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Improving crouch gait in children with CP through error augmentation

Award Number: R21HD116115
ORGANIZATION: NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 08/01/2024
PERIOD OF PERFORMANCE END DATE: 07/31/2026

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Improving crouch gait in children with CP through error augmentation - Children with cerebral palsy (CP) commonly exhibit pathologic gait patterns. Crouch gait, which is characterized by excessive stance phase knee flexion and may be accompanied by other deficits at the hip and/or ankle, is a common and debilitating gait disorder in children with CP. Left untreated or inadequately addressed, children with crouch gait will experience progressive gait deterioration, leading to a loss of ambulation in a large portion of adolescents with CP. While crouch gait is one of the most frequently observed gait deviations in children with CP, current intervention approaches including surgical and non-surgical have not been optimized to effectively address these key gait deficits in many children with CP. Specifically, surgical interventions, which typically target the hamstrings, remain the dominant interventions but outcomes are variable across different studies. Similarly, muscle strengthening programs have been developed to improve crouch gait, but studies showed inconsistent outcomes. Hamstrings botulinum toxin injections have been shown to modestly improve knee kinematics 2 weeks post injection, but the effects mostly disappeared by ~12 weeks, leading to a repeated injections of botulinum toxin during growth. Robotic assistance has been used to improve crouch gait in children with CP, although the effect was not retained after the removal of the assistance force. Thus, there is a clear need for the development of new interventions for improving crouch gait in children with CP, which requires a thorough examination of the motor learning mechanisms of the interventions. The overall objective of this study is to determine whether the application of a targeted resistance torque to the knee joint during overground walking will induce improvements in crouch gait in children with CP. Our central hypothesis is that increasing errors by applying a targeted perturbation torque to the knee joint during overground walking will facilitate motor learning and induce improvement in crouch gait in children with CP. Specifically, in Aim 1, we will determine the effect of error size on motor learning to improve crouch gait in children with CP. We expect to see a greater improvement in crouch gait in children with CP after applying a targeted resistance torque to the knee joint during the swing phase of gait in comparison to assistance torque during walking. In Aim 2, we will determine the effect of error variability on motor learning to improve crouch gait in children with CP. We expect to see a longer retention of improved crouch gait in children with CP after applying a varied resistance torque to the knee joint in comparison to a constant resistance torque during overground walking. Results from this study are expected to demonstrate the effect of error size and error variability on the motor learning of improved crouch gait in children with CP. The results of this study are expected to have an important positive impact by providing a strong justification for the development of an effective intervention for improving crouch gait in children with CP that is more effective than the best physical interventions currently available.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $189,035 )
2025	2025	REHABILITATION INSTITUTE OF CHICAGO	355 E ERIE ST	CHICAGO	IL	60611	COOK	USA	Child Health and Human Development Extramural Research	000	2	6/27/2025	NON-COMPETING CONTINUATION	$189,035
														Subtotal = $189,035

Issue Date FY: 2024 ( Subtotal = $240,451 )
2024	2024	REHABILITATION INSTITUTE OF CHICAGO	355 E ERIE ST	CHICAGO	IL	60611	COOK	USA	Child Health and Human Development Extramural Research	000	1	7/23/2024	NEW	$240,451
														Subtotal = $240,451

Grand Total All Awards = $429,486

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Improving crouch gait in children with CP through error augmentation

Award Number: R21HD116115

ORGANIZATION: NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 08/01/2024

PERIOD OF PERFORMANCE END DATE: 07/31/2026

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