Pilot evaluation of changes in motor control after wearable robotic resistance training in children with cerebral palsy

Conner, Benjamin C.; Schwartz, Michael; Lerner, Zachary F.

doi:10.1016/j.jbiomech.2021.110601

Cited by 29 publications

(27 citation statements)

References 41 publications

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“…Interventions that can improve these factors may improve metabolic power. This was recently observed in a pilot study by Conner et al A small group of children with CP improved DMC by 7% and reduced metabolic power by 29% after resistance training with an ankle exoskeleton (Conner et al, 2021). According to our results, metabolic power should decrease by 1-11% for a 7% improvement in DMC.…”

Section: Discussionmentioning

confidence: 58%

“…According to our results, metabolic power should decrease by 1-11% for a 7% improvement in DMC. These estimates are lower than Conner et al, but Conner et al have also shown that their exoskeleton training results in mechanically more efficient gait (Conner et al, 2021) and significantly greater muscle strength (Conner et al, 2020). Since our model does not include a metric of gait kinetics, this could have affected our causal effect estimates.…”

Section: Discussionmentioning

confidence: 71%

“…Conner et al (2020) recently showed that resistance training via ankle exoskeletons significantly improved muscle strength and reduced metabolic power in children with CP. Further, their exoskeleton training also caused significant improvements in motor control and walking mechanics (Conner et al, 2021). Prior studies of resistance training have demonstrated mixed results (MacPhail and Kramer, 1995; Damiano and Abel, 1998; Eagleton et al, 2004; Ryan et al, 2020), suggesting that muscle weakness may also be a cause of high metabolic power.…”

Section: Introductionmentioning

confidence: 99%

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Causal Effects Contributing to Elevated Metabolic Power During Walking in Children Diagnosed with Cerebral Palsy

Gill

Steele

Donelan

et al. 2022

Preprint

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Metabolic power (net energy consumed while walking per unit time) is, on average, two-to-three times greater in children with cerebral palsy (CP) than their typically developing peers, contributing to greater physical fatigue, lower levels of physical activity and greater risk of cardiovascular disease. The goal of this project was to identify the total causal effects of clinical factors that may contribute to high metabolic power demand in children with CP. We included children who 1) visited Gillette Children's Specialty Healthcare for a quantitative gait assessment after the year 2000, 2) were formally diagnosed with CP, 3) were classified as level I-III under the Gross Motor Function Classification System and 4) were 18 years old or younger. We created a structural causal model that specified the assumed relationships of a child's gait pattern (i.e., gait deviation index, GDI) and common impairments (i.e., dynamic and selective motor control, strength, and spasticity) with metabolic power. We estimated causal effects using Bayesian additive regression trees, adjusting for factors identified by the causal model. There were 2157 children who met our criteria. We found that a child's gait pattern, as summarized by the GDI, affected metabolic power approximately twice as much as the next largest contributor. Selective motor control, dynamic motor control, and spasticity had the next largest effects. Among the factors we considered, strength had the smallest effect on metabolic power. Our results suggest that children with CP may benefit more from treatments that improve their gait pattern and motor control than treatments that improve spasticity or strength.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

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Causal Effects Contributing to Elevated Metabolic Power During Walking in Children Diagnosed with Cerebral Palsy

Gill

Steele

Donelan

et al. 2022

Preprint

Self Cite

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“…Understanding whether individuals with neurologic injury can consistently alter synergy complexity and improve movement, or how interventions can support sustained changes in control remain active and important areas for future investigations. While recent literature has indicated that providing richer afferent information via spinal stimulation or sensorimotor biofeedback may promote greater supraspinal involvement and, therefore, more flexible synergy recruitment during movement, studies are still ongoing (Cheng et al, 2019; Conner et al, 2021; Gad et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

“…Because available interventions for these populations often fail to alter synergies (Shuman et al, 2019), developing new paradigms to directly improve synergy recruitment has become a critical priority in gait rehabilitation. This has spurred the development of biofeedback and robotic gait training paradigms which have thus far yielded promising, yet still highly variable results (Booth et al, 2019; Conner et al, 2021; Rouston et al, 2013). As such, mapping the relationship between biomechanical constraints and synergy modulation may further inform the design of these systems by highlighting gait parameters that can be directly targeted to produce greater and more consistent changes in motor control.…”

Section: Introductionmentioning

confidence: 99%

Muscle synergies are flexibly recruited during gait pattern exploration using motor control-based biofeedback

Spomer

Yan

Schwartz

et al. 2022

Preprint

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Understanding how the central nervous system coordinates diverse motor outputs has been a topic of extensive investigation. While it is generally accepted that a small set of synergies underlies many common activities, such as walking, whether synergies are equally robust across a broader array of gait patterns or can be flexibly modified remains unclear. Here, we evaluated the extent to which synergies changed as nondisabled adults (n = 14) explored gait patterns using custom biofeedback. Secondarily, we used Bayesian Additive Regression Trees to identify factors which were predictive of synergy modulation. Participants performed 41.1 ± 8.0 gait patterns using biofeedback, during which synergy recruitment changed depending on the type and magnitude of gait pattern modification. Specifically, a consistent set of synergies was recruited to accommodate small deviations from baseline, but additional synergies emerged for larger gait changes. Synergy complexity was similarly modulated; complexity decreased for 82.6% of the attempted gait patterns, however, distal gait mechanics were highly predictive of these changes. In particular, greater ankle dorsiflexion moments and knee flexion through stance, as well as greater knee extension moments at initial contact corresponded to a reduction in synergy complexity. Taken together, these results suggest that the central nervous system preferentially adopts a low-dimensional, largely invariant control strategy, but can modify that strategy to produce diverse gait patterns. Beyond improving understanding of how synergies are recruited during gait, study outcomes may also help identify parameters that can be targeted with interventions to alter synergies and improve motor control following neurological injury.

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Soleus H-reflex modulation in cerebral palsy and its relationship with neural control complexity: a pilot study

et al. 2022

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Pilot evaluation of changes in motor control after wearable robotic resistance training in children with cerebral palsy

Cited by 29 publications

References 41 publications

Causal Effects Contributing to Elevated Metabolic Power During Walking in Children Diagnosed with Cerebral Palsy

Causal Effects Contributing to Elevated Metabolic Power During Walking in Children Diagnosed with Cerebral Palsy

Muscle synergies are flexibly recruited during gait pattern exploration using motor control-based biofeedback

Soleus H-reflex modulation in cerebral palsy and its relationship with neural control complexity: a pilot study

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