is characterized by abnormal motor control as a result of a static brain lesion in a developing nervous system. A consequence of the resultant inappropriate descending input is that spinal mechanisms that promote coordinated reciprocal movements in the lower extremities are often underutilized and therefore may develop abnormally. This has a direct negative effect on motor development and initiates a cascade whereby restricted amounts and types of movements limit the reinforcement or development of motor pathways in the nervous system, further reducing motor potential. Our specific aim in this initial investigation is to conduct a three month motor-assisted (passive) cycling program using a special computerized motor-driven cycle in 20 ambulatory and non-ambulatory children with CP with the primary goal to train spinal locomotor circuits and thereby improve motor coordination and function. Secondary goals are to modulate spasticity and muscle stiffness, and enhance cortical plasticity. Cycling is a form of locomotion shown to have similar timing and phasing to walking and evidence of shared neural circuitry, and could provide a more effective and feasible in-home alternative to therapist-assisted supported treadmill training regimens. Fast (50RPM) motor-driven cycling produces reciprocal muscle activation in normals that may be even greater in persons with spasiticy. If it is found that cycling stimulates neural and motor recovery in CP, the data obtained in this prospective observational study will be used to support a RCT of passive and perhaps active-assisted cycling in CP.

描述（由申请人提供）：通过适当的刺激和练习，可以对人类进行脊髓运动回路的访问和训练。跑步机训练和 FES 自行车方案越来越多地用于 CMS 损伤患者，以利用这种潜力来改善协调性，并在可能的情况下恢复或促进行走。脊髓回路的激活也可能驱动皮质重组并进一步增强运动恢复。脑瘫 (CP) 是起源于儿童期的最常见的身体残疾，其特征是由于发育中的神经系统中的静态脑损伤导致运动控制异常。由此产生的不适当的下降输入的结果是，促进下肢协调往复运动的脊柱机制常常未被充分利用，因此可能发育异常。这对运动发育有直接的负面影响，并引发连锁反应，即运动的数量和类型受到限制，限制了神经系统中运动通路的强化或发展，进一步降低了运动潜力。我们在这项初步调查中的具体目标是对 20 名能走动和不能走动的 CP 儿童使用特殊的计算机化电机驱动自行车进行为期三个月的电机辅助（被动）骑行计划，其主要目标是训练脊髓运动回路，从而提高运动协调性和功能。次要目标是调节痉挛和肌肉僵硬，并增强皮质可塑性。骑自行车是一种运动形式，与步行具有相似的时间安排和阶段性，并且有共享神经回路的证据，并且可以为治疗师辅助支持的跑步机训练方案提供更有效、更可行的家庭替代方案。快速 (50RPM) 电机驱动的自行车运动会在正常人中产生相互的肌肉激活，而在痉挛患者中可能会产生更大的交互激活。如果发现骑自行车能刺激脑瘫患者的神经和运动恢复，这项前瞻性观察研究中获得的数据将用于支持脑瘫患者被动骑行和主动辅助骑自行车的随机对照试验。