The peripheral motor repertoire as a neuromuscular constraint on walking balance integrity in age-related falls risk

外周运动指令作为神经肌肉约束对年龄相关跌倒风险中步行平衡完整性的影响

• 批准号: 10266818
• 负责人: Jason R Franz
• 金额: $ 23.17万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10266818
• 关键词: Address; Affect; Age; Area; Benchmarking; Communities; Complex; Cross-Sectional Studies; Data; Development; Diagnosis; Diagnostic; Diagnostic tests; Elderly; Equilibrium; Fall prevention; Financial Hardship; Fright; Future; Gait; Goals; Guidelines; Impulsivity; Individual; Laboratories; Libraries; Link; Measurement; Measures; Mechanics; Motor; Muscle; Neurodegenerative Disorders; Neuropsychology; Optics; Peripheral; Predisposition; Prevention; Productivity; Prospective Studies; Public Health; Quality of life; Recording of previous events; Recurrence; Rehabilitation therapy; Retirement; Risk; Self Efficacy; Sensory; Speed; Surveys; Testing; Training; Walking; age related; aging population; design; equilibration disorder; evidence base; fall risk; falls; high risk; innovation; insight; interdisciplinary collaboration; locomotor tasks; neuromuscular; novel; novel strategies; preservation; prospective; response; synergism; treadmill; young adult

PROJECT SUMMARY Despite conventional diagnostic and rehabilitative efforts, and a rich understanding of standing balance control, our rapidly aging population remains at an exceptionally high risk of debilitating falls. A major contributor to this continued risk is that most falls occur during everyday walking tasks which are much less well understood and require more complex neuromuscular coordination. Our long-term goal is to introduce a novel neuromuscular mechanism for age-associated walking balance impairment as a strategic target for diagnostic testing, earlier prevention, and rehabilitation to prevent falls in older adults. We posit that all individuals rely on a principal number of peripheral neuromuscular commands – a “peripheral motor repertoire” – to accomplish everyday walking tasks during which falls may occur (e.g., walking, turning, gait initiation, precision stepping). Supported by promising pilot data, the objective of this R21 is to rigorously test the overarching hypothesis that a reduced peripheral motor repertoire used for everyday walking tasks represents a neuromuscular constraint on older adults’ ability to successfully respond to walking balance perturbations and thereby prevent falls in the community. This cross-sectional study has three aims. Specific Aim 1 will test the hypothesis that the peripheral motor repertoire (i.e., number of motor modules or muscle synergies) used to accomplish everyday walking tasks is reduced by falls history more than by age alone and negatively correlates with the number falls in the prior year. Specific Aim 2 will quantify the association between the peripheral motor repertoire, functional balance integrity, and fear of future falls. Here, we will test the hypothesis that the size of the peripheral motor repertoire used during everyday walking tasks associates more with functional balance integrity than fear of future falls. We will interpret this finding as evidence that a reduced peripheral motor repertoire represents a neuromuscular constraint that precipitates poor balance control versus an emergent strategy associated with a fear of recurrent falls. Specific Aim 3 will test the hypothesis that a reduced peripheral motor repertoire associates with larger susceptibility to a diverse combination of sensory and mechanical balance perturbation paradigms applied during walking. We will interpret this finding as a critical mechanistic link between the peripheral motor repertoire used during everyday walking tasks and ability to accommodate balance challenges relevant to falls in the community. The proposed study is innovative, and the first to combine: (1) state-of-the-art electromyographic analyses across everyday walking tasks during which falls may occur in young adults and in older adults with and without a history of falls, (2) functional and neuropsychological measures of walking balance integrity, balance self- efficacy, and fear of future falls, and (3) a combination of sensory and mechanical balance perturbation paradigms applied during walking. This project will provide pivotal insight into a very specific and innovative feature of neuromuscular control as a mechanism for age-related balance impairment while paving the way for planned prospective studies toward more effective targets for diagnostics and rehabilitation to prevent falls.

项目摘要 尽管常规的诊断和康复努力，以及对站立平衡控制的丰富理解，但 我们迅速衰老的人口仍然处于使人衰弱的高风险。对此的主要贡献者 持续的风险是，大多数跌倒在每天步行任务中都会发生，而这些跌倒的理解不多，而且 需要更复杂的神经肌肉配位。我们的长期目标是引入一种新颖的神经肌肉 与年龄相关的步行平衡障碍的机制，作为诊断测试的战略目标，更早 预防和康复以防止老年人跌倒。我们肯定所有人都依靠校长 每天完成的周围神经肌肉命令的数量 - “外围运动曲目” 可能会发生跌倒的步行任务（例如，步行，转弯，收集启动，精确步进）。支持 通过提出的飞行员数据，该R21的目的是严格测试总体假设，即减少的假设 外围电动机曲目每天都在行走任务代表对年长的神经肌肉限制 成年人成功应对步行平衡扰动的能力，从而防止 社区。这项横断面研究具有三个目标。具体目标1将检验外围的假设 电机曲目（即电动机模块或肌肉协同作用的数量）用于每天步行任务 跌倒的历史比单独的年龄降低了，并且与先前的数字下降相关 年。特定的目标2将量化外围电动机曲目，功能平衡之间的关联 正直，对未来的恐惧。在这里，我们将检验以下假设：外围电动机曲目的大小 每天使用的步行任务与功能平衡完整性相关，而不是对未来跌倒的恐惧。 我们将这一发现将其解释为证据，表明减少的外围运动库表示神经肌肉 约束宝贵的平衡控制与与害怕反复发生有关的紧急策略的约束 瀑布。特定的目标3将检验以下假设，即减少了与较大的外围电动机库库相关 对潜水的感觉和机械平衡扰动范式的敏感性 步行。我们将把这一发现解释为所用的外围电动机库之间的关键机理联系 每天，步行任务和适应与社区跌倒有关的平衡挑战的能力。 拟议的研究是创新的，是第一个结合的研究：（1）最先进的肌电分析 每天的步行任务中，年轻人和没有和没有的老年人可能会发生跌倒 瀑布的历史，（2）步行平衡完整性的功能和神经心理学衡量，平衡自我 功效，对未来的恐惧以及（3）感觉和机械平衡扰动的结合 步行过程中应用的范例。该项目将提供有关非常具体和创新性的关键见解 神经肌肉控制作为年龄相关平衡障碍机制的特征，同时为 计划的前瞻性研究针对更有效的诊断和康复目标，以防止下降。