van Hedel Hubertus J A, Bulloni Agata, Gut Anja
Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.
Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.
Front Rehabil Sci. 2021 Dec 10;2:788087. doi: 10.3389/fresc.2021.788087. eCollection 2021.
Rehabilitation therapy devices are designed for practicing intensively task-specific exercises inducing long-term neuroplastic changes underlying improved functional outcome. The Andago enables over-ground walking with bodyweight support requiring relatively high cognitive demands. In this study, we investigated whether we could identify children and adolescents with neurological gait impairments who show increased hemodynamic responses of the supplementary motor area (SMA) or prefrontal cortex (PFC) measured with functional near-infrared spectroscopy (fNIRS) when walking in Andago compared to walking on a treadmill. We further assessed the practicability and acceptability of fNIRS. Thirteen participants (two girls, 11 boys, age 8.0-15.7 years) with neurological impairments walked in the Andago and on a treadmill under comparable conditions. We measured hemodynamic responses over SMA and PFC during 10 walks (each lasting 20 s.) per condition and analyzed the data according to the latest recommendations. In addition, we listed technical issues, stopped the time needed to don fNIRS, and used a questionnaire to assess acceptability. Hemodynamic responses varied largely between participants. Participants with a typical hemodynamic response (i.e., increased oxygenated hemoglobin concentration) showed large cortical activations during walking in Andago compared to treadmill walking (large effect sizes, i.e., for SMA: = 0.91, = 4; for PFC: = 0.62, = 3). Other participants showed atypical (SMA: = 2; PFC: = 4) or inconclusive hemodynamic responses (SMA: = 5; PFC: = 4). The median time for donning fNIRS was 28 min. The questionnaire indicated high acceptance of fNIRS, despite that single participants reported painful sensations. Repetitive increased activation of cortical areas like the SMA and PFC might result in long-term neuroplastic changes underlying improved functional outcome. This cross-sectional pilot study provides first numbers on hemodynamic responses in SMA and PFC during walking in Andago in children with neurological impairments, reveals that only a small proportion of the participants shows typical hemodynamic responses, and reports that fNIRS requires considerable time for donning. This information is needed when designing future longitudinal studies to investigate whether increased brain activation of SMA and PFC during walking in Andago could serve as a biomarker to identify potential therapy responders among children and adolescents undergoing neurorehabilitation.
康复治疗设备旨在密集练习特定任务的运动，以诱导长期的神经可塑性变化，从而改善功能结果。Andago设备可在体重支持下进行地面行走，对认知要求相对较高。在本研究中，我们调查了能否识别出患有神经步态障碍的儿童和青少年，这些儿童和青少年在使用Andago行走时，与在跑步机上行走相比，通过功能近红外光谱（fNIRS）测量显示辅助运动区（SMA）或前额叶皮质（PFC）的血流动力学反应增加。我们还评估了fNIRS的实用性和可接受性。13名患有神经障碍的参与者（2名女孩，11名男孩，年龄8.0 - 15.7岁）在可比条件下在Andago和跑步机上行走。我们在每种条件下的10次行走（每次持续20秒）过程中测量了SMA和PFC的血流动力学反应，并根据最新建议分析了数据。此外，我们列出了技术问题，记录了佩戴fNIRS所需的时间，并使用问卷评估可接受性。参与者之间的血流动力学反应差异很大。具有典型血流动力学反应（即氧合血红蛋白浓度增加）的参与者在使用Andago行走时与在跑步机上行走相比，显示出较大的皮质激活（效应量较大，即对于SMA：= 0.91，= 4；对于PFC：= 0.62，= 3）。其他参与者显示出非典型（SMA：= 2；PFC：= 4）或不确定的血流动力学反应（SMA：= 5；PFC：= 4）。佩戴fNIRS的中位时间为28分钟。问卷显示对fNIRS的接受度较高，尽管有个别参与者报告有疼痛感。像SMA和PFC这样的皮质区域反复增加的激活可能会导致长期的神经可塑性变化，从而改善功能结果。这项横断面试点研究提供了患有神经障碍的儿童在使用Andago行走时SMA和PFC血流动力学反应的首批数据，揭示只有一小部分参与者显示出典型的血流动力学反应，并报告fNIRS佩戴需要相当长的时间。在设计未来的纵向研究以调查在使用Andago行走时SMA和PFC增加的脑激活是否可作为生物标志物来识别接受神经康复治疗的儿童和青少年中的潜在治疗反应者时，需要这些信息。
