Sensorimotor Learning in Children with Cerebral Palsy

脑瘫儿童的感觉运动学习

基本信息

批准号：
9009029
负责人：
Max J Kurz
金额：
$ 54.38万
依托单位：
UNIVERSITY OF NEBRASKA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-09-24 至 2019-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9009029
关键词：
Address Affect Age Ankle Attention Behavioral Biological Neural Networks Biomechanics Brain Brain imaging Cataloging Catalogs Cerebral Palsy Child Childhood Collection Corticospinal Tracts Development Diagnosis Diffusion Magnetic Resonance Imaging Educational process of instructing Exhibits Fiber Foundations Frequencies Future Goals Human Impairment Isometric Exercise Joints Knowledge Learning Location Logic Lower Extremity Magnetoencephalography Measures Methods Modeling Motor Motor Activity Motor Cortex Motor Skills Movement Muscle Musculoskeletal Musculoskeletal System Neurologic Neurons Operative Surgical Procedures Outcome Participant Pattern Performance Perinatal Peripheral Physical therapy Play Posture Probability Process Rehabilitation therapy Reporting Research Research Design Resolution Seminal Sensory Solid Somatosensory Cortex Staging Stretching Therapeutic Time Training Treatment Protocols United States Update Work ankle joint base behavior measurement cohort cooking density effective intervention feeding improved indexing individualized medicine innovation insight meetings motor impairment motor learning movement analysis neuromechanism neurophysiology programs public health relevance relating to nervous system research study sensory feedback strength training success thalamocortical tract treatment strategy trend

项目摘要

DESCRIPTION (provided by applicant): Cerebral palsy (CP) is one of the most prevalent and costly pediatric neurologic conditions diagnosed in the United States. Despite years of studies that have catalogued the motor impairments seen in children with CP, innovative and effective interventions have not emerged. At least part of the problem is that the majority of treatment approaches (e.g., surgical, stretching, strengthening) emphasize the musculoskeletal impairments that may affect the execution of the movement pattern, without attention to the abnormalities in sensorimotor cortical activity, which underlie the motor planning and programming that children with CP use to perform and learn motor tasks. Addressing this substantial gap is paramount, and central to our long-term research goals of developing innovative treatment strategies that have the highest probability of teaching children with CP new motor skills. To meet this goal, we have implemented an innovative scientific approach that uses high-density magnetoencephalography (MEG), diffusion-tensor imaging, and advanced human movement analysis methods to identify the neurophysiological factors that influence a child with CP's motor performance. The Specific Aims of this proposal will (1) determine how the stage-like beta and gamma sensorimotor cortical oscillations are modulated by intensively practicing a goal-directed motor task, (2) quantify how activity within the somatosensory cortices affects the sensorimotor integration processes that are necessary for learning a goal-directed motor task, and (3) quantify the relationships between the extent of activation within the sensorimotor cortices, motor behavioral improvements, and the integrity and quantity of fibers in the thalamocortical and corticospinal tracts. Briefly, our study will address these aims by quantifying the neurophysiological and motor behavioral changes that occur after practicing an isometric ankle plantarflexion target matching task. We will focus on an ankle motor task because control of the ankle joint is well recognized as playing a key role in the mobility and postural limitations seen in children with CP. Our study design consists of the collection of MEG and motor behavioral measures prior to training (baseline), after 3- days of intensive training, and a week after cessation of the training. Participants will include a cross-section of children with CP that have various levels of motor impairments (e.g., GMFCS I-IV), and a cohort of age- matched typically-developing children. Outcomes from the proposed experiments will be seminal for challenging and potentially redirecting the current rehabilitation methods that are used to teach children with CP new motor skills. Furthermore, we expect that the new neural indices of motor learning established in this proposal will provide critical insight on why some children with CP show vast improvements after therapy, whereas others are classified as non-responders. Understanding the neural mechanisms that may limit the progress of non-responders will enable us and other research groups to develop new individualized treatment strategies that will allow for all children with CP to have the best chance of learning new motor skills.

描述（由申请人提供）：脑性瘫痪 (CP) 是美国诊断的最常见和最昂贵的儿科神经系统疾病之一，尽管多年来的研究已经对 CP 儿童的运动障碍进行了分类，但创新和有效的干预措施已经出现。至少部分问题是，大多数治疗方法（例如手术、拉伸、强化）强调可能影响运动模式执行的肌肉骨骼损伤，而没有关注运动模式的执行。感觉运动皮层活动异常是脑瘫儿童用于执行和学习运动任务的运动规划和编程的基础，解决这一巨大差距至关重要，也是我们开发具有最高水平的创新治疗策略的长期研究目标的核心。为了实现这一目标，我们采用了一种创新的科学方法，该方法使用高密度脑磁图 (MEG)、扩散张量成像和先进的人体运动分析方法来识别影响的神经生理学因素。该提案的具体目标将 (1) 确定如何通过集中练习目标导向的运动任务来调节阶段式 β 和 γ 感觉运动皮层振荡，(2) 量化体感内的活动如何。皮质影响感觉运动整合过程，这是学习目标导向的运动任务所必需的，并且（3）量化感觉运动皮质内的激活程度、运动行为改善、简而言之，我们的研究将通过量化练习等长踝跖屈目标匹配任务后发生的神经生理学和运动行为变化来解决这些目标。因为众所周知，踝关节的控制在 CP 儿童的活动能力和姿势限制中发挥着关键作用，我们的研究设计包括在训练前收集 MEG 和运动行为测量。（基线），经过 3 天的强化训练后，以及停止训练一周后，参与者将包括具有不同程度运动障碍（例如 GMFCS I-IV）的脑瘫儿童。所提出的实验结果将对当前用于教授脑瘫儿童新运动技能的康复方法产生重大影响。该提案中建立的运动学习将为我们提供重要的见解，解释为什么一些患有脑瘫的儿童在治疗后表现出巨大的改善，而其他儿童则被归类为无反应者，了解可能限制无反应者进展的神经机制将使我们和其他研究受益。小组制定新的个性化治疗策略，使所有患有脑瘫的儿童都有最好的机会学习新的运动技能。