Optimizing locomotor training for children with severe cerebral palsy

优化重度脑瘫儿童的运动训练

• 批准号: 8408013
• 负责人: SANDRA L SAAVEDRA
• 金额: $ 1.84万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2012-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8408013
• 关键词: 8 year old; Address; Age; Body Weight; Bone Density; Cerebral Palsy; Child; Childhood; Classification; Clinical; Cross-Sectional Studies; Custom; Data; Development; Devices; Dysplasia; Electromyography; Family; Frequencies; Friends; Growth; Health; Hip region structure; Incidence; Infant; Intervention; Lead; Learning; Leg; Live Birth; Lower Extremity; Measures; Methods; Motor; Movement; Muscle; Musculoskeletal Equilibrium; Osteoporosis; Participant; Pattern; Performance; Posture; Protocols documentation; Rehabilitation therapy; Research; Research Design; Research Personnel; Risk Factors; Robotics; Self-Help Devices; Surface; System; Techniques; Testing; Time; Training; Walking; Weight-Bearing state; Work; clinical practice; design; functional outcomes; high risk; improved; innovation; insight; meetings; motor control; motor deficit; motor impairment; muscle strength; respiratory; response; scoliosis; socioeconomics

DESCRIPTION (provided by applicant): Cerebral palsy is the most common motor deficit in children with an incidence of 2-3 per 1000 live births. An important socioeconomic problem is that 44% of children with cerebral palsy (CP) never learn to walk independently even with current treatments. Non-ambulatory children with CP have higher risk of hip dysplasia, scoliosis, osteoporosis, diminished growth and respiratory illness. Ironically, hope for better functional outcome is reduced for these children because they are commonly excluded from motor control research and clinical innovations. For example, current locomotor interventions (body weight supported treadmill training (BWSTT), assistive devices, robotic locomotor training) are designed for higher functioning children who have attained upright control of the trunk. Thus locomotor intervention is either inaccessible or inefficient for those children with the greatest need. Researchers working with young typically developing (TD) infants (who have poor trunk control, naturally), tip the babies' trunks forward when supported on a treadmill to help them step. A specific angle of inclination has not, however, been proposed nor has the rationale for this posture been articulated or tested. It is hypothesized that this technique reduces the demands for trunk control while simultaneously reducing the muscle force required for infants to swing their legs and step. It is proposed that this technique could also work for children with moderate-to-severe CP. Using a custom trunk support device with adjustable forward inclination angle and pediatric motorized treadmill, step responses will be documented monthly in 7 infants (AIM 1) during the age range when trunk postural control normally develops (1-7 mo) and in 30 children with moderate-to-severe CP (Gross Motor Function Classification System Level III, IV and V) (2-4 or 6-8 years of age) (AIM 2). Concurrent assessment of the segmental level of trunk control will provide information necessary to test the hypotheses that the optimal angle of trunk inclination is related to the level of trunk control available to the infant/child. This is the first study to systematically evaluate the influence of trunk control on stepping responses during BWSTT. Surface electromyography (EMG) of trunk and leg muscles will be recorded during studies for AIM 1 and 2, to test the hypothesis that providing trunk support will reduce the postural demands and enhance reciprocal activation patterns for leg and trunk muscles during treadmill-elicited stepping (AIM 3). Insights from this research will provide specific information to optimize performance during locomotor treatment for those children with CP who have the greatest need.

描述（由申请人提供）：脑瘫是儿童中最常见的运动不足，每1000例活生生的发生率为2-3。一个重要的社会经济问题是，有44％的脑瘫儿童（CP）即使目前的治疗也永远不会学会独立行走。 CP的非疗法儿童患髋关节发育不全，脊柱侧弯，骨质疏松症，生长和呼吸道疾病的风险更高。具有讽刺意味的是，这些儿童通常会降低对更好的功能结果的希望，因为他们通常被排除在运动控制研究和临床创新之外。例如，当前的运动干预措施（体重支持的跑步机训练（BWSTT），辅助设备，机器人运动训练）是为了获得直立的行李箱控制的高功能较高的儿童而设计的。因此，对于那些最需要的儿童而言，运动干预是无法访问或效率低下的。与年轻人一起工作的研究人员（TD）婴儿（自然而然地控制躯干），在跑步机上支撑时，婴儿的树干向前倾斜，以帮助他们踩踏。但是，尚未提出特定的倾斜角度，也没有阐明或测试过这种姿势的理由。假设该技术减少了对躯干控制的需求，同时减少了婴儿摆动腿并踩踏所需的肌肉力。有人建议，该技术也可以适用于中度至重度CP的儿童。使用具有可调节的前向倾斜角度和小儿机动跑步机的定制躯干支撑装置，在躯干姿势控制正常发展（1-7 mo）和30名中度到中期的儿童中，将每月记录在7个婴儿（AIM 1）的每月记录步骤反应（AIM 1）（AIM 1）（总运动功能分类系统III II III，IV和6-4岁）（2-4岁）（2-4-4-4-4-4-4-8岁）。同时评估躯干控制的分段水平将提供必要的信息，以测试躯干倾斜度的最佳角度与婴儿/儿童可用的躯干控制水平有关。这是第一个系统地评估躯干控制对BWSTT期间垫脚反应的影响的第一项研究。在AIM 1和2的研究期间，将记录躯干和腿部肌肉的表面肌电图（EMG），以测试以下假设：提供躯干支撑将减少姿势需求，并增强踏板和躯干肌肉在跑步机 - 诱发的踩踏过程中的相互激活模式（AIM 3）。这项研究的见解将为那些最需要的CP儿童提供特定信息，以优化运动治疗期间的性能。