Dual-Tasking for Individuals with Lower Limb Amputation: Exploring the Relationship to Falls and Instrumental Activities of Daily Living

下肢截肢者的双重任务：探索跌倒与日常生活工具性活动的关系

• 批准号: 10312226
• 负责人: Laura Anita Swink
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-12-01 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10312226
• 关键词: Activities of Daily Living; Adult; Age; Amputation; Attention; Award; Awareness; Behavior Therapy; Behavioral Mechanisms; Blood Vessels; Categories; Clinical; Clinical Research; Cognition; Cognitive; Communities; Data; Development; Educational Intervention; Elderly; Etiology; Fall prevention; Foundations; Future; Gait; Gait speed; Goals; Health; Individual; Infrastructure; Intervention; Intervention Trial; Interview; Life; Lower Extremity; Measures; Medical; Mentors; Methods; Motor; Oral; Outcome; Parents; Participant; Pathology; Patient Self-Report; Performance; Persons; Phase; Population; Population Intervention; Process; Psyche structure; Quality of life; Recurrence; Rehabilitation therapy; Reporting; Research; Research Design; Research Personnel; Resources; Risk; Risk Factors; Role; Route; Self Efficacy; Speed; Structure; Task Performances; Telephone; Time; Training; Training Programs; Translating; Veterans; Walking; base; cognitive load; cognitive performance; cognitive task; cohort; comorbidity; design; disability; experience; fall risk; falls; high risk; improved; instrumental activity of daily living; limb amputation; meter; military veteran; novel; physical conditioning; primary outcome; programs; response; skills

Veterans with lower limb amputation (LLA), particularly those due to vascular etiology, are at high risk to fall. Part of this high fall risk could be due to their reported need to focus on each individual step when walking, which makes adding a concurrent task (e.g., carrying an object) highly demanding. Everyday activities typically require dual-tasking; therefore, problems with dual-task performance during daily life could account for the high number of falls for individuals with dysvascular LLA. In the older adult population, dual-task training (i.e., practicing two simultaneous tasks) improves simulated dual-task performance. Improving dual-task performance could reduce fall risk during every day activities (e.g., getting dressed, moving while washing dishes, talking on the phone, or folding laundry). Veterans with dysvascular LLA need programs to improve daily activity performance, as they often experience a myriad of comorbidities and medical complexities impacting participation in everyday life. Before a dual-task training program can be developed, preliminary relationships to dual-task performance need to be examined in this population. The long-term goal of this line of research is to implement novel dual-task interventions in the context of functionally relevant and ecologically valid tasks for Veterans with dysvascular LLA. The initial steps toward the long-term goal are proposed with this study, in three aims, using an observational cohort and concurrent parallel mixed-methods design: (1) compare the proportion of participants experiencing mutual interference during dual-task walking between fall groups (Non-fall vs. Recurrent Fall), (2) identify the relationships dual-task effects have with self-reported participation in activities of daily living, and (3) qualitatively explore the effects of dual-tasking on self-reported fall or near-fall dual-task scenarios. The quantitative phase (Aims 1 + 2) will identify how dual-task performance relates to falls and participation in activities of daily living (n=30 Veterans with dysvascular LLA); dual-tasking will be measured with basic walking gait and cognitive tasks, as typically measured with other older adult populations. Dual-task performance will be measured using dual-task effects, a calculation of the difference in gait and cognitive performance changes between the single and dual-task conditions. Gait speed (meters/second) will be measured and cognition will be quantified based on serial subtractions (corrected response ratio considering total responses and mistakes). The qualitative phase (Aim 3) will engage Veterans with LLA (n=up to 30) to explore underlying cognitive and behavioral mechanisms that contribute to increased risk for falls. This CDA1 proposal is supported by infrastructure and resources from a parent Merit trial that is led by the primary mentor. The data gathered from this study will inform the development of a dual-task training intervention trial (future CDA2 study) for Veterans with dysvascular LLA. During the award period, the candidate will capitalize on dedicated research time to develop clinical, research, and professional skills essential for a future role as a VA independent investigator. Specifically the candidate will develop greater expertise in: research design and analysis (quantitative and qualitative), clinical training for Veterans with LLA, behavioral interventions, and scientific presentation (written and oral).

下肢截肢（LLA）的退伍军人，尤其是由于血管病因的人，跌倒的风险很高。 这种高跌倒风险的一部分可能是由于他们据报道在行走时需要专注于每个单个步骤的需求， 这使得添加同时任务（例如，携带一个对象）高度要求。日常活动通常 需要双任务；因此，日常生活中双重任务性能的问题可能会说明高 血管LLA患者的跌倒次数。在老年人中，双重任务培训（即 练习两个同时任务）改善了模拟的双任务性能。改进双重任务 性能可以降低每天活动中的跌倒风险（例如，穿衣服，洗涤时移动 菜，打电话或折叠洗衣）。血管血管LLA的退伍军人需要计划 日常活动表现，因为他们经常经历无数合并症和医学复杂性 影响日常生活的参与。在制定双任务培训计划之前， 在该人群中需要检查与双任务绩效的关系。这条线的长期目标 研究是在功能相关和生态上实施新颖的双任务干预措施 血管血管LLA的退伍军人的有效任务。提出了长期目标的最初步骤 这项研究在三个目标中使用了观测组和并发的平行混合方法设计：（1） 比较在双重任务中经历相互干扰的参与者的比例 秋季组（非垂坠与经常性跌倒），（2）确定双重任务效应与自我报告的关系 参与日常生活的活动，（3）定性地探索双任务对自我报告的影响 秋季或近乎差的双任务场景。定量阶段（目标1 + 2）将确定双重任务的方式 表现与跌倒和日常生活活动有关（n = 30名血管血管LLA的退伍军人）； 双重任务将通过基本的步态和认知任务来衡量，通常与其他 老年人。双重任务性能将使用双任务效应进行测量，计算 单个任务和双任务条件之间的步态和认知性能变化的差异。步态速度 （米/第二秒）将根据串行减法进行测量，并将认知（校正） 响应率考虑总响应和错误）。定性阶段（AIM 3）将吸引退伍军人 使用LLA（n = 30）来探索有助于增加的认知和行为机制 跌倒的风险。该CDA1提案得到了父母功绩审判的基础架构和资源的支持 由主要导师领导。从这项研究中收集的数据将告知开发双重任务培训 干预试验（未来CDA2研究）对血管血管LLA的退伍军人。在奖励期内， 候选人将利用专门的研究时间来发展临床，研究和专业技能 作为VA独立研究员的未来角色至关重要。特别是候选人将发展更大 专业知识：研究设计和分析（定量和定性），对退伍军人的临床培训 LLA，行为干预和科学表现（书面和口头）。