Cortical correlates of gait in Parkinson's disease: impact of medication and cueing

帕金森病步态的皮质相关性：药物和提示的影响

• 批准号: 10561181
• 负责人: Martina Mancini
• 金额: $ 57.79万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-23 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10561181
• 关键词: Affect; Age; Area; Attention; Basal Ganglia; Brain; Cerebral cortex; Characteristics; Clinical Trials; Compensation; Complex; Cues; Dependence; Development; Devices; Dopamine; Elderly; Equilibrium; Executive Dysfunction; Feedback; Floor; Future; Gait; Gait abnormality; Gait speed; Goals; Healthcare Systems; Home; Image; Impaired cognition; Impairment; Intake; Intervention; Laboratories; Learning; Levodopa; Life; Malignant Neoplasms; Measures; Memory; Methods; Monitor; Motor; Motor Cortex; Movement; Multiple Sclerosis; Nervous System; Occipital lobe; Outcome; Parkinson Disease; Participant; Pattern; Performance; Peripheral Nervous System Diseases; Persons; Pharmaceutical Preparations; Pharmacological Treatment; Physiological; Population; Prefrontal Cortex; Quality of life; Randomized; Rehabilitation therapy; Resources; Risk; Route; Sensory; Speed; Survivors; System; Tactile; Techniques; Technology; Testing; Time; Translating; Traumatic Brain Injury; Visuospatial; Walking; Wireless Technology; Wrist; active control group; chronic neurologic disease; cognitive ability; cognitive function; cognitive reserve; disability; executive function; falls; frontal lobe; functional near infrared spectroscopy; improved; innovation; locomotor control; motor learning; multitask; novel; pharmacologic; secondary analysis; sensor; sensory cortex; skills; tactile stimulation; user-friendly; walking speed; wearable sensor technology; wireless

Project Summary/Abstract Walking automaticity, the ability of the nervous system to successfully coordinate movement with minimal use of executive resources, is a critical functional skill for independent mobility in daily life, and may be improved by medication and/or appropriate rehabilitation-based intervention. This ability is compromised, even in early stages of Parkinson's disease (PD). PD is responsible for major mobility disabilities and cognitive dysfunction and a worse quality of life than most other chronic neurological diseases, and it imposes a heavy burden on the health care system. Aim I will investigate the relation between cognitive function and walking automaticity in subjects with PD and age-matched healthy control subjects by measuring brain activity in different parts of the cerebral cortex while walking and turning. Levodopa, the most common pharmacological treatment in PD, improves certain aspects of gait, but it may worsen or not change other aspects, such as balance. The effects of levodopa on gait automaticity are not well understood. Aim II will characterize the changes in cortical activity during walking due to usual levodopa intake in people with PD. Cueing is often being used in rehabilitation. More recently, due to the increasingly user-friendly wireless technology, personalized, closed-loop cueing devices are now being developed as an improvement over fixed cueing methods (such us walking to the pace of a metronome or stepping over lines placed on the floor). Recently, we showed that step-synchronized tactile feedback improved gait automaticity in PD; however, it is not known which brain mechanisms are associated with learning of this tactile-feedback technique, nor if benefits transfer to mobility during daily-living. Our objective is to investigate the effects of step-synchronized, tactile cueing on gait automaticity measured in the laboratory; this is Aim III, a clinical trial. In addition, Aim III will explore the feasibility of using the cueing system at home for one week. This project will characterize the cortical correlates of gait automaticity, the changes in gait automaticity with dopamine replacement and cueing in people with PD, and how these changes translate to improvement in gait and turning. In with survivors. ultimately addition, personalized cueing-based rehabilitation could be effective for many other populations gait disturbances, such as peripheral neuropathy, multiple sclerosis, traumatic brain injury, and cancer There are minima l risks associated with this technology and the benefits could be significant in improving walking and reducing falls in various populations.Furthermore, by understanding more about the brain mechanisms associated with walking automaticity and motor learning through cueing, we will be able to open a new route for innovative, more tailored, rehabilitation interventions.

项目概要/摘要 步行自动化，神经系统以最少的使用成功协调运动的能力 执行资源，是日常生活中独立活动的关键功能技能，可以通过以下方式得到改善 药物治疗和/或适当的基于康复的干预。即使在早期，这种能力也会受到损害 帕金森病 (PD) 的各个阶段。 PD 是造成严重行动障碍和认知功能障碍的原因 与大多数其他慢性神经系统疾病相比，生活质量更差，给人们带来了沉重的负担 医疗保健系统。目的 我将研究认知功能与步行自动化之间的关系 通过测量帕金森病受试者和年龄匹配的健康对照受试者不同部位的大脑活动 行走和转身时的大脑皮层。左旋多巴是帕金森病最常见的药物治疗方法， 改善步态的某些方面，但可能会恶化或不会改变其他方面，例如平衡。效果 左旋多巴对步态自动化的影响尚不清楚。目标 II 将描述皮质活动的变化 由于帕金森病患者通常摄入左旋多巴，因此在步行时会出现这种情况。 提示经常用于康复。最近，由于越来越用户友好的无线 技术、个性化、闭环提示设备现在正在开发中，作为对固定设备的改进 提示方法（例如我们按照节拍器的节奏行走或跨过地板上的线）。 最近，我们发现步进同步触觉反馈可以改善 PD 的步态自动化；然而，它是 不知道哪些大脑机制与学习这种触觉反馈技术相关，也不知道是否 好处转移到日常生活中的流动性。我们的目标是研究步进同步的效果， 实验室测量的步态自动性触觉提示；这是 Aim III，一项临床试验。此外，目标III 将探讨在家使用提示系统一周的可行性。 该项目将描述步态自动化的皮质相关性、步态自动化的变化 帕金森病患者的多巴胺替代和提示，以及这些变化如何转化为步态的改善 和转动。在 和 幸存者。 最终 此外，基于提示的个性化康复可能对许多其他人群有效 步态障碍，例如周围神经病变、多发性硬化症、脑外伤和癌症 该技术的风险极小，但其效益可能非常显着 改善不同人群的步行并减少跌倒。此外，通过了解更多 关于与步行自动化和通过暗示进行运动学习相关的大脑机制，我们将 能够为创新的、更有针对性的康复干预开辟一条新途径。