Telerehabilitation balance training for community dwelling older adults

社区老年人远程康复平衡训练

• 批准号: 1159635
• 负责人: Kathleen Sienko
• 金额: $ 29.79万
• 依托单位: Regents of the University of Michigan - Ann Arbor
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1159635&HistoricalAwards=false
• 关键词: Telerehabilitation; balance; training; community; dwelling

PI: SienkoProposal: 1159635There are substantial physical, emotional, and monetary costs associated with balance impairments and the falls that typically ensue from acute or chronic bouts of instability. Given the large percentage of older individuals that experience balance problems, and the desire of these individuals as a whole to live independent lives, decreasing fall risks is of paramount importance. Balance training reinforces the development of sensorimotor strategies to improve postural control and functional mobility which is crucial for fall prevention in the older adult population. Sensory augmentation is a technique of augmenting or replacing compromised sensory information through, for example, vibrotactile cues of body position. The PI and other investigators have demonstrated that sensory augmentation decreases trunk sway during real-time operation in a laboratory setting, and preliminary results suggest that persistent improvements in balance performance exist over time periods of minutes to hours following a small number of training sessions. While the results of a single case study have shown improvements that lasted up to eight weeks, no systematic studies have been performed to determine the influence of sensory augmentation training on long-term retention following a large number of balance training sessions. The three primary goals of the proposed work are as follows: 1) Develop and characterize the efficacy of a telerehabilitation cell phone based balance training tool intended for use in the homes of community dwelling older adults; 2) Test for the persistence of balance improvements for older adults who receive vibrotactile sensory augmentation during standard at-home balance training exercises (intervention group) compared with the persistence of improvements for those who perform these exercises without sensory augmentation (three control groups); and 3) Assess the effect of telemedicine-assisted balance training on exercise program compliance.Intellectual MeritDespite the success of sensory augmentation technologies over the past ten years in improving standing balance for persons with balance deficits in laboratory settings, significant scientific questions remain unanswered; specifically, whether or not the carry-over effects of training with a sensory augmentation technology exceed the carry-over effects of training alone. Furthermore, existing sensory augmentation technologies were developed for continual use over a short number of supervised sessions rather than periodic rehabilitative use over many unsupervised session; specifically, user-centric, easy-to-use, homebased technologies have yet to be developed, thereby impeding potential widespread adoption. This work will develop a sensory augmentation device that is appropriate for repeated at-home use by older adults, based on a cell phone platform. Appropriateness, defined by ease of use, clear and accurate exercise instruction, proper stability thresholds (i.e., when to give corrective feedback), and correct assessment of progress (i.e., when to move on to the next exercise), will be supported by co-creative design of the device by engineers, prospective older adult end users, and those administering rehabilitation (physical therapists) throughout the design process. Furthermore, we will utilize the device's intrinsic functionality for telemedicine to communicate detailed information regarding at-home exercise compliance to the study team for evaluation of the cell phone platform as a means to increase compliance during at-home rehabilitative programs.Broader ImpactsIf balance improvements following an extended series of sensory augmentation sessions are demonstrated to be retained for time periods of weeks to months, significant impact on quality of life for balance-impaired individuals may be achieved through decreased fall risk, increased confidence in performing daily tasks, and ability to remain in an independent living facility for a longer period of time. Furthermore, periodic maintenance of these balance improvements may be enabled in a straightforward, home-based, and low-cost manner through the development of the cell phone balance trainer proposed here. For family members and other caregivers, this technology is expected to reduce the amount of required balance-related assistance. From a clinical standpoint, the telerehabilitation functionality of this technology will provide physical therapists with a mechanism to monitor compliance with prescribed at home balance therapy programs and track patient progress over a large series of sessions. By facilitating and recording balance metrics for a large number of rehabilitative training sessions that can take place over a long period of time, the device will provide a means to gather data that currently is unknown regarding the relationship between number of training sessions with sensory augmentation and persistence of positive outcomes. This understanding is critical to achieve satisfactory rehabilitation.

PI：Sienkoproposa：1159635，与平衡损伤相关的物理，情感和货币成本是实质性的，通常是由于急性或长期不稳定的跌倒所带来的跌倒。鉴于很大一部分经历了平衡问题的老年人以及这些人对生活独立生活的渴望，降低跌倒风险至关重要。平衡训练增强了感觉运动策略的发展，以改善姿势控制和功能性迁移率，这对于老年人群体的预防至关重要。感官增强是一种通过人体位置的纤维骨架提示来增强或替换受损的感觉信息的技术。 PI和其他研究人员已经表明，在实验室环境中实时操作期间，感觉增强会减少后备箱的摇摆，而初步结果表明，在少量培训课程后，持续的平衡绩效持续改善会在几分钟到几个小时内存在。虽然单个案例研究的结果显示了持续长达八周的改进，但在大量的平衡培训课程后，尚未进行系统的研究来确定感觉增强培训对长期保留的影响。拟议工作的三个主要目标如下：1）开发和表征远离手机基于手机的平衡培训工具的功效，旨在用于社区住宅老年人的家中； 2）测试在标准的在家平衡训练练习（干预组）期间接受纤维状运动感觉增强的老年人的平衡改善的持续性，而对那些没有感官增强的练习的人的持久性进行了改进（三个对照组）； 3）评估远程医疗辅助平衡培训对锻炼计划合规性的影响。尽管在过去十年中，在过去十年中取得了成功的依据，但在改善实验室环境中平衡缺陷的人的站立平衡方面取得了成功，但重要的科学问题仍然没有答案；具体而言，是否使用感官增强技术的培训对培训的承担效果是否超过了仅培训的承担效果。此外，在许多无监督的会议上开发了涉及短暂的监督会议，而不是定期康复的使用，以持续使用现有的感官增强技术；具体而言，以用户为中心的，易于使用的自制技术尚未开发，从而阻碍了潜在的广泛采用。这项工作将开发一种感官增强设备，适用于基于手机平台的老年人重复使用的家庭用途。适当性，通过易用性，清晰，准确的锻炼教学，适当的稳定阈值（即何时提供纠正反馈）以及对进度的正确评估（即何时继续进行下一次锻炼）的正确评估，将由工程师，前瞻性的老年人最终的使用者和这些疗养（范围内的人）的共同设计来支持设备的共同设计。此外，我们将利用该设备的远程医疗的固有功能来传达有关在家练习团队评估手机平台的详细信息，以评估手机平台的一种手段，以增加在家康复过程中的依从性。可以通过降低跌倒风险，增加对日常任务的信心以及在独立生活设施中持续更长的时间来实现个人。 此外，通过在此处提出的手机余额培训师的开发，可以直接地，基于家庭和低成本的方式来定期维护这些余额改进。对于家庭成员和其他护理人员，这项技术有望减少与余额相关的援助的数量。从临床角度来看，该技术的远程居民功能将为物理治疗师提供一种机制，以监控对家庭平衡疗法规定的依从性，并跟踪患者在一系列课程中的进步。通过促进和记录余额指标，可以在很长一段时间内进行大量的康复培训课程，该设备将提供一种收集数据的方法，这些数据目前尚不清楚，培训会议数量具有感官增强和持续的积极成果。这种理解对于实现令人满意的康复至关重要。