Perturbation training for enhancing stability and limb support control for fall-risk reduction among stroke survivors

用于增强稳定性和肢体支撑控制的扰动训练，以降低中风幸存者跌倒风险

基本信息

批准号：
9260665
负责人：
Tanvi Bhatt
金额：
$ 32.58万
依托单位：
UNIVERSITY OF ILLINOIS AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-23 至 2022-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9260665
关键词：
Activities of Daily Living Acute Address Affect Bilateral Biomechanics Centers for Disease Control and Prevention (U.S.)Clinical Communities Community Participation Control Groups Data Defense Mechanisms Devices Educational Status Effectiveness Elderly Environment Fall prevention Floor Gait Gait speed Health Care Costs Health Personnel Healthcare Hip Fractures Hip region structure Incidence Individual Injury Intervention Laboratories Learning Lesion Life Life Expectancy Limb structure Locomotor training Maintenance Therapy Measures Medical Morbidity - disease rate Oils Outpatients Paresis Performance Persons Phase Physical activity Population Positioning Attribute Prevention Measures Protocols documentation Psychological Impact Quality of life Randomized Randomized Controlled Trials Recovery Rehabilitation therapy Research Risk Risk Reduction Side Stroke Survivors Third-Party Payer Time Training Training Support Translations Vulnerable Populations Walking Weight-Bearing state Work acute stroke base chronic stroke clinical care cost design disorder prevention economic implication evidence base experience fall risk falls gait symmetry hemiparetic stroke high risk improved improved mobility mortality novel population health post stroke programs psychosocial sensor skills social implication stroke survivor traditional therapy

项目摘要

The long-term objective of this research is to develop an efficacious training paradigm to enhance stroke survivors' defense mechanisms against falls and possibly reduce healthcare cost. The Centers for Disease Control and Prevention estimates the direct medical cost for fall related injuries to be $34 billion annually. Forty percent to 70% of community-dwelling stroke survivors experience detrimental falls each year and tend to have 1.5 to 4 times higher risk of hip fracture than their healthy counterparts; with only less than 40% of those individuals regaining independent mobility. Falls, thus not only affect activities of daily living but also reduce mobility, increase risk of second stroke and mortality. Despite potential financial and functional implications of falls in this population, health-care personnel are limited in their ability to develop and validate interventions to reduce fall-risk for them. Further emphasis is placed on locomotor training with focus on enhancing paretic limb function. The project design consists of a randomized controlled trial to examine the ability of chronic stroke survivors to acquire, generalize and retain adaptations to slip-perturbation training for not only mitigating fall risk but also improving walking function. It also explores translation of this paradigm to the sub-acute population. The paradigm is novel in that it targets contributions of the paretic vs. non-paretic limbs on fall-risk through a bilateral training paradigm that involves training the non-paretic side first and then paretic to facilitate acquisition of fall-prevention skills on the paretic side, which may otherwise take longer to acquire training effects. The longer-term benefits of such perturbation training, targeting both limbs for reducing falls will be assessed not only in the laboratory but also in real life via wearable sensors, along with improved community walking function. The hypothesis of this study if supported by the results will provide an evidence-supported training protocol to reduce the fall-risk not only in people living with hemiparetic stroke but also among survivors of other acquired unilateral cortical lesions.

这项研究的长期目标是开发一种有效的训练模式，以增强中风幸存者的跌倒防御机制，并可能降低医疗成本。美国疾病控制与预防中心估计，每年因跌倒造成的伤害造成的直接医疗费用为 340 亿美元。每年有 40% 至 70% 的社区中风幸存者经历过跌倒，髋部骨折的风险往往比健康人高 1.5 至 4 倍；其中只有不到 40% 的人重新获得独立行动能力。因此，跌倒不仅影响日常生活活动，还会降低活动能力，增加第二次中风和死亡的风险。尽管跌倒会对这一人群产生潜在的财务和功能影响，但卫生保健人员制定和验证降低他们跌倒风险的干预措施的能力有限。进一步强调运动训练，重点是增强偏瘫肢体功能。该项目设计包括一项随机对照试验，旨在检查慢性中风幸存者获得、概括和保留对滑动扰动训练的适应能力，不仅可以减轻跌倒风险，还可以改善步行功能。它还探索了这种范式在亚急性人群中的应用。该范例的新颖之处在于，它通过双边训练范例来针对偏瘫肢体与非偏瘫肢体对跌倒风险的贡献，该范例包括首先训练非偏瘫一侧，然后训练偏瘫一侧，以促进偏瘫一侧获得跌倒预防技能侧，否则可能需要更长的时间才能获得训练效果。这种针对双肢减少跌倒的扰动训练的长期效益不仅将在实验室中进行评估，还将通过可穿戴传感器在现实生活中进行评估，并改善社区步行功能。这项研究的假设如果得到结果的支持，将提供一个有证据支持的训练方案，不仅可以降低偏瘫中风患者的跌倒风险，还可以降低其他获得性单侧皮质病变的幸存者的跌倒风险。