小儿脑瘫运动障碍评估及神经肌肉控制策略研究

Cerebral palsy (CP) is a syndrome caused by non-progressive brain damage and developmental defects during the period from pregnancy to infancy. Early diagnosis and intervention is the most effective way in improving rehabilitation therapy of the children with CP. Due to the deficiency of systematic study on movement dysfunction and neuromuscular control mechanism of infantile CP, the currently available methods for screening and assassment of CP routinely rely on the experience of clinical professionals, and their subjective feelings are prone to produce controversy with relatively high incidence of missed diagnosis or misdiagnosis. With the purpose to explore the scientific methods for early screening and rehabilitation assessment of CP, this proposal aims at a systematic study on movement dysfunction and neuromuscular control mechanism of infantile CP based on advanced surface electromyography (sEMG) measurement and processing technology. By the latest technical means of sEMG decomposition, sEMG pattern recognition and muscle synergy analysis, two research plans are proposed from the view of abnormal reflexes, abnormal muscle activities and abnormal muscle synergy existing in children with CP. One is to explore the sEMG-based quantitative methods for the early CP screening and movement dysfunction assessment. The other is to explore the neuromuscular control strategy of the abnormal gait of children with CP. The launching of this study will facilitate early diagnosis and rehabilitation therapy of infantile CP, and it also has great significance in improving the prognosis of children with CP.

脑性瘫痪是自受孕开始至婴儿期非进行性脑损伤和发育缺陷所导致的综合症，超早期诊断和早期干预是提高脑瘫患儿预后的决定因素。目前临床广泛使用的神经行为筛查法和康复评估方法主要依赖于医生的经验与主观感觉，漏诊或误诊的发生率高，同时缺乏对小儿脑瘫运动功能障碍及神经肌肉控制机理的系统性研究。本课题旨在采用先进的表面肌电采集与处理技术，借助肌电分解、肌电模式识别和肌肉协同机制研究领域的最新研究成果，以脑瘫患儿存在的反射异常、肌肉活动异常和步态协同异常为研究对象，一方面探索基于肌电的脑瘫早期筛查和脑瘫患儿运动功能障碍评估方法，另一方面对脑瘫患儿异常步态的神经肌肉控制策略展开研究，为早期脑瘫筛查和脑瘫患儿的康复治疗探索更为客观科学的方法手段。本研究的开展将有助于提高脑瘫的早期诊断和康复治疗水平，研究成果对提高脑性瘫痪儿童的预后具有重要的临床应用前景。

本课题采用肌电分解、肌电模式识别和肌肉协同分析等先进的表面肌电处理技术，以小儿脑性瘫痪为研究对象，对脑瘫运动障碍评估、脑瘫异常神经肌肉控制机制、脑瘫肌肉疲劳等关键问题展开了深入研究，取得了以下重要研究成果：（1）在聚酰亚胺柔性材料上设计并实现了一种新型的有源表面肌电电极阵列，保证了脑瘫患儿表面肌电信号采集质量；（2）从运动神经元发放特性、步态肌电模式稳定性、步态肌电的多尺度特性、步态肌肉协同异常、上肢运动肌肉协同异常等角度，验证了对脑瘫患儿运动障碍进行客观量化评估的可行性，提出了有效的脑瘫患儿异常步态评估和粗大运动功能量化评估方案；（3）通过对步态模式下各肌肉间的关联程度即共驱动特性、上肢多任务肌肉协同、下肢步态肌肉协同的研究，发现脑瘫患儿的肌肉协同结构与数目异常与神经损伤程度有关，且协同模式的异常可用于解释患者异常运动模式的原因；（4）在日常康复训练任务模式下的肌疲劳特性研究中，发现脑瘫患儿与健康受试者的肌疲劳差异性可反映脑瘫患儿神经肌肉系统中存在的复杂病变，如大型运动单位的减少、较高的运动单位发放同步性等。（5）开发了一套脑瘫患者上肢运动功能康复训练和评估系统，实现了基于上肢运动的游戏控制训练和反馈策略。本课题取得的研究成果有助于揭示脑性瘫痪病理，提高脑瘫的临床治疗和康复评估水平，对提高脑性瘫痪儿童的预后具有重要的临床应用前景。