Post-PT Extension of In-Home Dynamic Standing Table Use in Parkinson Disease

帕金森病患者在家动态站立台使用的 PT 后扩展

基本信息

批准号：
9245342
负责人：
Nicolaas Ida Bohnen
金额：
$ 23.25万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
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 2018-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9245342
关键词：
Activities of Daily Living Address Behavior Therapy Body Weight Clinical Cognitive Communities Computers Control Groups Controlled Clinical Trials Cues Data Devices Elderly Equilibrium Exercise Future Gait Goals Health Home environment Hour Impairment Life Link Lower Extremity Maintenance Motor Movement Muscle Musculoskeletal Musculoskeletal Equilibrium Outcome Measure Parkinson Disease Patients Physical Exercise Physical activity Physical therapy Population Quality of life Reading Regimen Reporting Research Risk Sample Size Symptoms System Testing Therapeutic Time Weight base clinical practice combat compliance behavior control trial disability exercise program experience falls fear of falling healthy lifestyle improved intervention effect mobility enhancement motor disorder novel physical inactivity programs sedentary sedentary lifestyle standard of care

项目摘要

Axial motor dysfunctions in Parkinson disease (PD) are least responsive to dopaminergic therapy and incline many patients towards a sedentary lifestyle. This places PD patients at increased risk for the negative consequences of physical inactivity. When PD patients develop postural imbalance and gait difficulties (PIGD), including falls, they are generally referred to physical therapy (PT) for optimal management. Although a Cochrane review confirms the (short-term) benefit of physical therapy in PD with PIGD motor features there is a critical gap in clinical practice on what to do next once the PT sessions are over. Clinical experience shows that most patients return to a sedentary lifestyle indicating an urgent need for post-PT in-home physical activity programs in PD with PIGD features to preserve mobility functions. Recent advances in physical activity research tout non-exercise physical activity (NEPA) approaches to promote healthy lifestyle modifications. For PD patients with PIGD, normal upright standing and weight-shifting (stepping) for longer periods of time may be an ideal form of NEPA. It activates lower extremity muscles and encourages postural activity. To promote this type of NEPA, we have developed a sit-stand desk system that enhances upright standing activity with weight-shifting movements. The "dynamic standing table" has a tabletop that oscillates in the horizontal plane, which cues users to make periodic mediolateral body weight shifting adjustments. Dynamic standing would represent a minimal level of physical activity compared to sitting, which is pervasive in PD subjects with PIGD motor features. Use of the dynamic standing table can easily be incorporated with routine desktop activities, such as computer use, reading, or watching TV and may promote physical activity. Preliminary data shows that patients with moderate PD are able to complete sessions of at least 3 hours without significant difficulty and may have motor and cognitive benefits from using this table. We propose an exploratory controlled trial of a post-PT in-home extension of a physical activity program in patients with PD and PIGD consisting of combined post-PT standard of care (i.e., weekly physical activity group sessions) with in-home dynamic standing table use versus the post-PT standard of care alone. The incremental addition of the dynamic table use is expected to more effectively reduce post-PT sedentary behavior compared to the standard of care alone. We will test the exploratory hypothesis that post-PT gains in mobility functions in PD patients with PIGD features will be preserved better with in-home dynamic standing table use compared to a control group.

帕金森病（PD）中轴向运动功能障碍对多巴胺能疗法的反应最低，并使许多患者倾向于久坐的生活方式。这使PD患者面临着身体不活跃的负面后果的风险。当PD患者出现姿势失衡和步态困难（PIGD）（包括跌倒）时，通常会转介到物理疗法（PT）以进行最佳管理。尽管Cochrane的评论证实了PD具有PIGD运动特征的PD物理治疗的（短期）益处，但一旦PT课程结束，临床实践中的临床实践差距很大。临床经验表明，大多数患者恢复了久坐的生活方式，表明迫切需要在PD中使用PD具有PIGD特征以保留迁移率功能的家庭体育锻炼计划。体育活动研究的最新进展提升了非运动体育锻炼（NEPA）的方法，以促进健康的生活方式改变。对于患有PIGD的PD患者，正常直立的站立和重量转移（步进）长时间可能是NEPA的理想形式。它激活下肢肌肉并鼓励姿势活动。为了促进这种类型的NEPA，我们开发了一种静坐台式系统，该系统可以通过重量变动运动来增强直立的直立活动。 “动态站立桌”的桌面可以在水平平面中振荡，该桌面可以提示用户进行周期性的中外侧体重转移调整。与坐姿相比，动态站立将代表最低水平的体育活动，这在具有PIGD运动特征的PD受试者中普遍存在。动态站立桌的使用可以轻松地与常规桌面活动（例如计算机使用，阅读或看电视）一起融合在一起，并可能促进体育锻炼。初步数据表明，中等PD的患者能够完成至少3个小时的会议而不会出现明显困难，并且使用此表可能具有运动和认知益处。我们建议对PD和PIGD患者进行体育活动计划的探索性对照试验，该试验由PD和PIGD患者组成，该试验由PT PTS后的护理后标准（即每周的体育活动组）组成，并具有家庭动态常驻餐桌使用，而单独的PTP CARCH标准。与单独护理标准相比，预期动态表的增量添加可以更有效地减少PT后久坐后的行为。我们将测试探索性假设，即PD患者的迁移率在具有PIGD特征的PD患者的迁移率提高，与对照组相比，使用室内动态常驻桌子可以更好地保留。