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，站立平衡控制缺陷会导致生活质量下降， 不幸的是，康复方法已经成功。 老年人跌倒发生率的降低（例如有针对性的强化练习、扰动训练）尚未实现 在慢性中风患者 (PwCS) 中也显示出同样的效果，但这种方法的失败可能部分是由于。 这些干预措施不包括针对导致损失的体感缺陷的成分 平衡，并且在 PwCS 中很常见。 该提案的目的是设计一种新颖的多感官增强方法来改善控制 通过感觉增强，人工反馈为神经系统提供了站立平衡的能力。 有关身体动态的信息，可用于防止失去平衡。 方法已被用来改善前庭缺陷个体的平衡能力，主要是通过应用 对躯干的振动刺激可以提供有关身体摇摆的信息。但是，存在三个主要障碍。 阻碍了 PwC​​S 中这种方法的有效使用。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 PwCS 存在认知缺陷。 对增强反馈的单一来源的关注并不能解释广泛的反馈方式 PwCS 对感觉刺激有反应，目前尚不清楚感觉增强是否有效。 在 PwCS 中更有效地作为培训工具（即在康复期间使用）或作为 辅助工具（即社区日常活动中佩戴的设备）。 这些障碍中的每一个都以体感增强为目标的假设为中心 对个体患者最有用的反馈源将改善中风后的平衡能力。 这一假设将通过三个具体目标来解决。 第一个具体目标是通过增强的感官反馈来表征平衡性能的变化 PwCS 中的四种不同的体感反馈来源将得到增强（躯干触觉、臀部 本体感觉、踝关节本体感觉、足底皮肤感觉），其中每一个都有助于控制 每种类型增强的相对有效性将针对个体进行量化。 以及从短暂的感官扰动中预测这种有效性的能力——这将是 快速确定适当的增强方法具有巨大价值第二个具体目标是评估。 多感官增强的人机交互优化的可行性和有效性。 许多感官反馈来源有助于平衡控制，这种新颖的优化的使用 确定改善个人平衡的最佳刺激范例的方法将增加 第三个具体目标是确定感觉增强产生重要临床影响的可能性。 当多感官增强作为一种方法应用时，是否会产生持续的平衡改善 训练设备或作为辅助设备在这里，两种训练效果（例如，改善平衡时）。 未应用增强）和辅助效果（例如，在长时间内持续改善平衡） 增强）将在为期 10 周的干预过程中进行评估。 该项目以感觉运动平衡控制的神经生理学为基础，应用 这种方法基于先前严格的基础科学研究。 从而进一步加深该领域对感觉反馈与平衡之间关系的理解，同时 同时增加对重要问题提供临床相关见解的可能性 中风后平衡缺陷。