Optimizing motor training in Parkinson disease through neural mechanisms

通过神经机制优化帕金森病的运动训练

• 批准号: 9268454
• 负责人: Madeleine Eve Hackney
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9268454
• 关键词: ARNT gene; Address; Adult; Adverse effects; Affect; American; Anterolateral; Area; Basal Ganglia; Behavior Control; Biological Neural Networks; Bypass; Caring; Cerebellum; Clinical; Clinical Research; Clinical Trials; Cognitive; Comorbidity; Complex; Cues; Dancing; Diabetes Mellitus; Disease; Doctor of Philosophy; Effectiveness; Evaluation; Faculty; Functional Magnetic Resonance Imaging; Functional disorder; Funding; Generations; Goals; Guidelines; Health education; Healthcare Systems; Heart Diseases; Image; Impairment; Individual; Intervention; Investigation; Lead; Learning; Lobule; Lower Extremity; Mediating; Mental Health; Mentors; Methodological Studies; Methodology; Methods; Moods; Motor; Motor Cortex; Movement; Neurocognitive; Neurology; Neurosciences; Operative Surgical Procedures; Outcome Measure; Parkinson Disease; Participant; Patients; Pattern; Performance; Persons; Pharmaceutical Preparations; Pharmacology; Problem Solving; Quality of life; Randomized Controlled Trials; Reading; Rehabilitation therapy; Research; Research Personnel; Rest; Severity of illness; Somatosensory Cortex; Stroke; Structure; System; Testing; Thalamic structure; Training; Veterans; Withdrawal; Wolves; aged; burden of illness; career; career development; cost; design; efficacy testing; experience; falls; foot; health related quality of life; imaging study; improved; improved functioning; improved mobility; improved outcome; instructor; limb movement; mobility enhancement; motor control; motor function improvement; motor impairment; motor rehabilitation; neural circuit; neural correlate; neural patterning; neuromechanism; neuromuscular system; novel; physical conditioning; putamen; rehabilitation strategy; relating to nervous system; relative effectiveness; response; self esteem; skills; socioeconomics; trial design

DESCRIPTION Veterans with Parkinson's disease (PD) have impaired mobility, which adversely affects their quality of life. The candidate has demonstrated the effectiveness of adapted tango dance, in which participants both lead (internally guide: IG) and follow (externally guide: EG) movement (Hackney & Earhart 2009, 2010). To improve outcomes, the underlying neural mechanisms for both motor impairments and improvement must be investigated. IG and EG movements have distinct neural patterns. Individuals with PD have trouble with IG movement but this problem is helped by strategies employed while "leading". During "following", participants with PD can exploit multiple external cues, which facilitate movement in PD, because EG tasks bypass the basal ganglia (Freedland et al., 2002). In older veterans with PD, we aim to determine neural activation patterns during IG and EG lower limb movement and then examine effects of IG and EG training on neural activation in conjunction with mobility improvements. The long-term goal is to optimize motor training for veterans with PD by understanding lower limb motor circuitry in PD as well as neural changes in circuitry through which training is effective. The objectives are as follows: 1. To explore neural activity of lower limb movements in veterans with PD under IG and EG conditions, and then to evaluate neural changes in circuitry after IG and EG training through adapted tango, using a randomized controlled trial design 2. To gain expertise in imaging of complex neuromotor systems of veterans with and without PD, and then apply this expertise to the evaluation of neural circuitry changes as a result of training. 3. To gain further experience in rehabilitative study methodology. 4. To Improve hypothesis generation, reasoning ability and problem solving while investigating PD motor impairment, its underlying mechanisms and response to targeted training. Mentoring: The mentoring team combines faculty with expertise in fMRI, rehabilitative clinical trials, and the care of persons with PD. Mentors include Krish Sathian, MD, Ph.D. (Primary, neurology, imaging), Steven L. Wolf, PhD. PT (motor rehabilitation, clinical trials), Daniel Corcos (PD, imaging, motor rehabilitation) and Bruce Crosson (PD, imaging, neurocognitive evaluation), Ph.D. Marian Evatt, MD and Kaundinya Gopinath, Ph.D. will serve as clinical and research collaborators, respectively. Career and Research Plan: Career development activities include coursework and seminars in neuroscience, imaging, statistical and rehabilitative methodology. The candidate's mentors will provide structured readings and discussions on motor systems, the pathophysiology of PD, motor rehabilitation and imaging applications. The research plan will begin with an fMRI investigation. We will examine neural correlates of a clinically-used foot-tapping task, during IG and EG conditions in veterans aged 40-70 with and without PD. Then, we will assess the relative effectiveness of IG versus EG training during an adapted tango class, compared to a behavioral control for improved mobility and foot tapping, Participants with PD will be assessed for disease severity, and will receive tests of outcome measures while "OFF" medications, 1 week before training, and 1 week and 1 month after training. Participants must attend 20 lessons of IG or EG adapted tango in 12 weeks, taught by an experienced instructor. In an fMRI scanner, we will assess participants for improved foot tapping after training and investigate changes in activation in specific neural circuits in conjunction with training effects upon mobilit. The candidate expects the proposed career and research plan will prepare her to apply for Merit Review funding to establish independence as an investigator. This plan will also provide greatly needed evidence to support guidelines for the treatment of motor impairment in veterans with PD.

描述 患有帕金森病 (PD) 的退伍军人活动能力受损，这对他们的生活质量产生了不利影响。候选人展示了改编探戈舞的有效性，其中参与者既领导（内部指导：IG）又跟随（外部指导：EG）动作（Hackney & Earhart 2009，2010）。为了改善结果，必须研究运动损伤和改善的潜在神经机制。 IG 和 EG 运动具有不同的神经模式。患有 PD 的人在 IG 运动方面存在困难，但通过“领导”时采用的策略可以解决这个问题。在“跟随”过程中，PD 参与者可以利用多种外部线索，从而促进 PD 中的运动，因为 EG 任务绕过基底神经节（Freedland 等，2002）。在患有 PD 的老年退伍军人中，我们的目标是确定 IG 和 EG 下肢运动期间的神经激活模式，然后检查 IG 和 EG 训练对神经激活以及活动能力改善的影响。长期目标是通过了解帕金森病下肢运动回路以及使训练有效的神经回路变化，优化帕金森退伍军人的运动训练。目标如下： 1. 采用随机对照试验设计，探讨 IG 和 EG 条件下患有 PD 的退伍军人下肢运动的神经活动，然后通过适应性探戈评估 IG 和 EG 训练后回路的神经变化 2获得患有和不患有帕金森症的退伍军人复杂神经运动系统成像方面的专业知识，然后将这些专业知识应用于评估训练引起的神经回路变化。 3. 获得更多 康复研究方法方面的经验。 4. 在研究PD运动障碍、其潜在机制和对针对性训练的反应时，提高假设生成、推理能力和解决问题的能力。指导：指导团队由具有功能磁共振成像、康复临床试验和帕金森病患者护理方面专业知识的教师组成。导师包括 Krish Sathian，医学博士、博士。 （初级、神经病学、影像学），Steven L. Wolf 博士。 PT（运动康复、临床试验）、Daniel Corcos（PD、影像学、运动康复）和 Bruce Crosson（PD、影像学、神经认知评估）博士。 Marian Evatt 医学博士和 Kaundinya Gopinath 博士将分别担任临床和研究合作者。职业和研究计划：职业发展活动包括神经科学、成像、统计和康复方法方面的课程和研讨会。候选人的导师将提供有关运动系统、PD 病理生理学、运动康复和成像应用的结构化阅读和讨论。该研究计划将从功能磁共振成像调查开始。我们将检查 40-70 岁患有或不患有 PD 的退伍军人在 IG 和 EG 条件下临床使用的足部敲击任务的神经相关性。然后，我们将在调整后的探戈课程中评估 IG 与 EG 训练的相对有效性，与改善活动能力和足部拍打的行为控制相比，PD 参与者将接受疾病严重程度评估，并将接受结果测量测试，同时“ OFF”药物，训练前 1 周、训练后 1 周和 1 个月。参与者必须在 12 周内参加由经验丰富的教练教授的 20 节 IG 或 EG 改编探戈课程。在功能磁共振成像扫描仪中，我们将评估参与者训练后足部拍打的改善情况，并研究特定神经回路激活的变化以及训练对活动的影响。候选人预计拟议的职业和研究计划将使她准备好申请绩效审查资金，以建立作为研究者的独立性。该计划还将提供急需的证据来支持患有帕金森病的退伍军人运动障碍的治疗指南。