Augmenting Ankle Plantarflexor Function and Walking Capacity in Children with Cerebral Palsy

增强脑瘫儿童的踝跖屈肌功能和行走能力

• 批准号: 10345932
• 负责人: Zachary Forest Lerner
• 金额: $ 44.7万
• 依托单位: NORTHERN ARIZONA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-22 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10345932
• 关键词: Address; Affect; Age; Ankle; Biofeedback; Cardiovascular Diseases; Cerebral Palsy; Characteristics; Child; Childhood; Clinical; Community Participation; Consensus; Cues; Development; Dorsal; Dose; Effectiveness; Family; Functional disorder; Future; Gait; Gender; Goals; Guidelines; Home; Impairment; Individual; Intervention; Knowledge; Length; Lower Extremity; Measures; Mechanics; Metabolic; Metabolic dysfunction; Muscle; Muscle function; Operative Surgical Procedures; Orthopedic Surgery; Orthotic Devices; Outcome; Participant; Pattern; Performance; Personal Satisfaction; Physical activity; Physical therapy; Pilot Projects; Precision therapeutics; Protocols documentation; Quality of life; Ramp; Randomized Controlled Trials; Resistance; Rhizotomy procedure; Robotics; Running; Severities; Shoes; Speed; Techniques; Testing; Time; Training Programs; United States; United States National Institutes of Health; Visit; Walking; Work; comparison intervention; cost; critical period; disability; effective therapy; evidence base; foot; functional improvement; functional outcomes; gait rehabilitation; improved; improved mobility; innovation; light weight; mobility aid; motor control; neuromuscular; peer; personalized intervention; physical conditioning; physically handicapped; post intervention; robot exoskeleton; robotic device; spasticity; standard of care; strength training; treadmill; treadmill training; walking speed

PROJECT SUMMARY A child’s ability to walk effectively is essential to their physical health and general well-being. Unfortunately, many children with cerebral palsy (CP), the most common cause of pediatric physical disability, have difficulty walking and completing higher-intensity ambulatory tasks. This leads to children with CP engaging in levels of habitual physical activity that are well below guidelines and those of children without disabilities, which in turn contributes to many secondary conditions, including metabolic dysfunction and cardiovascular disease. There is broad clinical consensus that plantarflexor dysfunction is a primary contributor to slow, inefficient, and crouched walking patterns in CP; individuals with CP need more effective treatments and mobility aids for plantarflexor dysfunction. To meet this need, this proposal aims to evaluate a holistic strategy to address impaired mobility from plantarflexor dysfunction in CP using a lightweight, dual-mode (assistive or resistive) wearable robotic device. This strategy combines two complementary techniques: (1) targeted ankle resistance for neuromuscular gait training that provides precision therapy to elicit long-term improvements in ankle muscle function, and (2) adaptive ankle assistance to make walking easier during sustained, high-intensity, or challenging tasks. The first specific aim is to quantify improvement in ankle muscle function and functional mobility following targeted ankle resistance gait training in ambulatory children with CP. The primary hypothesis for the first aim is that targeted ankle resistance training will produce larger improvements in lower-extremity motor control, gait mechanics, and clinical measures of mobility assessed four- and twelve-weeks post intervention compared to standard physical therapy and standard gait training. The second specific aim is to determine the efficacy of adaptive ankle assistance to improve capacity and performance during sustained, high-intensity, and challenging tasks in ambulatory children with CP. The primary hypothesis for the second aim is that adaptive ankle assistance will result in significantly greater capacity and performance during the six-minute-walk-test and graded treadmill and stair stepping protocols compared to walking with ankle foot orthoses and walking with just shoes. Both Specific Aims will explore the participant characteristics (e.g., age, gender, GMFCS level, walking speed, spasticity rating) that are associated with the greatest improvement in outcomes following each intervention to provide guidance for future clinical and at-home implementation. The proposed studies will establish fundamental knowledge on the ability for adaptive ankle interventions to treat walking impairment relative to standard of care in CP.

项目摘要 孩子有效行走的能力对于他们的身体健康和一般福祉至关重要。不幸的是，很多 脑瘫（CP）的儿童是小儿身体残疾的最常见原因，很难步行 并完成高强度的门诊任务。这导致患有CP的儿童从事习惯水平 体育锻炼远低于准则和没有残疾儿童的体育锻炼，这反过来促进 在许多次要情况下，包括代谢功能障碍和心血管疾病。有广泛 临床共识，即plantarflexor功能障碍是缓慢，效率低下和蹲伏的主要因素 CP中的模式； CP患者需要更有效的治疗方法和移动性辅助功能。 为了满足这一需求，该提案旨在评估一项整体策略，以解决来自 使用轻巧的双模式（辅助或电阻）可穿戴机器人装置中的CP中的plot骨反射器功能障碍。 该策略结合了两种完整的技术：（1）针对神经肌肉步态的靶向脚踝抗性 提供精确疗法以引起踝部肌肉功能的长期改善的训练，（2） 自适应脚踝的援助，使在持续，高强度或挑战任务中行走更轻松。第一个 具体目的是量化靶向踝关节后的踝关节功能和功能迁移率的改善 CP的门诊儿童的抵抗步态训练。第一个目标的主要假设是 脚踝耐药性训练将在低超高运动控制，步态力学和 与标准的物理相比，干预后的四个月和十二周的流动性临床测量结果评估了 治疗和标准聚会培训。第二个特定目的是确定自适应踝关节的效率 协助在持续，高强度和挑战任务中提高能力和绩效 患有CP的门诊儿童。第二个目标的主要假设是自适应踝关节援助将 在六分钟的步行测试和分级跑步机期间，能力和性能明显更高 与脚踝矫形器一起行走相比，Stagir垫脚协议和仅穿鞋行走。两者都具体 AIMS将探索参与特征（例如年龄，性别，GMFCS水平，步行速度，痉挛等级） 与每次干预后的结果的最大改善相关，以提供指导 用于未来的临床和家庭实施。拟议的研究将建立有关的基本知识 相对于CP中的护理标准，适应性踝关节干预措施的能力治疗行走障碍的能力。