Multisensory augmentation to improve the standing balance of people with chronic stroke

多感觉增强改善慢性中风患者的站立平衡

• 批准号: 10640299
• 负责人: JESSE C. DEAN
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10640299
• 关键词: Address; Adjuvant Therapy; Affect; American; Ankle; Balance training; Basic Science; Behavior; Clinical; Cognitive; Cognitive deficits; Communities; Cutaneous; Development; Devices; Effectiveness; Elderly; Equilibrium; Esthesia; Exercise; Exhibits; Feedback; Foundations; Hip region structure; Incidence; Individual; Intervention; Knowledge; Lateral; Methods; Motor; Movement; Nervous System; Participant; Patients; Pattern; Performance; Persons; Population; Probability; Proprioception; Quality of life; Randomized, Controlled Trials; Rehabilitation therapy; Research; Role; Self-Help Devices; Sensory; Source; Stimulus; Stroke; Tactile; Training; Translating; Veterans; Work; care costs; chronic stroke; clinically relevant; cutaneous sense; design; exoskeleton; experience; experimental study; fall risk; falls; foot; foot sole; human-in-the-loop; improved; individual patient; insight; invention; multisensory; neurophysiology; novel; novel strategies; post stroke; prevent; relative effectiveness; sensor; sensory feedback; somatosensory; success; tool

After a stroke, deficits in the control of standing balance contribute to a decreased quality of life, decreased functional mobility, and an increased risk of falls. Unfortunately, rehabilitation methods that have successfully reduced fall incidence in older adults (e.g., targeted strengthening exercises, perturbation training) have not yet shown the same benefits among people with chronic stroke (PwCS). This lack of success is likely due in part to these interventions not including a component that targets the somatosensory deficits that contribute to losses of balance and are quite common among PwCS. The objective of this proposal is to design a novel multisensory augmentation approach to improve the control of standing balance in PwCS. With sensory augmentation, artificial feedback provides the nervous system with information about the dynamic state of the body, which can be used to prevent losses of balance. Such methods have been used to improve balance among individuals with vestibular deficits, primarily by applying vibratory stimuli to the trunk that provide information about body sway. However, three primary barriers have prevented the effective use of this approach among PwCS. First, these methods rely on cognitive processing to interpret and respond to the novel source of feedback, while many PwCS have cognitive deficits. Second, the focus on a single source of augmented feedback does not account for the extensive variability in how PwCS respond to sensory stimulation. Finally, it is presently unclear whether sensory augmentation would be more effectively applied among PwCS as a training tool (i.e., used temporarily during rehabilitation) or as an assistive tool (i.e., a device worn during daily activities in the community). The proposed study will address each of these barriers, centered around the hypothesis that targeting somatosensory augmentation toward the feedback sources that are most useful for an individual patient will improve post-stroke balance performance. This hypothesis will be addressed through three Specific Aims. The first Specific Aim is to characterize changes in balance performance with augmented sensory feedback among PwCS. Four distinct sources of somatosensory feedback will be augmented (trunk tactile sense, hip proprioception, ankle proprioception, foot sole cutaneous sense), each of which can contribute to the control of mediolateral balance. The relative effectiveness of each type of augmentation will be quantified for individual participants, as will the ability to predict this effectiveness from brief sensory perturbations – which would be of great value in quickly identifying an appropriate augmentation approach. The second Specific Aim is to assess the feasibility and effectiveness of human-in-the-loop optimization of multisensory augmentation. Given the many sources of sensory feedback that can contribute to balance control, this use of novel optimization methods to identify the best stimulation paradigm to improve an individual’s balance would increase the likelihood of sensory augmentation having an important clinical impact. The third Specific Aim is to determine whether multisensory augmentation produces sustained balance improvements when applied as either a training device or as an assistive device. Here, both training effects (e.g., improved balance when augmentation is not applied) and assistive effects (e.g., continuously improved balance over long periods of augmentation) will be assessed over the course of a 10-week intervention. The proposed project has a foundation in the neurophysiology of sensorimotor balance control, applying sensory augmentation methods that are based on prior rigorous basic science research. This approach will thus further the field’s understanding of the relationship between sensory feedback and balance, while simultaneously increasing the probability of providing clinically relevant insight into the important problem of post-stroke balance deficits.

中风后，在控制平衡的控制中定义会导致生活质量下降，改善 功能流动性和跌倒风险增加。不幸的是，成功的康复方法 老年人的秋季事件减少（例如，有针对性的加强运动，扰动训练）尚未 在慢性中风（普华永道）中显示出同样的好处。缺乏成功可能部分归因于 这些干预措施不包括针对体感的组件定义的损失 平衡，在普华永道中很常见。 该建议的目的是设计一种新型的多感官增强方法来改善控制 普华永道的站立平衡。通过增强感官，人工反馈为神经系统提供了 有关身体动态状态的信息，可用于防止平衡损失。这样的 方法已用于改善前庭定义的个体之间的平衡，主要是通过应用 振动性刺激到提供有关身体摇摆的信息的躯干。但是，三个主要障碍有 防止普华永道中有效使用这种方法。首先，这些方法依赖于认知处理 解释和回应新的反馈来源，而许多普华永道则具有认知缺陷。第二， 关注单一来源的增强反馈来源并不能说明如何 普华永道对感觉刺激做出反应。最后，尚不清楚感官增强是否会 在普华永道中更有效地应用于训练工具（即在康复期间暂时使用）或 辅助工具（即，在社区日常活动中佩戴的设备）。拟议的研究将解决 这些障碍中的每一个都围绕以下假设，即针对体感朝向 对个别患者最有用的反馈来源将改善中风后平衡表现。 该假设将通过三个具体目标解决。 第一个具体目的是通过增强感觉反馈来表征平衡绩效的变化 在普华永道中。体验反馈的四个不同来源将得到增强（树干触觉，臀部 本体感受，踝关节感受，脚部唯一皮肤感），每种感觉都可以有助于控制 中外侧平衡。每种增强类型的相对有效性将被量化 参与者，从短暂的感官扰动中预测这种有效性的能力也将是 快速确定适当的增强方法的重视。第二个具体目的是评估 人类在多感觉增强的环境优化的可行性和有效性。鉴于 许多可以导致平衡控制的感觉反馈来源，这种新型优化的使用 确定最佳刺激范式以提高个人平衡的方法将增加 感官增强的可能性具有重要的临床影响。第三个具体目的是确定 当将多感官增强作为一个 训练设备或作为辅助设备。在这里，这两种训练效果（例如，何时提高了平衡 不应用增强）和辅助效应（例如，长期不断提高平衡 增强）将在10周的干预过程中进行评估。 拟议的项目在感觉运动平衡控制的神经生理学基础上，应用 基于先前严格的基础科学研究的感觉增强方法。这种方法会 因此，进一步进一步了解了感觉反馈与平衡之间的关系，而 同样，增加了提供临床上相关洞察力的可能性 中风后余额定义。