PROJECT SUMMARY/ABSTRACTCerebral palsy (CP) is a movement disorder characterized by deficits in strength and coordination. Thesubsequent gait deficits associated with CP lead to a progressive decline in function due to the secondary effectsof having a movement disorder during development. Interventions seeking to mitigate these effects have onlybeen partially successful because they have not addressed both muscle recruitment (i.e. strength) andcoordination within one top-down therapy. Recently we developed a wearable adaptive resistance therapy thatis able to address both of these aspects with promising results for improving neuromuscular control metabolicefficiency and functional mobility. To maximize the efficacy of this intervention two important considerationsmust be addressed: 1) What is the appropriate level of resistance to prescribe for maximizing neuromuscularresponse as children acclimate to the intervention? 2) What is the overall trajectory in training effects from thistherapy and are these effects maintained after the therapy stops? In addition there is limited understanding ofthe underlying mechanisms of observed improvements in neuromuscular control with this novel therapy. Thehigh levels of co-contraction in children with CP have been attributed to deficits in stretch reflex modulation butwhether or not improvements in reflex modulation are responsible for the observed decreases in ankle co-contraction with wearable adaptive resistance has not yet been explored.The main objective of this research proposal is to further investigate a wearable adaptive resistance interventionfor children with CP. The first specific aim is to assess the acclimation to adaptive resistance by measuring theneuromuscular response of children with CP across five visits as a low moderate and high level of resistanceis applied while walking. The second specific aim to quantify the time-course and maintenance of training effectsfor the ten participants by measuring changes in neuromuscular control (i.e. co-contraction about the ankle andthe complexity of neural control) and reflex modulation (via H-reflex testing) across five training visits withwearable adaptive resistance as well as a two-week post-training follow-up visit. Our primary outcome variablefor Aim 1 ix plantar flexor activation magnitude relative to baseline while walking with resistance. Our primaryoutcome variables for Aim 2 are ankle co-contraction level neural control complexity (as determined by a musclesynergy analysis) and reflex modulation (via H-reflex testing) while walking without resistance.The completion of this work will improve our understanding of wearable adaptive resistance includingfundamental knowledge about appropriate training levels and underlying mechanisms with the ultimate goal ofdeveloping an intervention that can enable physical activity for children with CP allowing them to engage withtheir peers and environment for healthy development and functional independence.