Remote dynamic cycling for the customized off-site rehab in Parkinson’s disease.

用于帕金森病定制场外康复的远程动态循环。

• 批准号: 10609837
• 负责人: Aasef G Shaikh
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10609837
• 关键词: Affect; Area; Artificial Intelligence; Caring; Clinic; Clinic Visits; Clinical; Cognition; Cognitive; Communication; Communities; Data; Deterioration; Development; Devices; Dopamine; Dose; Equilibrium; Exercise; Exercise Therapy; Feedback; Future; Goals; Group Homes; Health Insurance Portability and Accountability Act; Health Personnel; Home; Hour; Independent Living; Individual; Intervention; Laboratories; Levodopa; Location; Logistics; Longterm Follow-up; Measures; Mental Depression; Monitor; Motor; Movement Disorder Society Unified Parkinson' s Disease Rating Scale; Movement Disorders; Nerve Degeneration; Nursing Homes; Ohio; Outcome; Outcome Measure; Outpatients; Parkinson Disease; Participant; Patients; Performance; Persons; Pharmaceutical Preparations; Phase; Progressive Disease; Quality of life; Regimen; Rehabilitation therapy; Research; Resources; Safety; Schedule; Secure; Self Direction; Site; Social support; Speed; Strategic Planning; Symptoms; System; Techniques; Technology; Testing; Time; Titrations; Torque; Travel; Veterans; Vision; Visit; artificial intelligence algorithm; awake; cost effective; cost effectiveness; data exchange; effectiveness testing; efficacy evaluation; efficacy testing; exercise regimen; experience; frailty; functional decline; functional improvement; improved; individualized medicine; instrument; motor deficit; motor function improvement; motor symptom; novel; operation; pandemic disease; participant safety; post intervention; provider intervention; remote assessment; remote delivery; remote health care; remote monitoring; response; safety supervision; sensor; therapy outcome; user-friendly; virtual; wearable device; wearable sensor technology; wireless fidelity; wireless sensor

Parkinson’s disease (PD) progressively deteriorates motor function. Successful rehabilitation, leading to a favorable course of movement disorders in PD, is contingent upon frequent, regular, and patient-specific exercise regimen that is customized to the individual needs. Latter requires regular interventions from the provider and frequent visits to the rehab facility. Lack of access, poor social support, inability to travel, home-bound status, or pandemics are significant hurdles in delivering effective rehab to the PD patients. Our vision is to offer customized and cost-effective PD rehab using a remotely operated technology near or at the patients’ homes. This technology would be remotely monitored and customized online to titrate therapeutic outcomes optimized for each patient. The proof of this concept was already established in our laboratory, a technology called dynamic cycling. The highlight of this technology is a stationary bike operating at a rapid speed (cadence) with programmable variability in speed and power/torque hence promoting motor performance superior to traditional motorized bikes (i.e. static cycling). The next step towards our ultimate vision of at-home exercise therapy is remotely operated dynamic bike. We have already built remotely operated dynamic bike; the current proposal will objectively examine the efficacy of a novel, remotely delivered and remotely adjusted dynamic cycling paradigm using remotely monitored motor outcomes. Comparison will be made with remote static cycling. The study will be launched at three community based wellness locations to assure the subject safety, ease of access, compliance, and as needed support. Aim 1 will examine the hypothesis that dynamic cycling will immediately improve the motor function in PD. The effects will be prominent on the dopamine-sensitive motor deficits. The repetition will enhance motor improvement. The participants will use wearable sensors for the remote assessments of motor symptoms in PD before and immediately after each exercise session. The information from the wearable sensors and the bike will be utilized to further adjust the bike parameters for the next dynamic cycling session. We will also measure effects on subjective ratings of motor function, cognition and balance before, and at 0, 3, and 6 months after the cycling intervention. Aim 2 will analyze the effects of dynamic cycling on motor fluctuations, declining response to levodopa in an early and unpredictable manner significantly affecting the quality of life in the PD. We hypothesize that dynamic cycling will reduce the motor fluctuations in PD. The efficacy of dynamic cycling on improvement in motor fluctuation over a 12-hour awake period will be measured every day with the wearable sensors that communicate via secure cloud. The immediate clinical impact is that the technology will be immediately deployed to the Veteran’s group homes, nursing homes, and community based VA clinics. The project will provide sufficient information to carry our ultimate vision, at-home dynamic cycling serving three critical needs: 1) customized therapy, 2) easy access, and 3) safety and cost-effectiveness.

帕金森氏病（PD）逐渐恶化运动功能。 PD中运动者的有利过程取决于频繁，规则和特定于患者的运动 根据个人需求定制的方案。 经常访问康复设施，无法获得社会支持，无能为力 Pandemics在为PD患者提供有效的康复方面是无栏的。 使用在患者家附近或在患者家附近或在患者家中进行远程操作的技术定制且具有成本效益的PD康复。 该技术WOWLD在网上进行远程监控和自定义，以滴定优化的治疗结果 对于每个患者 骑自行车。 速度和功率/扭矩的可编程变异性，因此促进运动性能优于传统 电动自行车（即静态骑行）。 远程操作的动态自行车 将客观地检查小说，远程传递和远程调整的动态chy潮的功效 使用远程电动机与远程静态循环进行了远程监测 研究将在三个基于委员会的健康地点启动，以确保主题安全，易于访问， 合规性和根据需要的支持。 改善PD的运动功能。 重复会增强电动机的改进。 每次练习后，对PD的运动症状进行评估 从可穿戴的传感器和自行车开始，以进一步调整Thext动态的自行车参数 骑自行车会议。 在骑自行车干预后的0、3和6个月之前。 关于运动波动，以不可预测的方式下降了对左旋多巴的反应 PD的生活质量 动态循环在12小时清醒时期的电动机波动改善的功效将 每天都有通过安全云进行通信的可穿戴传感器。 该技术将立即部署到资深人士的房屋，疗养院和社区 基于VA的诊所。 骑自行车满足三个批判性需求：1）定制治疗，2）轻松进入，3）安全性和成本效益。