Early Childhood Constraint Therapy for Sensory/Motor Impairment in Cerebral Palsy

儿童早期针对脑瘫感觉/运动障碍的约束疗法

基本信息

批准号：
8963256
负责人：
Nathalie Maitre
金额：
$ 49.26万
依托单位：
RESEARCH INST NATIONWIDE CHILDREN'S HOSP
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：
2015-08-21 至 2020-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8963256
关键词：
2 year old 3 year old Accounting Address Adult Affect Aftercare Age Age-Months Brain Caregivers Cerebral Palsy Child Childhood Clinical Control Groups Development Diagnosis Disabled Children Emotional Event-Related Potentials Functional disorder Future Goals Growth and Development function Hand Home environment Hour Impairment Infant Intervention Learning Limb structure Link Measures Methods Monitor Motor Movement Movement Disorders Neuronal Plasticity Observational Study Outcome Parents Pathway interactions Patients Phase Play Process Randomized Randomized Clinical Trials Randomized Controlled Trials Rehabilitation Research Rehabilitation therapy Resources Sensory Sensory Process Severities Side Social Functioning Tactile Testing Therapeutic Therapeutic Studies Time Toy Training Translational Research Upper Extremity Waiting Lists arm base constraint induced movement therapy design disability early childhood early experience evidence base experience functional improvement hemiparesis improved infancy motor disorder motor impairment neglect neurodevelopment programs public health relevance relating to nervous system routine therapy sensory feedback skills social somatosensory trial design

项目摘要

DESCRIPTION (provided by applicant): Cerebral palsy (CP) is the most common pediatric movement disorder, affecting 3.6/1000 children in the US, with 11,000 new diagnoses every year. Motor and sensory dysfunction in CP often worsen over time, leading to costly lifelong physical, social and emotional disabilities. However, interventions that take advantage of activity-dependent brain plasticity can result in lasting improvements of movement execution and extremity use that optimize motor and social function into adulthood. Among the greatest challenges in the rehabilitation of children with CP is overcoming developmental disregard (DD). This form of neglect starts in infancy impairs the ability to infer new and effective movements and contributes to neurodevelopmental trajectories that rarely equal those of typically developing children. The sooner a therapy can overcome DD, the greater its impact on later neurodevelopment, especially if it can start before 3 years old, when neural plasticity is greatest Constraint-induced movement therapy (CIMT), well-studied in adults, improves upper extremity function through forced-use and sensory exposure of a neglected extremity. The short-term objective of this proposal is to show that CIMT at or before 2 years old can improve upper extremity sensory and motor function and thereby mitigate DD. To accomplish this, the study uses a randomized controlled trial (RCT) design with a wait- list control, in children 12-24 months with asymmetric CP. The CIMT intervention includes 1 month of soft constraint wear on the less affected arm (1/2 day sessions, electronically-monitored) combined with a validated parent-implemented home-based program of reach training and sensory exposures for the more affected extremity, in addition to routine therapy sessions (current standard CP treatment). Children with CP will be assessed at baseline, and at 1 and 7 months. Children assigned to the control group will receive CIMT after the RCT is finished and be assessed again. Typically developing (TD) age-matched children will also be tested. The RCT phase of the trial will demonstrate that CIMT improves the sensory and motor function of an affected upper extremity. The comparison of TD children and CP children before treatment will answer mechanistic questions about how the relationship between sensory and motor function contributes to impairments. Finally, referencing all CP children to TD children will provide new information on how the severity of CP and the timing of CIMT may change the neurodevelopmental trajectories of treated children. This will inform the evidence-based design of future trials of rehabilitation n developing children with disabilities. Importantly, the CIMT intervention itself does not involve extensive material and intellectual resources and focuses instead on implementing a carefully monitored home-based program, allowing an application to settings with limited access to resources. The overarching goals of this proposal are therefore to address gaps in the continuum of translational research in the field of pediatric cerebral palsy in order to increase the clinical and societal relevance of this type of rehabilitation research.

描述（由申请人提供）：脑瘫 (CP) 是最常见的儿科运动障碍，影响美国每 1000 名儿童中的 3.6 名，每年有 11,000 名新诊断的脑瘫患者的运动和感觉功能障碍往往会随着时间的推移而恶化，导致高昂的治疗费用。然而，利用活动依赖性大脑可塑性的干预措施可以持久改善运动执行和四肢使用，从而优化成年后的运动和社会功能。脑瘫儿童康复的最大挑战是克服发育忽视（DD），这种形式的忽视从婴儿期开始，会损害推断新的有效运动的能力，并导致神经发育轨迹很少与正常发育的儿童相同。治疗可以克服 DD，对以后的神经发育的影响就越大，特别是如果它可以在 3 岁之前开始，此时神经可塑性最强。约束诱导运动疗法 (CIMT) 在成人中得到充分研究，可以改善上肢通过强迫使用和被忽视的肢体的感觉暴露来改善肢体功能该提案的短期目标是表明 2 岁或之前的 CIMT 可以改善上肢的感觉和运动功能，从而减轻 DD。该研究采用随机对照试验 (RCT) 设计和等待名单对照，针对 12-24 个月的不对称 CP 儿童进行 CIMT 干预，其中包括对受影响较小的手臂进行 1 个月的软约束佩戴（1/2 天的疗程，患有 CP 的儿童将在基线时接受评估，并且在 RCT 完成后分配到对照组的儿童将接受 CIMT，并且通常还会对年龄匹配的儿童进行评估。试验的 RCT 阶段将证明 CIMT改善受影响上肢的感觉和运动功能治疗前 TD 儿童和 CP 儿童的比较将回答有关感觉和运动功能之间的关系如何导致损伤的机制问题。关于 CP 的严重程度和 CIMT 的时机如何改变儿童的神经发育轨迹的新信息这将为未来发育中残疾儿童的康复试验的循证设计提供信息。重要的是，CIMT 干预治疗本身。不涉及大量的物质和智力资源，而是侧重于实施仔细监控的家庭计划，允许在资源有限的环境中应用，因此，该提案的总体目标是解决转化研究连续性中的差距。小儿脑瘫领域，以增加此类康复研究的临床和社会相关性。