VESTIBULAR REHAB & STABILITY MODELING FOR OLDER PATIENTS

前庭康复

• 批准号: 2769321
• 负责人: DAVID E KREBS
• 金额: $ 22.73万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-09-01 至 2000-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2769321
• 关键词: balance; biomechanics; computer simulation; eye movements; functional ability; gait; head movements; human middle age (35-64); human old age (65+); human subject; human therapy evaluation; labyrinth disorder; model design /development; nystagmography; nystagmus; physical therapy; posture; proprioception /kinesthesia; rehabilitation; vertigo; vestibular apparatus

Balance impairment in general, and vestibulopathy (VSP) in particular, cause disability that accounts for substantial morbidity and decreased quality of life, particularly among older adults. The efficacy of vestibular rehabilitation programs for locomotor instability has to date not been investigated rigorously, although clinical evidence supports its use. Further, current biomechanical models of human instability are chiefly limited to standing "posturography" tests. Because all project patients will have postural instability, we apply sophisticated modeling techniques to better understand the biomechanical correlates of instability during standing, and activities of daily living (ADL) including gait, stair climbing and transferring from sitting to standing. The aims of the proposed investigation are to: (1) Determine the efficacy of vestibular rehabilitation (VR) for mid-life to the oldest-old VSP patients. We hypothesize that 1) VR improves dynamic stability during standing and locomotor ADL tasks significantly more than general conditioning exercises; 2) Dynamic stability improvement correlates directly (r>.7) with head stability improvement; 3) Standing posturography, dynamic locomotor ADL and clinical measures will be significantly correlated (r>.7); 4) Normal elders receiving VR improve their dynamic stability about 50% less than matched subjects with VSP; and 5) On 1 year followup, greater than or equal to 80% retention of the 12 week post-test dynamic stability will be observed. (2) To develop better biomechanical models of dynamic stability in older VSP patients. We hypothesize that 1) CG momentum and displacement characterize patients' stability significantly better than CP displacement alone, and 2) Whole body kinematic data can definitively characterize dynamic stability strategies. We propose to study 100 VSP patients in a randomized, double-blind prospective clinical trial of vestibular rehabilitation. Assessments at 0, 6 and 12 weeks will be conducted for all subjects. Half will receive VR starting immediately after intake, while another group will receive general conditioning exercises for 6 weeks. Following the 6 week re- test, the conditioning exercise group will receive specific vestibular rehabilitation. Fifty healthy, matched normals will receive VR between 0 and 6 week tests. At each test, quantitative vestibular function, posturography, full-body kinematic and kinetic analyses of ADL performance, and clinical data will be analyzed. In short, the methods used include sophisticated and expensive techniques and equipment that may not be available to most clinicians; we have, however, isolated these objective measurements from the rehabilitation process, the latter using "low technology" measurement and treatment approaches accessible in any clinic.

通常，平衡损害，尤其是前庭病（VSP）， 导致残疾造成大量发病率并减少 生活质量，特别是在老年人中。 的功效 运动不稳定性的前庭康复计划已经迄今 尽管临床证据支持其 使用。 此外，当前人类不稳定性的生物力学模型是 主要限于“姿势”测试。 因为所有项目 患者将具有姿势不稳定，我们采用复杂的建模 更好地了解生物力学相关的技术 站立期间的不稳定和日常生活活动（ADL） 包括步态，楼梯攀爬和从坐着转移。 拟议调查的目的是： （1）确定前期恢复（VR）的疗效 给最古老的VSP患者。 我们假设1）VR改善 站立和运动ADL任务期间的动态稳定性 不仅仅是一般的调节练习； 2）动态稳定性 改进与头部稳定性直接相关（r> .7）； 3）站立术后术，动态运动ADL和临床措施 将显着相关（r> .7）； 4）接受VR的正常长者 提高他们的动态稳定性，比匹配的受试者少50％ VSP; 5）在1年的随访中，大于或等于80％的保留率 将观察到12周的测试后动态稳定性中。 （2）开发更好的较旧动态稳定性生物力学模型 VSP患者。 我们假设1）CG动量和位移 表征患者的稳定性明显优于CP 单独位移，2）全身运动学数据可以确定 表征动态稳定策略。 我们建议在随机的双盲中研究100名VSP患者 前庭康复的前瞻性临床试验。 评估 所有受试者将进行0、6和12周。 一半会收到 VR在摄入后立即开始，而另一组将收到 一般条件练习6周。 在6周之后 - 测试，调节运动组将获得特定的前庭 康复。 五十个健康的，匹配的正常人将在之间获得VR 0和6周测试。 在每个测试中，定量前庭函数， ADL的姿势学，全体运动学和动力学分析 性能和临床数据将进行分析。 简而言之 使用的包括精致且昂贵的技术和设备 大多数临床医生可能无法使用；但是，我们已经隔离了这些 康复过程的客观测量，后者使用 “低技术”测量和治疗方法可在任何 诊所。

项目成果

Posturography changes do not predict functional performance changes.

姿势变化并不能预测功能表现的变化。

• 发表时间: 1998
• 期刊: The American journal of otology.
• 作者: O'Neill,DE;Gill-Body,KM;Krebs,DE
• 通讯作者: Krebs,DE

Vestibulopathy and age effects on head stability during chair rise.

前庭病和年龄对椅子上升过程中头部稳定性的影响。

• DOI: 10.1080/000164801300006272
• 发表时间: 2001
• 期刊: Acta oto-laryngologica
• 影响因子: 1.4
• 作者: McGibbon,CA;Krebs,DE;Scarborough,DM
• 通讯作者: Scarborough,DM

Is base of support greater in unsteady gait?

• DOI: 10.1093/ptj/82.2.138
• 发表时间: 2002-02-01
• 期刊: PHYSICAL THERAPY
• 影响因子: 3.2
• 作者: Krebs, DE;Goldvasser, D;Gill-Body, KM
• 通讯作者: Gill-Body, KM

Vestibular rehabilitation outcomes: velocity trajectory analysis of repeated bench stepping.

前庭康复结果：重复卧推的速度轨迹分析。

• DOI: 10.1016/s1388-2457(00)00387-4
• 发表时间: 2000
• 期刊: Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology
• 作者: Goldvasser,D;McGibbon,CA;Krebs,DE
• 通讯作者: Krebs,DE

Base of support is not wider in chronic ataxic and unsteady patients.

慢性共济失调和不稳定患者的支持基础并不广泛。

• DOI: 10.1080/165019702760390392
• 发表时间: 2002
• 期刊: Journal of rehabilitation medicine
• 影响因子: 3.5
• 作者: Seidel,Brigitta;Krebs,DavidE
• 通讯作者: Krebs,DavidE