Learn2Walk (Brain meets spine: the neural origin of toddler*s first step) PART II - Children with cerebral palsy

Walking is a functional activity that crucially contributes to an individual*s
ability to participate fully in society. Cerebral palsy (CP) is a
non-progressive chronic disorder involving poor motor control, spasticity,
paralysis, and other neurological problems caused by lesions in an immature
brain, which affects motor development and leads to walking problems. Gait
analysis of older children with CP have been thoroughly investigated, but the
development of proper locomotor primitives (also known as muscles synergies) as
well as the interplay between brain and muscular activity in these children is
entirely unexplored. It has been shown that the coordinated muscle activation
in neonate stepping is described by two locomotor primitives that are retained
throughout development, and supplemented by two new ones that become manifest
in Typically Developing (TD) children during the first independent steps. It*s
also known that limited motor primitives are a reflection of different
pathologic gait patterns as seen in CP. However, it is unknown how the
development of locomotor primitives is related to topological changes of neural
functional networks, the neural network dynamics and the cortico-muscular
coherence in both TD and CP children. Unveiling these mechanisms of
(pathological) motor development might open up new
paradigms for early intervention in CP.

In order to define these new paradigms, we will need to understand how the
current treatment protocols effect on locomotor primitives, neural networks and
cortico-muscular coherence during walking in children with CP.

The overall aim of the study is to characterize the underlying mechanisms of
the development of walking in children with CP, through the combined
measurement of electromyography (EMG) and electroencephalography (EEG). We will
in particular identify the muscular and neural aspects responsible for the
development of new (if any) locomotor primitives to obtain a detailed
understanding of the interplay between brain and muscular activity underlying
this process. In addition, we will investigate the dynamical and mechanical
aspects of the pathologic gait.

Our second objective is to assess the effect of orthoses,BTA injections, SDR or
physical therapy have an effect on the muscular and neural aspects of the gait
pattern of children with CP.

Experimental longitudinal study (5 sessions in 2 years).

pre-post treatment study (2 sessions in 12 months)

For each subject, the full experiment will take a maximum of two to five
sessions of approximately 2.5 hours, divided over 2 years. In that time
children will undergo kinematics, EMG and EEG setup and they will walk on a
treadmill and overground. During treadmill walking we will use a special
pediatric treadmill with handle-bars in front and on the side of the child. To
protect participants from falling, the parent or experimenter will support the
very young and/or unstable children by arms or trunk. Total risk of side
effects or adverse events during, or after the assessments and during walking
on the treadmill is negligible. Periods of rest will be allowed between the
measurements to prevent fatigue or accommodate focus of concentration.
Furthermore, the procedure will be immediately paused as soon as the child
shows any form of distress, and discontinued if the distress does not
disappear. Parents will also be made aware that they are free to withdraw from
the study at any time without giving a reason.