Combined Cognitive and Gait Training

认知和步态联合训练

• 批准号: 8500036
• 负责人: JANIS J. DALY
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8500036
• 关键词: Address; Adult; Aftercare; Age; American; Attention; Biomechanics; Body Weight; Cognitive; Day Care; Disabled Persons; Enrollment; Environment; Exercise; Gait; Healthcare Systems; Impairment; Institutionalization; Intervention; Korean War; Laboratories; Life; Measures; Medical Societies; Methods; Motor; Movement; Pathway interactions; Patients; Pattern; Phase; Population; Process; Protocols documentation; Quality of life; Randomized; Recovery; Reporting; Research; Residual state; Role; Self Care; Speed; Stimulus; Stroke; Survivors; Task Performances; Testing; Time; Training; Veterans; Vietnam; Visual; Walking; Work; acute stroke; base; chronic stroke; clinically significant; cognitive change; cognitive training; cost; data acquisition; design; disability; distraction; functional disability; handicapping condition; improved; innovation; post stroke; response; restoration; success; tool; treadmill training

DESCRIPTION (provided by applicant): Combined Cognitive and Gait Training Problem: Recent research in gait training for chronic stroke survivors showed that gait coordination can be best restored using the following interventions together: exercise, over ground gait training, and body weight supported treadmill training (BWSTT). These results are important because, to our knowledge, there have been no other reports of the restoration of gait coordination for those with persistent gait deficits (> 6 months after stroke). However, a remaining problem was that the restored coordinated gait movements measured in the laboratory did not generalize for many subjects to the everyday environment. The known confluence of several factors can cause lack of generalization. First, it is known that dual task performance (walking and cognitive attention task) can degrade both gait speed and attention ability, even in healthy adults. Second, stroke can impair attention. Third, during walking in the everyday environment, attention is required in order to safely process normally occurring stimuli. Therefore, given the success of the new gait training protocol in the lab setting, it is important to address the problems remaining, for the generalization of recovered functional gait (gait speed) and gait coordination to the everyday environment. Purpose: Aim 1 is to test an innovative combination of motor and cognitive training that is designed to restore functional gait (gait speed) and gait coordination to the everyday environment. Hypothesis I: Combined cognitive and motor training will produce greater gains in gait speed in the dual task test condition, versus motor training alone. Primary measure: gait speed, measured under the dual task conditions of walking and dealing with a visual distraction (obstacles) in the gait pathway. Secondary measures include: gait coordination, time spent walking in everyday environment, and life role participation (quality of life). Aims 2 and 3 are t investigate the within-group, separate motor and cognitive changes in response to the respective treatments for each of the two study groups. Methods: For Aim 1, Hyp I, thirty-eight subjects (>6 months post stroke) will be enrolled and randomized to either 1) Gait Training + Cognitive Training; or 2) Gait Training alone. Subjects in both groups will receive treatment 5 times/wk, 3hrs/session, for 12wks. The Gait Training Protocol will include: exercise; body weight supported treadmill training (BWSTT); and over ground gait training. For Group 1, the cognitive training will be phased into the daily sessions, by first emphasizing cognitive training alone, and subsequently dual training (cognitive and motor). Aims 2 and 3 measures will include gait measures acquired both with and without a cognitive task, as well as cognitive measures acquired both with and without the gait task. Pre-/post-treatment comparisons will be made within each of the two treatment groups. Clinical Significance: The proposed intervention has the potential to restore safe, coordinated, functional walking in the every day environment.

描述（由申请人提供）： 认知和步态联合训练问题：最近对慢性中风幸存者步态训练的研究表明，结合使用以下干预措施可以最好地恢复步态协调：运动、地面步态训练和体重支撑跑步机训练（BWSTT）。这些结果很重要，因为据我们所知，还没有其他关于持续步态缺陷（中风后> 6个月）的人恢复步态协调的报告。然而，剩下的一个问题是，在实验室中测量的恢复的协调步态运动并不能推广到许多受试者的日常环境中。已知的多种因素的综合作用可能会导致缺乏概括性。首先，众所周知，双重任务表现（步行和认知注意力任务）会降低步态速度和注意力能力，即使对于健康的成年人也是如此。其次，中风会损害注意力。第三，在日常环境中行走时，需要集中注意力，以便安全地处理正常发生的刺激。因此，鉴于新的步态训练方案在实验室环境中的成功，解决剩余的问题非常重要，以便将恢复的功能步态（步态速度）和步态协调推广到日常环境中。目的：目标 1 是测试运动和认知训练的创新组合，旨在恢复日常环境中的功能性步态（步态速度）和步态协调。 假设一：与单独的运动训练相比，在双任务测试条件下，结合认知和运动训练将产生更大的步态速度增益。主要测量：步态速度，在行走和处理步态路径中的视觉干扰（障碍物）的双重任务条件下测量。次要指标包括：步态协调、在日常环境中行走的时间以及生活角色参与（生活质量）。目标 2 和 3 不是调查两个研究组各自的治疗对组内单独运动和认知的变化。方法：对于目标 1，Hyp I，将招募 38 名受试者（中风后 6 个月以上）并随机分配至 1) 步态训练 + 认知训练；或 2) 单独的步态训练。两组受试者将接受每周 5 次、每次 3 小时的治疗，持续 12 周。步态训练方案将包括： 锻炼；体重支持跑步机训练（BWSTT）；以及地面步态训练。对于第一组，认知训练将分阶段进行到日常训练中，首先强调认知训练，并且 随后进行双重训练（认知和运动）。目标 2 和 3 测量将包括有和没有认知任务时获得的步态测量，以及有和没有步态任务时获得的认知测量。将在两个治疗组中的每一个内进行治疗前/治疗后的比较。临床意义：所提出的干预措施有可能恢复日常环境中安全、协调、功能性的行走。