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.

对前庭系统的损害是一个常见的问题，通常导致实质性残疾。在大多数情况下， 没有有效的药物来恢复前庭功能。相反，治疗的主要是前庭 康复以促进中央运动学习，从而增强前庭反射受损并补偿 对于前庭赤字。前庭疗法包括在家中进行的练习计划 在诊所中，由训练有素的前庭治疗师监督。凝视稳定性练习目标是前庭 反射并改善头部运动期间的视力；平衡练习有助于恢复良好的姿势控制。 尽管前庭疗法有效，但目前有几个关键的局限性。首先， 锻炼难度不能精确地校准每个患者的特定损害水平。第二， 遵守治疗不能轻易监测。最后，标准练习可能还不够 参与鼓励继续练习。该项目的目的是测试自定义的可行性 用于凝视稳定性练习的交互式前庭游戏。游戏是基于视觉歧视任务 测试头部旋转期间的视力。可以自定义和调整任务的困难 根据患者的初始功能水平和随着时间的流逝而逐步增长。 这项试点研究有两个目标。第一个目标将测试游戏在 前庭功能正常的健康个体中的前庭反射。该方法将基于 前庭适应的先前研究，其中前庭不匹配（头部运动）和视觉（运动的运动 观看场景）输入会导致前庭形式反射的增益发生了变化。在同一组中 受试者，视觉 - vestibular程度的增量增加了VOR增益的变化 将不匹配的单步适应方法与更传统的方法进行比较。这 假设是游戏将导致前庭反射增益发生变化，并且这种变化将是 通过增量策略更大。 第二个目的是测试一群前庭游戏的可行性和游戏经验 有外围前庭次数裁缝的退伍军人，他们正在接受或最近完成标准的退伍军人 前庭康复疗法。每个患者都会玩游戏，并提供他们的经验反馈。 我们还将记录相同的生理数据（在玩游戏前后）以评估 短期电动机响应。患者每周将参加一次比赛，每次比赛四个会议；这将提供 我们拥有有关随着时间的推移凝视稳定性改善的初步数据。来自此目标的数据将支持 与常规疗法相比，我们游戏的多道临床试验的未来应用。