Balance Control Mechanisms, Age-Related Changes, and Methods for Improvement of Balance During Gait

平衡控制机制、与年龄相关的变化以及改善步态平衡的方法

• 批准号: 9257205
• 负责人: Robert J Peterka
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2020-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9257205
• 关键词: Address; Affect; Age; Aging; Ankle; Anterior; Body Patterning; Body measure procedure; Cause of Death; Characteristics; Clinical; Cues; Custom; Data; Data Analyses; Databases; Development; Devices; Elderly; Environment; Equilibrium; Future; Gait; Gait abnormality; Generations; Goals; Health; Health Care Costs; Incidence; Individual; Intervention; Knowledge; Lateral; Lead; Leg; Measurement; Measures; Medial; Methods; Modeling; Morbidity - disease rate; Motion; Motor; Movement; Outcome Measure; Participant; Pattern; Physiological; Population; Posture; Prosthesis; Protocols documentation; Questionnaires; Recruitment Activity; Regulation; Rehabilitation therapy; Research; Research Project Grants; Response to stimulus physiology; Risk Factors; Role; Scheme; Sensory; Surface; Testing; Torque; Traumatic Brain Injury; Veterans; Visual; Walking; Weight; Width; age group; age related; balance prosthesis; balance testing; base; clinical development; design; experimental study; falls; gait rehabilitation; improved; instrument; male; mathematical model; mortality; motor control; multisensory; neuroregulation; novel; prototype; public health relevance; response; screening; sensory system; somatosensory; targeted treatment; treadmill; visual-vestibular; volunteer; willingness; young adult

 DESCRIPTION (provided by applicant): Objectives: The objectives are to understand the mechanisms that maintain medial-lateral (ML) balance during stance and walking gait and how age affects these mechanisms. The focus is on ML balance because previous evidence indicates that stability is more problematic in the ML direction than in the anterior-posterior direction and that a sizable proportion of falls in older individuals occur in the ML direction. Based on preliminary results, an additional objective is to begin prototype development of a balance aid that could potentially improve balance during gait and reduce the likelihood of falls in subjects with deficits that affect balance. Plan: The proposa includes 4 Aims, three of which investigate different aspects of the neural control of balance during gait and one Aim that proposes to apply results from the other Aims to explore development of a prosthesis to improve stability during gait. The neural control of balance during gait requires the regulation of two different aspects of movement. The first aspect involves the mechanism that controls body orientation in space and relative to the environment. This aspect requires the integration of information from multiple sensory systems (visual, vestibular, proprioceptive, and somatosensory) and the subsequent generation of appropriate motor actions that maintain a desired body posture. Aim 1 will characterize the multi-sensory influences on orientation control during gait, will compare them to results from stance, and will determine how age influences these orientation control mechanisms. The second aspect of balance control during gait involves mechanisms that maintain dynamic balance. Dynamic balance refers to the oscillating pattern of body motion that occurs with each step cycle. Multiple control mechanisms are potential contributors to dynamic balance, including a mechanism based on the regulation of step timing. This step-timing mechanism is not currently recognized as a major contributor to dynamic balance, but our preliminary results reveal its importance. Aim 2 experiments will characterize the mechanisms contributing to dynamic balance and determine the influence of age on these mechanisms. Aim 3 will primarily determine whether gait measures obtained using our proposed methods correspond to gait measures obtained by conventional methods. Aim 4 will explore development of a balance aid to improve balance during gait by triggering stepping based on measures of body motion. Methods: Participants will be recruited primarily from an existing NCRAR database of volunteers who have expressed willingness to participate in research projects at NCRAR. At least 50% of the subjects in this database are Veterans. Subject groups will include young Veterans (ages 18 to 45 years) and older Veterans (>65 years) with 20 subjects in each group. Subjects will fill out screening questionnaires that provide a self- rating of balance confidence and have been shown to correlate with clinical examinations that predict the likelihood of falls. Aim 1 and 2 experiments will be performed on a custom balance test device that can deliver controlled disturbances by tilting the platform surface or the visual scene viewed by the subject. Participants either stand on the platform surface or perform a stepping-in-place gait that has similar characteristics, in terms of ML balance control, as a normal walking gait. Recorded data include body sway measures, platform forces, step width, timing of steps, and actual surface and visual scene motion. Aims 3 and 4 will use galvanic vestibular stimulation to perturb balance during walking. Data analysis will quantify body sway measures, identify stimulus-response relationships, and identify the contributions of different mechanisms for dynamic balance control. Existing mathematical models of balance during stance and during gait will be combined to account for experimental data such that identified model parameters are physiologically meaningful and also provide outcome measures for comparison across age groups. Statistical comparison between results from younger and older adults will determine the extent to which age influences balance during gait.

 描述（由申请人提供）： 目标：目标是了解在立场和步行聚集期间维持媒体外边（ML）平衡的机制，以及年龄如何影响这些机制。重点是ML平衡，因为先前的证据表明，在ML方向上的稳定性比在前后方向上更有问题，并且在ML方向上，老年人的跌倒比例很大。基于初步结果，一个额外的目标是开始原型开发平衡援助，该援助有可能在步态过程中提高平衡，并减少影响平衡的受试者的跌倒可能性。计划：该提案包括4个目标，其中三个调查了步态神经元控制的不同方面，而一个目标是采用另一个目的的提案，以探索假体的发展以提高步态过程中的稳定性。步态过程中步态的神经控制需要调节两个。运动的不同方面。第一个方面涉及控制空间中身体方向和相对于环境的机制。这方面需要从多个感觉系统（视觉，前庭，本体感受和体感）中整合信息，并随后生成适当的运动动作，以保持所需的身体姿势。 AIM 1将表征步态过程中对方向控制的多感觉影响，将它们与立场的结果进行比较，并将确定年龄如何影响这些取向控制机制。战斗中平衡控制的第二个方面涉及保持动态平衡的机制。动态平衡是指每个步骤周期发生的身体运动的振荡模式。多种的 控制机制是导致动态平衡的潜在因素，包括基于步骤正时调节的机制。目前，这种步进机制尚未被认为是导致动态平衡的主要因素，但是我们的初步结果揭示了其重要性。 AIM 2实验将表征导致动态平衡的机制，并确定年龄对这些机制的影响。 AIM 3将主要确定使用我们提出的方法获得的符合措施是否对应于传统方法获得的步态度量。 AIM 4将通过基于身体运动的测量来触发步进阶段，探索平衡援助的发展，以提高步态的平衡。方法：参与者将主要是从现有的NCRAR数据库中招募的志愿者，他们表示愿意参加NCRAR的研究项目。该数据库中至少有50％的受试者是退伍军人。主题组将包括年轻的退伍军人（18至45岁）和年龄较大的退伍军人（> 65岁），每组有20名受试者。受试者将填写筛选问卷，这些问卷提供了平衡信心的自我评级，并已证明与预测跌倒可能性的临床检查相关。 AIM 1和2实验将在自定义平衡测试设备上进行，该测试设备可以通过倾斜平台表面或受试者观看的视觉场景来提供受控的灾难。参与者要么站在平台表面上，要么执行具有相似特征的阶梯步态，该特征在ML平衡控制方面是正常的步行步态。记录的数据包括身体摇摆措施，平台力量，步骤宽度，步骤的时机以及实际的表面和视觉场景运动。 AIM 3和4将使用电力前庭刺激在步行过程中扰动平衡。数据分析将量化身体的摇摆度量，确定刺激反应关系，并确定不同机制对动态平衡控制的贡献。现有的数学模型在立场和步态期间的平衡模型将被合并，以说明实验数据，以便确定的模型参数具有物理意义，并且还提供了跨年龄组比较的结果指标。年轻人和老年人结果之间的统计比较将决定年龄在步态过程中影响平衡的程度。