A Balanced Reach Training Platform to Address Balance Disorders in Older and Neurologically Disabled Veterans

平衡伸展训练平台，可解决老年和神经残疾退伍军人的平衡障碍问题

• 批准号: 10710392
• 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: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10710392
• 关键词: Accidental Injury; Activities of Daily Living; Address; Adult; Affect; Age; Age Years; Aging; Articular Range of Motion; Balance training; Behavior; Biomechanics; Cessation of life; Clinic; Clinical assessments; Control Groups; Deterioration; Development; Diabetes Mellitus; Diagnosis; Diagnostic; Disabled Persons; Disease; Elderly; Elements; Engineering; Equilibrium; General Population; Goals; Healthcare Systems; High Prevalence; Hour; Human; Impairment; Individual; Injury; Intervention; K-Series Research Career Programs; Life; Lower Extremity; Measures; Methods; Morbidity - disease rate; Movement; Musculoskeletal; Neurologic; Obesity; Patients; Perception; Performance; Peripheral Nervous System Diseases; Persons; Population; Posture; Prevalence; Protocols documentation; Psychophysics; Quality of Care; Research; Resistance; Risk; Stroke; Structure; System; Testing; Therapeutic Intervention; Time; Training; Training Activity; Traumatic Brain Injury; Treatment Cost; Treatment Protocols; Veterans; Walking; accurate diagnosis; base; care costs; career development; clinical efficacy; clinical training; combat; cost; design; disability; dosage; equilibration disorder; exercise training; fall injury; fall risk; falls; functional decline; functional disability; improved; innovation; instrument; military veteran; motor learning; muscle degeneration; nervous system disorder; neurophysiology; novel; novel diagnostics; portability; rehabilitation research; response; sarcopenia; success; tool; trend; Accidental Injury; Activities of Daily Living; Address; Adult; Affect; Age; Age Years; Aging; Articular Range of Motion; Balance training; Behavior; Biomechanics; Cessation of life; Clinic; Clinical assessments; Control Groups; Deterioration; Development; Diabetes Mellitus; Diagnosis; Diagnostic; Disabled Persons; Disease; Elderly; Elements; Engineering; Equilibrium; General Population; Goals; Healthcare Systems; High Prevalence; Hour; Human; Impairment; Individual; Injury; Intervention; K-Series Research Career Programs; Life; Lower Extremity; Measures; Methods; Morbidity - disease rate; Movement; Musculoskeletal; Neurologic; Obesity; Patients; Perception; Performance; Peripheral Nervous System Diseases; Persons; Population; Posture; Prevalence; Protocols documentation; Psychophysics; Quality of Care; Research; Resistance; Risk; Stroke; Structure; System; Testing; Therapeutic Intervention; Time; Training; Training Activity; Traumatic Brain Injury; Treatment Cost; Treatment Protocols; Veterans; Walking; accurate diagnosis; base; care costs; career development; clinical efficacy; clinical training; combat; cost; design; disability; dosage; equilibration disorder; exercise training; fall injury; fall risk; falls; functional decline; functional disability; improved; innovation; instrument; military veteran; motor learning; muscle degeneration; nervous system disorder; neurophysiology; novel; novel diagnostics; portability; rehabilitation research; response; sarcopenia; success; tool; trend

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 Veterans would benefit substantially more from an accurate diagnosis and treatment of fall propensity. Despite its importance, much is still unknown about the manner in which balance control 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 methods to address existing gaps in the diagnosis and treatment of balance impairments through the development of a Balanced Reach Training Protocol (BRTP). The BRTP continuously challenges subjects to perform reaching tasks at the limits of their balance for an extended period of time, and increases these limits as subjects demonstrate improved performance. The goal of this tool 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 BRTP 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 BRTP's most immediate and salient metric is the limiting boundary of standing reach; and we hypothesize that expanding this boundary, as the BRTP is designed to do, will improve balance 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. [Though the BRTP is a training platform, we also believe that the performance metrics and analytical results produced by it can form the basis for new diagnostic measures that more reliably and precisely quantify and explain balance performance problems; and 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 population, the BRTP is a general tool that can aid in the diagnosis and treatment of balance disorders arising from conditions other than aging. These include obesity, diabetes (which often leads to lower extremity muscle degeneration and peripheral neuropathy), sarcopenia, vestibular disorders, and neurological disorders such as stroke. Veterans whose balance has been compromised by Traumatic Brain Injury (TBI) (whether combat-related or not) may also benefit from the BRTP.

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％ 年龄和13％）；从准确的诊断和治疗秋天的治疗中，退伍军人将大大受益 倾向。尽管它的重要性，但对于平衡控制的方式仍然不知道 因年龄和疾病而妥协。有证明有风险的人的治疗干预措施已被证明 效用有限。工程方法非常适合研究和评估平衡；但是必须 被应用于过度简单的场景，这些场景缺乏探测肌肉骨骼和的复杂性 神经生理基础以保持平衡和跌倒。 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 提高工程方法，以解决平衡诊断和处理中现有差距 通过制定平衡触及培训方案（BRTP）的损害。 BRTP 不断挑战受试者，以在其平衡的范围内执行达到任务，以进行扩展 随着受试者表现出改善的性能，并增加了这些限制。目标的目标 工具是定量评估和提高处于风险的个人在受到干扰时保持平衡的能力 身体及其部位的自愿运动 - 这是许多重要的平衡灾害与许多不可或缺的一部分 日常生活的活动可能会降低。 BRTP专注于在 与大多数这样的测试和培训方案不同，平衡的限制不会以这种方式挑战受试者。 BRTP最直接，最显着的指标是站立范围的限制边界。我们假设 像BRTP旨在做到的那样，扩大这个边界的扩大将提高平衡并使个人更多 对跌倒的抵抗力（在预期平衡灾害的背景下）。 确认这一假设可以为现有培训协议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。 [尽管BRTP是一个培训平台，但我们也相信性能指标和分析 由其产生的结果可以构成更可靠，更准确的新诊断措施的基础 量化和解释平衡绩效问题；并跟踪它们随着时间的变化。] 诊断和治疗方案将对VA医疗保健系统特别有益 将导致改进：患者吞吐量，护理质量和治疗费用。虽然这个 提案针对老化的退伍军人人口，BRTP是一种通用工具，可以帮助诊断和 通过衰老以外的其他疾病引起的平衡障碍的治疗。这些包括对象，糖尿病 （通常导致下肢肌肉变性和周围神经病），肌肉减少症， 平衡一直是前庭疾病的退伍军人，以及中风等神经系统疾病。 受创伤性脑损伤（TBI）（是否与战斗相关）损害也可能受益于BRTP。