Computerized game-based vestibular rehabilitation: assessment of feasibility and motor learning

基于计算机游戏的前庭康复：可行性评估和运动学习

• 批准号: 10290300
• 负责人: MARK F. WALKER
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-12-01 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10290300
• 关键词: Affect; Brain; Clinic; Clinical; Clinical Trials; Custom; Data; Development; Diabetes Mellitus; Discrimination; Disease; Enrollment; Equilibrium; Exercise; Eye; Feedback; Functional disorder; Future; General Population; Goals; Head; Head Movements; Home; Image; Impairment; Individual; Learning; Monitor; Motion; Motion Sickness; Motor; Musculoskeletal Equilibrium; Patients; Performance; Peripheral; Pharmaceutical Preparations; Physical activity; Physiological; Pilot Projects; Play; Positioning Attribute; Process; Protocols documentation; Quality of life; Reflex action; Rehabilitation therapy; Research; Retina; Rotation; Stroke; Supervision; System; Testing; Time; Training; Translations; Traumatic Brain Injury; Veterans; Vision; Visual; Visual Acuity; Visual Motion; Work; base; computer game; computerized; conventional therapy; design; disability; exercise program; experience; experimental study; fall risk; feasibility testing; flexibility; functional disability; game development; gaze; healthy volunteer; improved; improved functioning; inner ear diseases; innovation; interactive tool; motor learning; novel; recruit; response; retinal imaging; therapeutic effectiveness; therapeutic evaluation; tool; vestibular reflex; vestibulo-ocular reflex; visual-vestibular

Damage to the vestibular system is a common problem that often leads to substantial disability. For most cases, there is no effective medication to restore vestibular function. Instead, the mainstay of treatment is vestibular rehabilitation to promote central motor learning that will enhance impaired vestibular reflexes and compensate for the vestibular deficit. Vestibular therapy consists of a program of exercises that are performed at home and in the clinic, supervised by a trained vestibular therapist. Gaze stability exercises target the vestibulo-ocular reflex and improve vision during head movement; balance exercises help to restore good postural control. Although vestibular therapy is effective, there are several key limitations as it is currently practiced. First, the difficulty of exercises cannot be precisely calibrated to each patient's specific level of impairment. Second, compliance with therapy cannot be easily monitored. Finally, standard exercises may not be sufficiently engaging to encourage continued practice. The objective of this project is to test the feasibility of a customized interactive vestibular game for gaze stability exercises. The game is based on a visual discrimination task that tests visual acuity during rotations of the head. The difficulty of the task can be customized and adjusted incrementally based on the patient's initial level of function and progress over time with treatment. There are two aims of this pilot study. The first aim will test the ability of the game to induce plasticity in the vestibulo-ocular reflex in healthy individuals with normal vestibular function. The approach will be based on prior studies of vestibular adaptation, in which a mismatch of vestibular (head motion) and visual (motion of the scene being viewed) inputs leads to a change in the gain of the vestibulo-ocular reflex. In the same group of subjects, the change in VOR gain provoked by an incremental increase in the degree of visual-vestibular mismatch will be compared to that induced by the more traditional approach of single-step adaptation. The hypothesis is that the game will lead to a change in vestibulo-ocular reflex gain, and that this change will be larger with the incremental strategy. The second aim will be to test the feasibility and playing experience of the vestibular game in a group of veterans with peripheral vestibular hypofunction, who are undergoing or who have recently completed standard vestibular rehabilitation therapy. Each patient will play the game and will provide feedback of their experience. We will also record the same physiological data (vestibulo-ocular reflex gain before and after playing) to assess short term motor response. The patients will play the game once a week for four sessions each; this will provide us with preliminary data regarding improvements in gaze stability over time. The data from this aim will support a future application for a multisession clinical trial of our game in comparison to conventional therapy.

前庭系统损伤是一个常见问题，通常会导致严重残疾。对于大多数情况， 没有有效的药物可以恢复前庭功能。相反，治疗的主要方法是前庭治疗 康复以促进中枢运动学习，从而增强受损的前庭反射并进行代偿 对于前庭缺陷。前庭疗法包括在家中进行的一系列锻炼，以及 在诊所，由经过培训的前庭治疗师监督。凝视稳定性练习针对前庭眼 头部运动时反射并改善视力；平衡练习有助于恢复良好的姿势控制。 尽管前庭疗法是有效的，但目前的实践存在几个关键限制。首先， 锻炼的难度无法根据每个患者的具体损伤程度进行精确校准。第二， 治疗的依从性无法轻易监测。最后，标准练习可能还不够 参与以鼓励继续练习。该项目的目的是测试定制的可行性 用于凝视稳定性练习的交互式前庭游戏。该游戏基于视觉辨别任务 测试头部旋转时的视力。任务难度可自定义调整 根据患者的初始功能水平和治疗过程中的进展情况逐步进行。 这项试点研究有两个目的。第一个目标将测试游戏诱导可塑性的能力 具有正常前庭功能的健康个体的前庭眼反射。该方法将基于 先前对前庭适应的研究，其中前庭（头部运动）和视觉（大脑运动）不匹配 正在观看的场景）输入会导致前庭眼反射增益的变化。在同一组中 受试者视觉前庭程度的逐渐增加引起 VOR 增益的变化 失配将与更传统的单步适应方法引起的失配进行比较。这 假设游戏会导致前庭眼反射增益的变化，并且这种变化将 增量策略更大。 第二个目标是在一组人中测试前庭游戏的可行性和游戏体验。 患有外周前庭功能减退症、正在接受或最近完成标准治疗的退伍军人 前庭康复治疗。每个患者都会玩游戏并提供他们的体验反馈。 我们还将记录相同的生理数据（演奏前后的前庭眼反射增益）来评估 短期运动反应。患者每周玩一次游戏，每次玩四次；这将提供 我们提供了有关随着时间的推移凝视稳定性改善的初步数据。该目标的数据将支持 与传统疗法相比，我们的游戏的多阶段临床试验的未来应用。