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（由适用提供）：脑瘫（CP）是最常见的儿科运动障碍，影响美国3.6/1000名儿童，每年有11,000个新诊断。 CP的运动和感觉功能障碍通常会随着时间的流逝而需要，从而导致昂贵的身体，社交和情绪障碍。但是，利用依赖活动的大脑可塑性的干预措施会导致运动执行和肢体使用的持久改进，从而将运动和社会功能优化到成年期。 CP儿童康复最大的挑战之一是克服了发育无视（DD）。这种忽视形式始于婴儿期，会损害推断新运动和有效运动的能力，并有助于神经发育轨迹，这些轨迹很少等于典型的儿童。疗法越早可以克服DD，其对以后神经发育的影响越大，尤其是当它可以在3岁之前开始，当神经可塑性是最大的约束诱导的运动疗法（CIMT）时，成人良好的运动疗法（CIMT）可以通过强制使用和感官暴露于负性极端的良好的上肢功能。该提案的短期目标是表明CIMT在2岁之前或之前可以改善上肢感觉和运动功能，从而减轻DD。为此，在12-24个月的儿童中，研究使用了一个随机对照试验（RCT）设计，并使用了等待名单控制。 CIMT干预包括在受影响较小的手臂（1/2天，以电子方式对象）上的1个月软约束磨损，并结合经过验证的经验证的基于父母的基于父母的家庭培训和感官接触的家庭计划，以实现更受影响的肢体，除了常规治疗（当前标准CP治疗）外（当前的标准CP治疗）外。 CP的儿童将在基线和1个月和7个月时评估。分配给对照组的儿童将在RCT完成后接受CIMT并再次评估。通常还将对发展（TD）年龄匹配的儿童进行测试。试验的RCT阶段将证明CIMT改善了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关系如何有助于损害的机理问题。最后，将所有CP儿童引入TD儿童将提供有关CP和CIMT时间的严重性如何改变治疗儿童的神经发育轨迹的新信息。这将为未来的康复试验基于证据的设计而培训。重要的是，CIMT干预本身并不涉及广泛的材料和智力资源，而是专注于实施精心监控的基于家庭的计划，从而使应用程序的应用程序访问有限的资源访问设置。因此，该提案的总体目标是解决小儿脑瘫领域的差距，以提高这种康复研究的临床和社会相关性。