Clinical trial NCT02246751: Case Series_Targeted Training for Trunk Control Cerebral Palsy
Official title: Effect of Targeted Training on Sensorimotor Control of Trunk Posture
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Cerebral Palsy
Keywords: postural control
Targeted Training
cerebral palsy
sensorimotor control
trunk segments
Lead sponsor: University of Hartford
Sponsor class: OTHER
First posted: 2014-09-23
Enrollment: 10
Sex: ALL
Minimum age (years): 2
Maximum age (years): 12
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: BASIC_SCIENCE

Brief summary: Little is known about how children with cerebral palsy (CP) use their sensory systems (touch, sense of body position, balance organs in the inner ear, vision) to help them achieve trunk control for independent sitting. If a child with CP does not achieve trunk control by 4 years of age their prognosis for motor skill development including walking is poor. Clinical researchers at The Movement Centre in Oswestry, England have developed a method called Targeted Training in which children train trunk control in small segments from the top down using a custom fit training device. This study aims to examine how children with moderate to severe CP use sensory information for trunk control before, during and after a program of Targeted Training.

Detailed description: One of the major challenges of motor control is to understand how the central nervous system controls the degrees of freedom of the body. This is particularly evident in cerebral palsy (CP), which is the most prevalent chronic childhood motor disability and is one of the most disabling and costly chronic disorders of children and adults. Deficits in postural control and sensorimotor integration are hallmarks of CP. Although postural control of the trunk for independent sitting creates the foundation for all other motor tasks, surprisingly little is known about how children with CP use sensory input to guide their development of upright control (which occurs in typically developing infants by 8 months of age). This lack of knowledge limits our ability to effectively assess and treat children with neuromotor deficits in trunk control.

The objectives of this project are to identify sensory reliance and sensory re-weighting in a study of children with moderate-to-severe CP (4-12 years of age) before and after Targeted Training for Trunk Control. A novel trunk support device will enable testing of participants who lack (or are still developing) stable sitting. In experiments, kinematics of the head and trunk will be measured. Sensory reliance and re-weighting will be identified from postural trunk responses to sensory conflict stimuli consisting of tilts of a visual surround and/or tilts of a surface which participants sit upon. Generally, participants with a high reliance on vestibular feedback will remain upright with respect to gravity during all tests; whereas a high reliance on cutaneous or visual feedback will produce trunk sway away from upright and toward the surface or visual surround tilt, respectively. To tease apart biomechanical, physical, and neurological contributions to trunk sway, sensorimotor integration modeling will be used to complement data interpretation.

Eligibility criteria: Inclusion Criteria:

* cerebral palsy
* age 2-12 years
* Gross Motor Function Classification System (GMFCS) Level III, IV or V

Exclusion Criteria:

* spinal fixation
* fixed scoliosis
* uncontrolled seizures

Primary outcomes:
measure: Change in sensory motor processes
timeFrame: 9 months and 1 and 3 months post training
Secondary outcomes:
measure: Change in gross motor functional skills (e.g. sitting, crawling, standing)
timeFrame: 9 months and 1 & 3 months post training
measure: Segmental Assessment of Trunk Control
timeFrame: 2, 4, 6, 8 and 9 months and 1 & 3 months post training
Other outcomes:
measure: Participation and Environment Measure for Children and Youth (CY) or Young Children (YC) (PEM-CY for children 5-12 years of age, or YC-PEM for children 2-5 years)
timeFrame: 9 months and 3 months post training
Locations:
city: West Hartford
country: United States
facility: Pediatric Balance Laboratory; University of Hartford;
state: Connecticut
Study officials:
affiliation: University of Hartford
name: Sandra Saavedra, MS, PT, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: University of Hartford
name: Adam Goodworth, MS, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Goodworth AD, Peterka RJ. Sensorimotor integration for multisegmental frontal plane balance control in humans. J Neurophysiol. 2012 Jan;107(1):12-28. doi: 10.1152/jn.00670.2010. Epub 2011 Sep 21.
citation: Goodworth AD, Peterka RJ. Contribution of sensorimotor integration to spinal stabilization in humans. J Neurophysiol. 2009 Jul;102(1):496-512. doi: 10.1152/jn.00118.2009. Epub 2009 Apr 29.
citation: Saavedra SL, van Donkelaar P, Woollacott MH. Learning about gravity: segmental assessment of upright control as infants develop independent sitting. J Neurophysiol. 2012 Oct;108(8):2215-29. doi: 10.1152/jn.01193.2011. Epub 2012 Jul 25.
citation: Butler PB, Saavedra S, Sofranac M, Jarvis SE, Woollacott MH. Refinement, reliability, and validity of the segmental assessment of trunk control. Pediatr Phys Ther. 2010 Fall;22(3):246-57. doi: 10.1097/PEP.0b013e3181e69490.