Date on Master's Thesis/Doctoral Dissertation

5-2017

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Physiology and Biophysics

Degree Program

Physiology and Biophysics, PhD

Committee Chair

Ovechkin, Alexander

Committee Co-Chair (if applicable)

Behrman, Andrea

Committee Member

Behrman, Andrea

Committee Member

Joshua, Irving

Committee Member

Maldonado, Caludio

Committee Member

Howland, Dena

Committee Member

Lominadze, David

Committee Member

Terson de Paleville, Daniela

Author's Keywords

spinal cord injury in children; trunk motor control; respiratory motor control; development; pulmonary function testing in children; motor control

Abstract

Independent sitting is a major milestone and is also a prerequisite for optimal performance of activities of daily living (ADLs). Development of sitting posture control is a dynamic process involving control of degrees of freedom of head and trunk. Traditionally, trunk has been modeled as a single unit (segment). However, recent studies have suggested that it is made up multiple spinal units, controlled by a combination of trunk muscles. During typical development, posture control of trunk is different for different trunk segments. This motor development of trunk control is a complex process due to constant interaction between the nervous system and environment. Any interruption in the normal processes would further complicate it, affecting the typical development of the child. Poor trunk control and respiratory complications are characteristic features among children, adolescents, and adults with neuromuscular disorders. Pediatric spinal cord injuries (SCIs) also pose a unique challenge compared to SCI in adults because of the continuous physical and cognitive development. Children with SCI exhibit deficits in trunk motor control, which impair their ability to sit or ambulate. These motor deficits can lead to compensatory changes in other segments of the body, which cause further deviations from typical postures. Trunk muscles have the dual function of supporting both, breathing and trunk posture. Therefore, in children with SCI, impairment of posture control will also affect respiratory functions. Depending on level and severity of the injury, can potentially lead to severe respiratory insufficiency. Symptoms of respiratory insufficiency are highly correlated with the level and severity of spinal lesions. Injury at higher cervical and thoracic cord levels causes paresis and paralysis of most of the respiratory muscles, which increase the workload of breathing. As a result, respiratory complications are the leading cause of death among children with SCI. Therefore, impairment of posture control following SCI also affects respiratory functions. Lack of appropriate tools to evaluate trunk motor control following SCI restricts the ability to understand its development and therefore it is a challenge to design treatments and strategies to slow down or prevent the progress of long-term effects of SCI in children. In this dissertation, we studied the postural control using a Segmental Assessment Trunk Control (SATCo) test and respiratory motor control using Respiratory Motor Control Assessment (RMCA) protocol in typically developing (TD) children and compared their results to age-matched children with SCI.