Proactive and reactive perturbation training to reduce falls and improve gait stability in people with chronic stroke

主动和反应性扰动训练可减少慢性中风患者跌倒并提高步态稳定性

• 批准号: 10380567
• 负责人: JESSE C. DEAN
• 金额: $ 32.16万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10380567
• 关键词: Address; American; Balance training; Behavior; Clinical; Clinical Trials; Communities; Control Groups; Development; Effectiveness; Ensure; Environment; Equilibrium; Fall prevention; Gait; Goals; Incidence; Intervention; Intervention Studies; Investigation; Laboratories; Leg; Link; Location; Locomotor training; Measures; Mechanics; Methods; Motion; Movement; Nature; Neuromechanics; Outcome; Patients; Pelvis; Persons; Play; Population; Posture; Quality of life; Randomized; Rehabilitation therapy; Research; Resources; Role; Specificity; Stroke; Stroke prevention; Techniques; Training; Walking; Width; Work; balance testing; base; care costs; chronic stroke; clinically relevant; design; experience; fall risk; falls; fear of falling; foot; gait rehabilitation; high risk; improved; innovation; insight; knowledge of results; novel; post stroke; pressure; prevent; rehabilitation paradigm; resilience; response; stroke rehabilitation; stroke survivor; success; therapy development; walking stability

PROJECT SUMMARY / ABSTRACT Following a stroke, deficits in independent mobility are a primary contributor to decreased quality of life, as many people with chronic stroke (PwCS) are prevented from returning to their prior levels of activity participation or involvement in the community. A major cause of mobility deficits is gait instability, which can increase the risk of falls and limit independent function. While several common rehabilitation methods (e.g. locomotor training, traditional balance training, strengthening) can improve some aspects of function, they have failed to address fall incidence among PwCS. In part, this lack of success is likely due to current interventions not being targeted toward the specific mechanisms causing post-stroke gait instability. A long-term goal of this research is to develop a toolbox of mechanism-based interventions to improve various aspects of post-stroke function. As a step toward this goal, the objective of the present proposal is to determine whether targeted perturbation training can reduce falls in PwCS by improving gait stability. While perturbation training has previously been used to reduce fall risk in other clinical populations, it has thus far been unsuccessful at doing so among PwCS. This lack of success may be due to the nature of the applied perturbations, which are traditionally designed to elicit discrete Reactive responses to avoid a loss of balance. In contrast, the present proposal will apply mechanical perturbations designed to elicit Proactive adjustments in the neuromechanical strategies used to ensure walking stability with every step. Such Proactive perturbations may be better suited to prevent the intrinsic movement errors that are a primary contributor to losses of balance and falls among PwCS. The central hypothesis of this work is that that unlike Reactive methods, Proactive perturbation training will retrain generalized gait stabilization strategies, reducing the risk of falls. This hypothesis will be addressed through three Specific Aims. The first Specific Aim is to determine whether fall rate in PwCS is reduced by Proactive or Reactive training, with immediate clinical implications for the development of interventions that can be applied in the real world. The second Specific Aim is to characterize the neuromechanical mechanisms that underlie gait changes with perturbation training, revealing whether the stabilization strategies normally used to ensure walking balance can be strengthened with appropriately targeted perturbations. Finally, the third Specific Aim is to determine whether Proactive or Reactive training produces generalized gait stabilization, as an ideal intervention would improve resilience even to untrained perturbations that may be experienced in real world walking. The proposed project is based on a neuromechanical framework of bipedal walking control, and thus allows investigation of both clinically relevant outcomes (fall rate) and mechanistic measures of the strategies used to ensure stability. The knowledge resulting from this project has the potential to contribute to the development of a larger-scale rehabilitation paradigm addressing the important problem of post-stroke falls.

项目概要/摘要 中风后，独立活动能力的缺陷是导致生活质量下降的主要原因，因为 许多慢性中风 (PwCS) 患者无法恢复到之前的活动水平 参与或介入社区。行动不便的一个主要原因是步态不稳定，这可以 增加跌倒的风险并限制独立功能。虽然几种常见的康复方法（例如 运动训练、传统平衡训练、强化）可以改善某些方面的功能，它们有 未能解决 PwCS 中跌倒发生率的问题。缺乏成功的部分原因可能是当前的干预措施 没有针对导致中风后步态不稳定的特定机制。 这项研究的长期目标是开发一个基于机制的干预工具箱，以改善各种 中风后功能的各个方面。作为实现这一目标的一步，本提案的目标是确定 有针对性的扰动训练是否可以通过提高步态稳定性来减少 PwCS 跌倒。扰动时 培训以前曾被用于降低其他临床人群的跌倒风险，但迄今为止已被 普华永道在这方面做得并不成功。这种缺乏成功可能是由于所应用的性质 扰动，传统上旨在引发离散的反应响应以避免失去平衡。 相比之下，本提案将应用旨在引发主动调整的机械扰动 用于确保每一步行走稳定性的神经力学策略。这种主动的扰动 可能更适合防止固有的运动误差，这是造成损失的主要原因 PwCS 之间的平衡和下降。这项工作的中心假设是，与反应式方法不同， 主动扰动训练将重新训练广义步态稳定策略，降低跌倒风险。这 假设将通过三个具体目标来解决。 第一个具体目标是确定主动训练还是被动训练是否可以降低 PwCS 的跌倒率， 对开发可应用于现实世界的干预措施具有直接的临床意义。 第二个具体目标是描述步态变化背后的神经力学机制 扰动训练，揭示通常用于确保行走平衡的稳定策略 可以通过适当的有针对性的扰动来加强。最后，第三个具体目标是确定 主动训练或反应训练是否能产生普遍的步态稳定性，作为理想的干预措施 提高对现实世界行走中可能遇到的未经训练的扰动的恢复能力。 该项目基于双足行走控制的神经力学框架，因此允许 对临床相关结果（跌倒率）和所用策略的机械测量进行调查 确保稳定性。该项目产生的知识有可能促进以下领域的发展： 解决中风后跌倒这一重要问题的更大规模的康复模式。