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.

到目前为止，跌倒是造成意外伤害和老年人死亡的主要原因。退伍军人人口是 由于跌倒的影响更大，因为它比总人口大得多（在65年内45％ 年龄为13％），残疾患病率更高。那，退伍军人将更多地受益 通过准确的诊断和平衡功能的处理。尽管它的重要性，但仍然未知 关于年龄和疾病损害平衡的方式。人们的治疗干预措施 有被证明有限的效用有限的人。工程方法非常适合学习和 评估平衡；但是到目前为止，必须应用于过度简化的场景 探测肌肉骨骼和神经生理碱的平衡和跌倒。 这项研究的长期目标是从VA康复研究与开发开始 （RR＆D）职业发展奖（CDA-2），是为诊断的改进指令和协议 以及与平衡有关的姿势和运动协调问题的处理。该提议大大 进步工程和心理物理方法，以解决诊断和治疗中现有差距 通过开发平衡评估和培训平台（BATP）来平衡损害。 BATP的目标是定量评估和提高高危个人在 受到身体及其部位的自愿运动的干扰 - 重要的平衡灾害类别 与许多日常生活活动不可或缺的一部分，可以降低跌倒。 BATP的评估模块很快 建立受试者的余额极限（LOB），然后在达到任务中的性能 叶。这些更好地揭示了平衡定义以进行识别和评估。 BATP的训练模块的 目标是通过持续挑战他们在其上执行触及任务来增加受试者的LOB 当前的LOB，当他们证明熟练度扩大到达任务以增加叶子时。 与大多数这样的测试和培训不同，BATP专注于平衡限制的性能 不会以这种方式挑战主题的协议。 BATP最直接，最显着的指标是Lob 站立我们假设扩展该叶子，因为BATP的设计要做，将有所改善 平衡功能并使个人对跌倒的抵抗力（在预期平衡的背景下 干扰）。 确认这一假设可以为现有培训方案的谦虚提供新的看法 成功率和设计新协议的指导，有可能显着改善这些方案 费率。我们认为，BATP产生的性能指标和分析结果可以形成 更可靠，更精确量化并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变化的敏感性。这样的诊断 和治疗方案将对VA医疗保健系统特别有益，因为这将导致 改进：患者吞吐量，护理质量和治疗费用。尽管该提议针对 老年人中风人口，BATP是一种通用工具，可以帮助诊断和治疗 平衡疾病是由中风以外的其他条件引起的。这些包括肥胖，糖尿病（通常 导致下肢肌肉变性和周围神经病），肌肉减少症，前庭疾病， 以及其他神经学疾病，例如帕金森氏病。退伍军人的平衡已被妥协 通过创伤性脑（TBI）也可以从这些工具中受益。