Investigating subthreshold vestibular stimulation as a strategy for rehabilitation in individuals with bilateral vestibular hypofunction

研究阈下前庭刺激作为双侧前庭功能减退患者的康复策略

基本信息

批准号：
10571440
负责人：
Andrew Raymond Wagner
金额：
$ 10万
依托单位：
OHIO STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-01-01 至 2023-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10571440
关键词：
Address Adult Age Animal Model Automobile Driving Balance training Behavior Bilateral Clinical Trials Cues Data Development Plans Diagnosis Disease Dizziness Doctor of Philosophy Ear Equilibrium Esthesia Exposure to Face Functional disorder Future Goals Head Movements Health Health Expenditures Hour Individual Institution Intervention Knowledge Lead Learning Lesion Measures Mentors Mentorship Methods Monitor Motion Movement Nature Nervous System Neuronal Plasticity Neurons Ohio Outcome Pathology Patient Self-Report Patients Performance Personal Satisfaction Phase Protocols documentation Quality of life Rehabilitation therapy Research Research Project Grants Rotation Sampling Scientist Secondary to Sensory Series Stimulus Symptoms System Techniques Training Translations Universities Vestibular Function Tests Vestibular loss Vision Work career career development clinical development desensitization design environmental change fall risk falls gaze health related quality of life improved improved outcome innovation neural neurophysiology novel novel strategies recruit rehabilitation science rehabilitation strategy response sensory stimulus skills vestibulo-ocular reflex

项目摘要

1 Project Summary/Abstract 2 In individuals with bilateral vestibular hypofunction (BVH), vestibular responses to self-motion cues are reduced 3 bilaterally, often without a defined cause. The persistent state of desensitization yields symptoms of bouncing or 4 unstable vision, dizziness, imbalance, and falls; collectively, these symptoms lead to a substantial reduction in 5 quality of life. However, despite the sizeable impact of BVH on quality of life, health care expenditures, and falls, 6 interventions tailored to the specific needs of patients with BVH, as opposed to patients with unilateral lesions, 7 have yet to be developed. The objective of this proposal is to investigate a novel strategy for improving vestibular 8 function in individuals with BVH. The nervous system possesses a robust capacity to regulate neural activity in 9 the face of changing environmental or internal conditions. When exposed to a weak sensory stimulus (e.g., slow 10 movements of the head), a specific type of neural plasticity, “homeostatic plasticity”, has been shown to increase 11 the responsiveness of the involved neurons to subsequent motion stimuli. In this project, we aim to determine if 12 such mechanisms, prompted by periods of subthreshold (i.e., low amplitude) motion, may serve as a potential 13 strategy for driving plasticity in the lesioned vestibular system. Specifically, in individuals diagnosed with BVH 14 we will (1) measure changes in sensitivity to self-motion cues immediately following a subthreshold motion 15 stimulus (Aim 1), (2) characterize changes in vestibular function after repeated exposure to a subthreshold 16 motion stimulus (Aim 2), and (3) determine if the addition of a subthreshold motion “primer” can improve the 17 outcomes of vestibulo-ocular reflex (VOR) adaptation (Aim 3A) and balance training (Aim 3B). We hypothesize 18 that the use of a subthreshold stimulus, secondary to its capacity to drive plastic changes in the vestibular 19 system, will lead to an increased sensitivity to self-motion cues, as well as positive changes in vestibular function 20 (e.g., gaze stability, balance), in patients with BVH. In accordance with the topic of the proposed research project, 21 my long-term career goal is to establish a research lab that focuses on developing innovative treatments for 22 vestibular dysfunction. To achieve this goal, the proposed career development plan focuses on acquiring the 23 skills and knowledge required to design, implement, monitor, and analyze the results of clinical trials in the 24 rehabilitation sciences; more specifically, this includes (1) gaining a better understanding of the 25 neurophysiological principles underlying vestibular plasticity/learning, (2) learning state-of-the-art techniques for 26 analyzing the behavior of the VOR, and (3) learning current methods for adapting the gain of the VOR. The 27 mentored phase of the training plan will take place at Ohio State University in the lab of Dr. Daniel Merfeld, PhD. 28 Consistent with the translational nature of the project, the mentorship team will consist of clinician-scientists and 29 basic vestibular scientists, both at Ohio State (Daniel Merfeld, PhD & Kevin Kerber, MD) and at external 30 institutions (Michael Schubert, PT, PhD, and Soroush Sadeghi Ghandehari, MD, PhD). 31 32 33 34 35

1 项目概要/摘要 2 在双侧前庭功能减退 (BVH) 的个体中，前庭对自我运动线索的反应减弱 3 双侧，通常没有明确的原因持续的脱敏状态会产生弹跳或跳动的症状。 4 视力不稳定、头晕、不平衡、跌倒，这些症状综合起来导致视力大幅下降； 5 生活质量。然而，尽管 BVH 对生活质量、医疗保健支出和跌倒有相当大的影响，针对 BVH 患者（而不是单侧病变患者）的特定需求量身定制的 6 种干预措施， 7 尚未开发该提案的目的是研究一种改善前庭的新策略。 8 BVH 患者的功能神经系统具有强大的调节神经活动的能力。 9 面对不断变化的环境或内部条件时受到微弱的感官刺激（例如缓慢）。 10 次头部运动），一种特定类型的神经可塑性，“稳态可塑性”，已被证明可以增加 11 相关神经元对后续运动刺激的反应性在这个项目中，我们的目标是确定是否。 12 这种机制，由亚阈值（即低振幅）运动周期推动，可以作为潜在的 13 驱动受损前庭系统可塑性的策略，特别是在诊断为 BVH 的个体中。 14 我们将 (1) 测量阈下运动后立即对自我运动提示的敏感性变化 15 种刺激（目标 1）、（2）表征重复暴露于阈下后前庭功能的变化 16 运动刺激（目标 2），以及 (3) 确定添加阈下运动“引物”是否可以改善 17 前庭眼反射 (VOR) 适应（目标 3A）和平衡训练（目标 3B）的结果。 18 使用阈下刺激，次要的是其驱动前庭可塑性变化的能力 19 系统，将导致对自我运动线索的敏感性增加，以及前庭功能的积极变化 20（例如，凝视稳定性、平衡），BVH 患者根据拟议研究项目的主题， 21 我的长期职业目标是建立一个研究实验室，专注于开发创新疗法 22 前庭功能障碍为了实现这一目标，拟议的职业发展计划的重点是获得设计、实施、监测和分析临床试验结果所需的 23 项技能和知识 24 康复科学；更具体地说，这包括 (1) 更好地了解前庭可塑性/学习的 25 条神经生理学原理，(2) 学习最先进的技术 26 分析VOR的行为，以及(3)学习当前用于调整VOR增益的方法。培训计划的第 27 阶段指导阶段将在俄亥俄州立大学 Daniel Merfeld 博士的实验室中进行。 28 与该项目的转化性质一致，指导团队将由临床医生科学家和 29 名基础前庭科学家，来自俄亥俄州立大学（Daniel Merfeld 博士和 Kevin Kerber 医学博士）和外部 30 个机构（Michael Schubert，PT、PhD 和 Soroush Sadeghi Ghandehari，MD、PhD）。 31 32 33 34 35