A Balanced Reach Training Platform to Address Balance Disorders in Older and Neurologically Disabled Veterans

平衡伸展训练平台，可解决老年和神经残疾退伍军人的平衡障碍问题

• 批准号: 10531855
• 负责人: Joseph Edward Barton
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10531855
• 关键词: Accidental Injury; Activities of Daily Living; Address; Adult; Affect; Age; Age-Years; Aging; Articular Range of Motion; Balance training; Behavior; Biomechanics; Cessation of life; Clinic; Clinical assessments; Control Groups; Development; Diabetes Mellitus; Diagnosis; Diagnostic; Disabled Persons; Disease; Elderly; Elements; Engineering; Equilibrium; General Population; Goals; Healthcare Systems; High Prevalence; Hour; Human; Impairment; Individual; Injury; Intervention; K-Series Research Career Programs; Lead; Life; Lower Extremity; Measures; Methods; Morbidity - disease rate; Movement; Musculoskeletal; Neurologic; Obesity; Patients; Perception; Performance; Peripheral Nervous System Diseases; Persons; Population; Posture; Prevalence; Protocols documentation; Psychophysics; Quality of Care; Research; Resistance; Risk; Stroke; Structure; System; Testing; Therapeutic Intervention; Time; Training; Training Activity; Traumatic Brain Injury; Treatment Cost; Treatment Protocols; Veterans; Volition; Walking; accurate diagnosis; base; care costs; career development; clinical efficacy; combat; cost; design; disability; dosage; equilibration disorder; exercise training; fall injury; fall risk; falls; functional decline; functional disability; improved; innovation; instrument; military veteran; motor learning; muscle degeneration; nervous system disorder; neurophysiology; novel; novel diagnostics; portability; rehabilitation research; response; sarcopenia; success; tool; trend

Falls are by far the leading cause of accidental injury and death in older adults. The Veteran population is more severely affected by falls since it is significantly older than the overall population (45% over 65 years of age vs. 13%); and Veterans would benefit substantially more from an accurate diagnosis and treatment of fall propensity. Despite its importance, much is still unknown about the manner in which balance control is compromised by age and disease. Therapeutic interventions for people who are at risk of falling have proven to be of limited utility. Engineering methods are well suited to study and evaluate balance; but have to date been applied to overly simplified scenarios that lack the complexity to probe the musculoskeletal and neurophysiological bases for balance and falls. The long term objective of this research, which began with a VA Rehabilitation Research & Development (RR&D) Career Development Award (CDA-2), is to develop improved directives and protocols for the diagnosis and treatment of balance-related posture and movement coordination problems. This proposal significantly advances engineering methods to address existing gaps in the diagnosis and treatment of balance impairments through the development of a Balanced Reach Training Protocol (BRTP). The BRTP continuously challenges subjects to perform reaching tasks at the limits of their balance for an extended period of time, and increases these limits as subjects demonstrate improved performance. The goal of this tool is to quantitatively assess and improve at-risk individuals' ability to maintain balance when disturbed by volitional movements of the body and its parts—an important class of balance disturbances integral to many activities of daily living that can precipitate falls. The BRTP focuses on performance at and just beyond the limits of balance, unlike most such tests and training protocols that do not challenge subjects in this way. The BRTP's most immediate and salient metric is the limiting boundary of standing reach; and we hypothesize that expanding this boundary, as the BRTP is designed to do, will improve balance and make individuals more resistant to falls (in the context of expected balance disturbances). Confirmation of this hypothesis could provide a new perspective on existing training protocols' modest success rates, and direction for the design of new protocols with the potential to significantly improve these rates. [Though the BRTP is a training platform, we also believe that the performance metrics and analytical results produced by it can form the basis for new diagnostic measures that more reliably and precisely quantify and explain balance performance problems; and track changes in them over time.] Such diagnostic and treatment protocols would be particularly beneficial to the VA Health Care System, as it would lead to improvements in: patient throughput, quality of care, and treatment costs. Though this proposal targets the aging Veteran population, the BRTP is a general tool that can aid in the diagnosis and treatment of balance disorders arising from conditions other than aging. These include obesity, diabetes (which often leads to lower extremity muscle degeneration and peripheral neuropathy), sarcopenia, vestibular disorders, and neurological disorders such as stroke. Veterans whose balance has been compromised by Traumatic Brain Injury (TBI) (whether combat-related or not) may also benefit from the BRTP.

迄今为止，跌倒是老年人意外伤害和死亡的主要原因。 由于其年龄显着高于总人口（45% 的人超过 65 岁），因此受跌倒的影响更为严重 年龄 vs. 13%）；退伍军人将从跌倒的准确诊断和治疗中受益更多 尽管平衡控制很重要，但人们对平衡控制的方式仍然知之甚少。 事实证明，对有跌倒风险的人的治疗干预措施会受到年龄和疾病的影响。 工程方法非常适合研究和评估平衡，但必须过时； 被应用于过于简化的场景，缺乏探测肌肉骨骼和 平衡和跌倒的神经生理学基础。 这项研究的长期目标始于 VA 康复研究与开发 (RR&D) 职业发展奖 (CDA-2)，旨在制定改进的诊断指令和协议 这一建议对与平衡相关的姿势和运动协调问题的治疗意义重大。 推进工程方法来解决平衡诊断和治疗中现有的差距 通过制定平衡伸展训练协议 (BRTP) 来消除损伤。 持续挑战受试者在其平衡能力的极限下长时间完成任务 一段时间，并随着受试者表现出改善的表现而增加这些限制。 工具是定量评估和提高高危个体在受到干扰时保持平衡的能力 身体及其部位的意志运动——一类重要的平衡障碍，对许多人来说都是不可或缺的 BRTP 重点关注可能导致跌倒的日常生活活动。 平衡的极限，与大多数此类测试和训练方案不同，它们不会以这种方式挑战受试者。 BRTP 最直接、最显着的指标是站立范围的极限，我们勇敢地面对这一点。 正如 BRTP 的设计初衷一样，扩大这一边界将改善平衡并使个人更加 抗跌落能力（在预期的平衡干扰的情况下）。 这一假设的证实可以为现有培训协议的适度性提供新的视角。 成功率，以及有可能显着改善这些的新方案的设计方向 [虽然 BRTP 是一个培训平台，但我们也相信其绩效指标和分析。 它产生的结果可以为新的诊断措施奠定基础，这些措施更加可靠和准确 量化并解释平衡性能问题；并跟踪它们随时间的变化。] 诊断和治疗方案对退伍军人管理局医疗保健系统特别有利，因为它 将导致以下方面的改善：患者吞吐量、护理质量和治疗成本。 该提案针对的是老龄化退伍军人群体，BRTP 是一个通用工具，可以帮助诊断和 治疗由衰老以外的疾病引起的平衡障碍，包括肥胖、糖尿病。 （常导致下肢肌肉退化和周围神经病变）、肌肉减少症、 前庭疾病和神经系统疾病，例如中风的退伍军人。 遭受创伤性脑损伤 (TBI)（无论是否与战斗相关）的患者也可以从 BRTP 中受益。