An Engineering-Based Balance Assessment and Training Platform

基于工程的平衡评估和培训平台

• 批准号: 10450625
• 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: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10450625
• 关键词: Accidental Injury; Activities of Daily Living; Address; Affect; Age; Age-Years; Aging; Anterior; Articular Range of Motion; Assessment tool; Balance training; Behavior; Cessation of life; Clinical; Clinical Trials; Data; Deterioration; Development; Diabetes Mellitus; Diagnosis; Diagnostic; Disabled Persons; Disease; Elderly; Elements; Engineering; Equilibrium; Evaluation; Exposure to; General Population; Goals; Healthcare Systems; High Prevalence; Hour; Human; Individual; Injury; K-Series Research Career Programs; Knowledge; Lead; Link; Lower Extremity; Measurement; Measures; Methods; Modeling; Motion; Movement; Musculoskeletal; Neurologic; Obesity; Parkinson Disease; Patients; Perception; Performance; Peripheral Nervous System Diseases; Population; Posture; Protocols documentation; Psychophysics; Quality of Care; Rehabilitation therapy; Research; Resistance; Resolution; Risk; Stroke; Structure; Sum; System; Testing; Therapeutic Intervention; Time; Training; Training Activity; Treatment Cost; Treatment Protocols; Veterans; Virtual and Augmented reality; Volition; accurate diagnosis; balance testing; base; care costs; career development; combat; comparative efficacy; cost; design; disability; equilibration disorder; fall risk; falls; fear of falling; functional decline; functional disability; improved; innovation; military veteran; motor learning; muscle degeneration; neurophysiology; novel diagnostics; portability; protocol development; rehabilitation research; sarcopenia; success; tool

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 has a higher prevalence of disability. Thus, Veterans would benefit substantially more from an accurate diagnosis and treatment of balance function. Despite its importance, much is still unknown about the manner in which balance 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 and psychophysical methods to address existing gaps in the diagnosis and treatment of balance impairments through the development of a Balance Assessment and Training Platform (BATP). The goal of the BATP 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 BATP’s Assessment Module quickly establishes the subject’s Limit of Balance (LoB), and then measures performance in a reaching task while at the LoB. These better expose balance deficits for identification and evaluation. The BATP’s Training Module’s goal is to increase subjects’ LoB by continuously challenging them to perform the reaching task at their current LoB, and when they demonstrate proficiency expanding the reaching task to increase their LoB. The BATP 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 BATP’s most immediate and salient metric is the LoB for standing reach; and we hypothesize that expanding this LoB, as the BATP is designed to do, will improve balance function 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. We believe that the performance metrics and analytical results produced by the BATP can form the basis for new diagnostic measures that more reliably and precisely quantify and explain balance performance problems; as well as have the sensitivity to 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 stroke population, the BATP is a general tool that can aid in the diagnosis and treatment of balance disorders arising from conditions other than stroke. These include obesity, diabetes (which often leads to lower extremity muscle degeneration and peripheral neuropathy), sarcopenia, vestibular disorders, and otherneurological disorders such as Parkinson’sdisease. Veterans whose balance has been compromised by TraumaticBrainInjury(TBI—whether combat-related or not) may also benefit from these tools.

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%），并且残疾发生率较高，因此，退伍军人将受益更多。 尽管平衡功能很重要，但仍有很多未知之处。 关于年龄和疾病对平衡的损害方式。 事实证明，对于有跌倒风险的人来说，工程方法非常适合研究和使用。 评估平衡；但迄今为止已应用于缺乏复杂性的过度场景 探索平衡和跌倒的肌肉骨骼和神经生理学基础。 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。 推进工程和心理物理学方法，以解决诊断和治疗方面的现有差距 通过开发平衡评估和培训平台（BATP）来消除平衡障碍。 BATP 的目标是定量评估和提高高危个体在以下情况下保持平衡的能力： 受到身体及其部位的意志运动的干扰——一类重要的平衡障碍 BATP 的评估模块是许多日常生活活动中不可或缺的一部分，可导致快速跌倒。 建立受试者的平衡极限（LoB），然后测量在达到任务时的表现 这些可以更好地揭示 BATP 培训模块的平衡缺陷。 目标是通过不断挑战受试者完成其能力范围内的任务来提高受试者的 LoB 当前的 LoB，当他们表现出熟练程度时，可以扩展到达任务以增加他们的 LoB。 与大多数此类测试和训练不同，BATP 侧重于达到或超出平衡极限的表现 不以这种方式挑战受试者的协议 BATP 最直接和最显着的指标是 LoB。 对于站立范围；并且我们努力扩大此 LoB（正如 BATP 的设计目的）将改善 平衡功能并使个人更能抵抗跌倒（在预期平衡的背景下） 干扰）。 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 我们相信，BATP 产生的绩效指标和分析结果可以形成。 更可靠、更精确地量化和解释平衡的新诊断措施的基础 性能问题；以及随着时间的推移跟踪它们的变化的敏感性。 和治疗方案将特别有益于 VA 医疗保健系统，因为这将导致 改善：患者吞吐量、护理质量和治疗成本。 对于老年中风患者，BATP 是一种通用工具，可以帮助诊断和治疗 由中风以外的疾病引起的平衡障碍包括肥胖、糖尿病（通常是肥胖）。 导致下肢肌肉退化和周围神经病变）、肌肉减少症、前庭疾病、 以及其他神经系统疾病，例如帕金森病，其平衡受到损害。 TraumaticBrainInjury（TBI——无论是否与战斗相关）也可能从这些工具中受益。