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.

项目摘要 /摘要 中风后，独立流动性的缺陷是减少生活质量的主要因素，因为 许多患有慢性中风（PWC）的人无法返回其先前的活动水平 参与或参与社区。步态不稳定性的主要原因是步态不稳定性 增加跌倒的风险并限制独立功能。而几种常见的康复方法（例如 运动训练，传统的平衡训练，加强）可以改善功能的某些方面，它们具有 未能解决普华永道的秋季发病率。在某种程度上，缺乏成功可能是由于当前的干预措施 并非针对引起冲程后步态不稳定性的特定机制。 这项研究的长期目标是开发基于机制的干预措施的工具箱，以改善各种 击球后功能的各个方面。作为朝着这一目标的一步，本提案的目的是确定 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普华永道的跌倒。同时扰动 培训以前已被用来降低其他临床人群的跌倒风险，到目前为止 在普华永道中这样做不成功。缺乏成功可能是由于应用的性质 传统上旨在引起离散的反应反应以避免失去平衡的扰动。 相比之下，本提案将应用机械扰动，以激发主动调整 神经力学策略用于确保步行稳定的每一步。这种积极的扰动 可能更适合防止内在运动错误，这是损失损失的主要因素 pwcs之间的平衡和落在。这项工作的核心假设是与反应性方法不同， 积极的扰动训练将培训广义步态稳定策略，从而降低跌倒的风险。这 假设将通过三个特定目标解决。 第一个具体目的是确定普华永道的跌倒率是通过主动或反应性训练降低的， 对可以在现实世界中应用的干预措施的发展具有直接的临床意义。 第二个具体目的是表征步态下的神经力学机制 扰动训练，揭示了通常用于确保步行平衡的稳定策略 可以通过适当的靶向扰动来加强。最后，第三个具体目的是确定 无论是主动还是反应性训练都会产生广泛的步态稳定，因为理想的干预措施将 即使对现实世界中可能经历的未经训练的扰动，提高了弹性。 拟议的项目基于两足步行控制的神经力学框架，因此允许 研究临床相关结果（跌倒率）和用于策略的机理措施 确保稳定。该项目产生的知识有可能为发展做出贡献 一个大规模的康复范式解决了中风后跌倒的重要问题。