Spinal Segmental Contributions to Sitting & Reaching in Cerebral Palsy

脊柱节段对坐姿的影响

• 批准号: 8608569
• 负责人: MARJORIE HINES WOOLLACOTT
• 金额: $ 28.15万
• 依托单位: UNIVERSITY OF OREGON
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-03-01 至 2016-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8608569
• 关键词: Address; Adult; Age; Behavioral; Birth; Cerebral Palsy; Chest; Child; Chronic Disease; Classification; Clinical; Cross-Sectional Studies; Data; Development; Equilibrium; Foundations; Functional disorder; Goals; Head; Infant; Knowledge; Learning; Longitudinal Studies; Lumbar Regions; Measures; Methods; Modeling; Motor; Movement; Muscle; Musculoskeletal Equilibrium; Outcome; Pattern; Pelvis; Population; Process; Rehabilitation therapy; Research; Severities; Spinal; Staging; System; Time; Training; Vertebral column; base; clinical practice; disability; grasp; improved; kinematics; motor deficit; novel; novel strategies; outcome forecast; prevent; public health relevance; research study; response; skills

DESCRIPTION (provided by applicant): The long-term goal of this research is 1) to understand mechanisms used by typically developing (TD) infants in attaining head & trunk control for the development of sitting balance and associated reaching skills, and 2) to apply that knowledge to understanding and improving these skills in children with cerebral palsy (CP). While trunk postural control creates the basis for reaching skills, little is known about how spinal stability develops; in fact there are almost no clinical measures of intermediate stages of trunk stability. In the case of children with CP this lack of knowledge is critical. Our experiments address these limitations. Experiments will determine developmental changes in kinematics of head stability, trunk muscle activation patterns and patterns of reaching movements with different levels of trunk support in TD infants and children with CP. Specific Aim 1 is a longitudinal study evaluating contributions of spinal segments to head stability and reaching skills in 3-9 month old TD infants as they gain sitting balance. We hypothesize: 1) head stability emerges first at higher levels of trunk support and stability progresses sequentially down the spine in a time dependent manner, associated with the rostro-caudal development of coordinated muscle response patterns during sitting; and 2) emergence of efficient reaching movements is associated with the mastery of postural control at a given level of trunk development. Specific Aim 2 is a cross-sectional study evaluating contributions of spinal segments to trunk stability and reaching in children with moderate to severe CP. We hypothesize that 1) within children with various levels of severity of CP (Gross Motor Function Classification System levels III, IV, V) we will see arrested levels of spinal development along a continuum of that which is seen during sitting balance development in TD children; thus lack of sitting spinal control reflects deficits in coordination at a specific spinal level; 2) reaching deficits will be associated with postural control deficits at specific spinal levels. The study of segmental contributions to spinal control is novel and challenges current clinical concepts for assessment and treatment of sitting development; thus it brings critical new information to our understanding of both typical development and constrained development in children with CP.

描述（由申请人提供）：这项研究的长期目标是1）了解通常发育（TD）婴儿在获得头部和躯干控制方面使用的机制，以发展坐着平衡和相关的达到技能，以及2）应用这些知识来理解和提高脑瘫儿童（CP）儿童的这些技能。尽管躯干姿势控制为达到技能创造了基础，但对脊柱稳定性的发展知之甚少。实际上，几乎没有临床衡量中间阶段的躯干稳定性。对于患有CP的孩子，这种缺乏知识至关重要。我们的实验解决了这些局限性。实验将确定头部稳定性运动学，躯干肌肉激活模式的发展变化以及在TD婴儿和CP儿童中具有不同级别的躯干支持的运动模式。特定目标1是一项纵向研究，评估脊柱段对头部稳定性和在3-9个月大的TD婴儿中获得技能的贡献，因为它们获得了平衡。我们假设：1）头部稳定性在较高水平的躯干支撑和稳定性下首先以时间依赖的方式依次向下沿着脊柱延伸，这与坐着过程中协调的肌肉反应模式的rostro-caudal发育有关； 2）出现有效到达运动的出现与在给定的躯干发育水平上掌握姿势控制有关。特定目标2是一项评估脊柱段对中度至重度CP儿童的脊髓段和触及的贡献的横断面研究。我们假设1）在CP严重程度不同的儿童中（总运动函数分类系统III，IV，V），我们将看到沿TD儿童坐着平衡发育过程中的连续体的脊柱发育的被捕水平；因此，缺乏坐姿的脊柱控制反映了特定脊柱水平的配位缺陷。 2）达到缺陷将与特定脊柱水平的姿势控制缺陷有关。对脊柱控制的分段贡献的研究是新颖的，并且挑战了当前的临床概念，以评估和治疗坐姿发展；因此，它为我们对CP儿童的典型发展和约束发展的理解带来了关键的新信息。