Remote dynamic cycling for the customized off-site rehab in Parkinson’s disease.

用于帕金森病定制场外康复的远程动态循环。

• 批准号: 10424644
• 负责人: Aasef G Shaikh
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10424644
• 关键词: Affect; Area; Artificial Intelligence; Caring; Clinic; Clinic Visits; Clinical; Cognition; Cognitive; Communities; Custom; Data; Development; Devices; Dopamine; Dose; Equilibrium; Exercise; Exercise Therapy; Feedback; Future; Goals; Group Homes; Health Insurance Portability and Accountability Act; Health Personnel; Home; Hour; Independent Living; Individual; Intervention; Laboratories; Levodopa; Location; Logistics; Longterm Follow-up; Measures; Mental Depression; Monitor; Motor; Movement Disorder Society Unified Parkinson' s Disease Rating Scale; Movement Disorders; Nerve Degeneration; Nursing Homes; Ohio; Outcome; Outcome Measure; Outpatients; Parkinson Disease; Participant; Patients; Performance; Persons; Pharmaceutical Preparations; Phase; Progressive Disease; Quality of life; Regimen; Rehabilitation therapy; Research; Resources; Safety; Schedule; Secure; Self-Direction; Site; Social support; Speed; Strategic Planning; Symptoms; System; Techniques; Technology; Testing; Time; Torque; Travel; Veterans; Vision; Visit; artificial intelligence algorithm; awake; base; cost effective; cost effectiveness; data exchange; effectiveness testing; efficacy evaluation; efficacy testing; exercise regimen; experience; frailty; functional decline; functional improvement; individualized medicine; instrument; motor deficit; motor function improvement; motor symptom; novel; operation; pandemic disease; participant safety; post intervention; programs; provider intervention; remote assessment; remote delivery; remote health care; remote monitoring; response; safety supervision; sensor; therapy outcome; user-friendly; virtual; wearable device; wearable sensor technology; wireless sensor

Parkinson’s disease (PD) progressively deteriorates motor function. Successful rehabilitation, leading to a favorable course of movement disorders in PD, is contingent upon frequent, regular, and patient-specific exercise regimen that is customized to the individual needs. Latter requires regular interventions from the provider and frequent visits to the rehab facility. Lack of access, poor social support, inability to travel, home-bound status, or pandemics are significant hurdles in delivering effective rehab to the PD patients. Our vision is to offer customized and cost-effective PD rehab using a remotely operated technology near or at the patients’ homes. This technology would be remotely monitored and customized online to titrate therapeutic outcomes optimized for each patient. The proof of this concept was already established in our laboratory, a technology called dynamic cycling. The highlight of this technology is a stationary bike operating at a rapid speed (cadence) with programmable variability in speed and power/torque hence promoting motor performance superior to traditional motorized bikes (i.e. static cycling). The next step towards our ultimate vision of at-home exercise therapy is remotely operated dynamic bike. We have already built remotely operated dynamic bike; the current proposal will objectively examine the efficacy of a novel, remotely delivered and remotely adjusted dynamic cycling paradigm using remotely monitored motor outcomes. Comparison will be made with remote static cycling. The study will be launched at three community based wellness locations to assure the subject safety, ease of access, compliance, and as needed support. Aim 1 will examine the hypothesis that dynamic cycling will immediately improve the motor function in PD. The effects will be prominent on the dopamine-sensitive motor deficits. The repetition will enhance motor improvement. The participants will use wearable sensors for the remote assessments of motor symptoms in PD before and immediately after each exercise session. The information from the wearable sensors and the bike will be utilized to further adjust the bike parameters for the next dynamic cycling session. We will also measure effects on subjective ratings of motor function, cognition and balance before, and at 0, 3, and 6 months after the cycling intervention. Aim 2 will analyze the effects of dynamic cycling on motor fluctuations, declining response to levodopa in an early and unpredictable manner significantly affecting the quality of life in the PD. We hypothesize that dynamic cycling will reduce the motor fluctuations in PD. The efficacy of dynamic cycling on improvement in motor fluctuation over a 12-hour awake period will be measured every day with the wearable sensors that communicate via secure cloud. The immediate clinical impact is that the technology will be immediately deployed to the Veteran’s group homes, nursing homes, and community based VA clinics. The project will provide sufficient information to carry our ultimate vision, at-home dynamic cycling serving three critical needs: 1) customized therapy, 2) easy access, and 3) safety and cost-effectiveness.

帕金森氏病（PD）逐渐检测到运动功能。成功的康复，导致 PD中有利的运动障碍过程，取决于经常，规则和特定于患者的运动 根据个人需求定制的方案。后者需要提供者的定期干预措施 经常参观康复设施。缺乏访问权，社会支持不佳，无法旅行，家庭结局或 大流行者在为PD患者提供有效的康复方面是重大障碍。我们的愿景是提供 使用在患者家附近或在患者家附近或在患者家中进行远程操作的技术定制且具有成本效益的PD康复。 该技术将在网上进行远程监控和定制，以优化滴定治疗结果 每个患者。这个概念的证据已经在我们的实验室中建立，这是一种称为动态的技术 骑自行车。这项技术的亮点是一辆固定的自行车，以快速速度（Cadence）运行 速度和功率/扭矩的可编程变异性，因此促进运动性能优于传统 电动自行车（即静态骑自行车）。下一步朝着我们在家运动疗法的最终愿景的是 远程操作的动态自行车。我们已经建造了远程操作的动态自行车。当前的建议 将客观地检查小说，远程交付和远程调整的动态循环的有效性 使用远程监测的运动结果范式。比较将与远程静态循环进行。这 研究将在三个基于社区的健康地点启动，以实现主题安全性，易于访问性， 合规性，并根据需要的支持。 AIM 1将检查动态循环将立即的假设 改善PD的运动功能。对多巴胺敏感的电动机定义的效果将是突出的。这 重复将增强运动的改善。参与者将使用可穿戴传感器进行遥控 每次运动前后对PD中运动症状的评估。信息 从可穿戴的传感器和自行车将用于进一步调整下一个动态的自行车参数 骑自行车。我们还将衡量对运动功能，认知和平衡的主观评级的影响 在骑自行车干预后的0、3和6个月之前。 AIM 2将分析动态循环的影响 关于运动波动，以早期和不可预测的方式下降对左旋多巴的反应会显着影响 PD的生活质量。我们假设动态循环将减少PD中的运动波动。 动态循环在12小时清醒期内的电动机波动改善的功效将被测量 每天都有可穿戴的传感器，这些传感器通过安全云进行通信。直接的临床影响是 该技术将立即部署到资深的团体房屋，护士房屋和社区 基于VA诊所。该项目将提供足够的信息来实现我们的最终视野 骑自行车满足了三个关键需求：1）定制治疗，2）轻松进入，3）安全性和成本效益。