Modulating brain networks to reduce gait variability in older adults at risk of falling

调节大脑网络以减少有跌倒风险的老年人的步态变异

基本信息

批准号：
10549840
负责人：
On-Yee Amy Lo
金额：
$ 12.49万
依托单位：
HEBREW REHABILITATION CENTER FOR AGED
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-01-15 至 2024-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10549840
关键词：
Acute Aging Attention Brain Brain imaging Clinical Research Clinical Trials Cognition Complex Data Disease Dorsal Elderly Electrodes Eligibility Determination Exhibits Exposure to Frequencies Functional Magnetic Resonance Imaging Gait Geriatrics Goals Impaired cognition Individual Injury Intervention Lead Link Magnetic Resonance Imaging Measures Mind Motion Movement Outcome Participant Pattern Performance Randomized Rehabilitation therapy Research Rest Scalp structure Scientist Sensory Process Techniques Testing Time Training Unsteady Gait Visit Walking Work career career development cognitive neuroscience cognitive task cohort design effective intervention evidence base fall risk falls follow-up gait rehabilitation improved innovation interest multimodality neural neuroimaging neuromechanism neuroregulation noninvasive brain stimulation novel patient oriented post intervention primary outcome recruit secondary analysis secondary outcome smartphone application sustained attention transcranial direct current stimulation treatment arm

项目摘要

PROJECT SUMMARY My career goal is to lead efforts to improve gait rehabilitation and mitigate falls risk in older adults by conducting innovative research focused on the neural control and enhancement of gait and mobility. I am particularly interested in developing individualized, multi-modal, and patient-centered interventions that can both stand alone and be combined with current evidenced-based geriatrics rehabilitation programming. Though walking is a repetitive task, one’s temporospatial patterns of movement during walking vary from stride to stride. This gait variability, if sufficiently high, is predictive of both falls and cognitive decline in older adults. Still, the neural mechanisms that give rise to gait variability are not completely understood. We thus lack effective interventions to minimize gait variability in older adults. However, our team has demonstrated that in older adults, those with elevated gait variability exhibit worse ability to sustain performance on a continuous cognitive task over time (i.e., sustained attention). My work has also linked gait variability to the functional connectivity between the two large-scale brain networks believed to underserve sustained attention—namely, the dorsal attention network (DAN) and the default network (DN)—in multiple cohorts of older adults. Based upon these discoveries, we designed a novel multi-channel transcranial direct current stimulation (tDCS) intervention to simultaneously facilitate the excitability of the DAN and inhibit the excitability of the DN. Our preliminary data suggests that a single exposure to this tDCS, as compared to sham, reduces gait variability when tested just following stimulation. My overarching hypothesis is that this form of tDCS can modulate the functional connectivity between the DAN and DN and thus reduce gait variability in older adults. In this project, we will test this hypothesis by examining the acute after-effects of a single session of tDCS on resting-state functional connectivity (Aim 1), as well as determining the effects of a multi-session tDCS intervention on gait variability and related outcomes (Aim 2). We will recruit 30 older adults free of major disease that exhibit higher-than-typical gait variability. Participants will first complete a baseline assessment and two fMRI visits. The same participants will then be randomized to a tDCS intervention arm (ten, once-daily, 20-min sessions) or a ShamàtDCS intervention arm (five, once-daily, 20-min sessions of sham in week one followed by five, once- daily, 20-min sessions of tDCS in week 2). The primary outcome of gait variability will be assessed daily using a validated smartphone app for the entire study period. We expect to demonstrate that tDCS can modulate functional connectivity and reduce gait variability in older adults. The results from this project are expected to inform the design of a larger, more definitive trial of tDCS designed to optimize brain connectivity as it relates to gait variability in older adults. This research, combined with specific training in advanced neuroimaging and neuromodulation, cognitive neuroscience in aging, and the conduct a clinical research in vulnerable older adults, will greatly facilitate my efforts to transition into an independence clinician scientist.

项目概要我的职业目标是通过以下方式领导改善步态康复和跌倒风险的工作我正在开展专注于神经控制以及步态和活动能力增强的创新研究。对开发个性化、多模式和以患者为中心的干预措施特别感兴趣两者都是独立的，并且可以与当前基于证据的老年病康复规划相结合。尽管步行是一项重复性任务，但步行时人的时空运动模式与步幅不同如果这种步态变化足够大，则预示着老年人会跌倒和认知能力下降。尽管如此，引起步态变异的神经机制尚未完全被了解。然而，我们的团队已经证明，可以采取有效的干预措施来最大限度地减少老年人的步态变异。对于老年人，步态变异性较高的人表现出较差的连续表现能力我的工作还将步态变异性与功能联系起来。两个大规模大脑网络之间的连接被认为不足以维持持续的注意力，即背侧注意力网络（DAN）和默认网络（DN）——在多个老年人群体中。根据这些发现，我们设计了一种新型多通道经颅直流电刺激（tDCS）干预同时促进 DAN 的兴奋性并抑制 DN 的兴奋性。初步数据表明，与假手术相比，单次暴露于这种 tDCS 可以减少步态变异性当刺激后进行测试时，我的总体假设是这种形式的 tDCS 可以调节 DAN 和 DN 之间的功能连接，从而减少老年人的步态变异。我们将通过检查单次 tDCS 对静息状态的急性后遗症来检验这一假设功能连接（目标 1），以及确定多会话 tDCS 干预对步态的影响我们将招募 30 名没有表现出重大疾病的老年人。高于典型的步态变异性。参与者将首先完成基线评估和两次功能磁共振成像检查。然后，相同的参与者将被随机分配到 tDCS 干预组（十次、每天一次、每次 20 分钟）或 ShamàtDCS 干预组（第一周进行 5 次、每天一次、每次 20 分钟的假手术，随后进行 5 次、每次 1 次）第 2 周每天进行 20 分钟的 tDCS 训练，每天将使用以下方法评估步态变异性的主要结果。我们希望证明 tDCS 可以在整个研究期间进行调节。该项目的结果预计将增强老年人的功能连接并减少步态变异。为设计更大规模、更明确的 tDCS 试验提供信息，该试验旨在优化相关的大脑连接这项研究结合了高级神经影像学和特殊训练。神经调节、衰老认知神经科学以及对弱势老年人进行临床研究成人，将极大地促进我向独立临床科学家的转变。