A Balanced Reach Training Platform to Address Balance Disorders in Older and Neurologically Disabled Veterans

到目前为止，跌倒是老年人意外受伤和死亡的主要原因。退伍军人人数是 受跌倒影响更严重，因为它比总人口年龄大得多(65岁以上45% 年龄与13%)；退伍军人将从准确的跌倒诊断和治疗中受益更多 倾向性。尽管平衡控制很重要，但关于平衡控制的方式仍有许多未知之处 因年龄和疾病而受损。对有跌倒风险的人的治疗干预已被证明 用处有限工程方法非常适合于研究和评估平衡；但必须是最新的 被应用于过于简单的场景，这些场景缺乏探测肌肉骨骼和 平衡和跌倒的神经生理学基础。 这项研究的长期目标，始于退伍军人康复研究和开发 (RR&D)职业发展奖(CDA-2)，是为诊断制定改进的指令和方案 以及与平衡相关的姿势和运动协调问题的治疗。这项提议意义重大 先进的工程方法，以解决平衡诊断和治疗中存在的差距 通过制定平衡覆盖培训议定书(BRTP)，减少残疾。BRTP 不断挑战受试者，让他们在更长的时间内达到平衡的极限 一段时间，并随着受试者表现出更好的表现而增加这些限制。这样做的目的是 工具是定量评估和提高高危个体在受到干扰时保持平衡的能力 身体及其部分的意志性运动--一类重要的平衡障碍 日常生活中可能导致跌倒的活动。BRTP关注的是 平衡的极限，不像大多数这样的测试和训练方案，不以这种方式挑战受试者。这个 BRTP最直接和最显著的衡量标准是站立范围的极限边界；我们假设 扩大这种边界，就像BRTP设计的那样，将改善平衡，使个人更 抗跌倒(在预期的平衡干扰的情况下)。 这一假设的证实可以为现有训练方案的适度提供一个新的视角 成功率和设计新协议的方向，有可能显著改善这些 费率。[虽然BRTP是一个培训平台，但我们也相信绩效指标和分析 它产生的结果可以成为新的诊断措施的基础，这些措施更加可靠和准确 量化和解释平衡绩效问题；并跟踪这些问题随时间的变化。]是这样的 诊断和治疗方案将特别有利于退伍军人保健系统，因为它 将导致以下方面的改善：患者吞吐量、护理质量和治疗成本。虽然这件事 提案针对的是老龄化的退伍军人人口，BRTP是一种通用工具，可以帮助诊断和 治疗由衰老以外的疾病引起的平衡障碍。这些疾病包括肥胖、糖尿病 (这通常会导致下肢肌肉变性和周围神经病变)、骨质疏松症 前庭障碍，以及中风等神经障碍。退伍军人的余额已经 被创伤性脑损伤(TBI)损害的人(无论是否与战斗有关)也可能受益于BRTP。

Falls are by far the leading cause of accidental injury and death in older adults. The Veteran population is more severely affected by falls since it is significantly older than the overall population (45% over 65 years of age vs. 13%); and Veterans would benefit substantially more from an accurate diagnosis and treatment of fall propensity. Despite its importance, much is still unknown about the manner in which balance control is compromised by age and disease. Therapeutic interventions for people who are at risk of falling have proven to be of limited utility. Engineering methods are well suited to study and evaluate balance; but have to date been applied to overly simplified scenarios that lack the complexity to probe the musculoskeletal and neurophysiological bases for balance and falls. The long term objective of this research, which began with a VA Rehabilitation Research & Development (RR&D) Career Development Award (CDA-2), is to develop improved directives and protocols for the diagnosis and treatment of balance-related posture and movement coordination problems. This proposal significantly advances engineering methods to address existing gaps in the diagnosis and treatment of balance impairments through the development of a Balanced Reach Training Protocol (BRTP). The BRTP continuously challenges subjects to perform reaching tasks at the limits of their balance for an extended period of time, and increases these limits as subjects demonstrate improved performance. The goal of this tool is to quantitatively assess and improve at-risk individuals' ability to maintain balance when disturbed by volitional movements of the body and its parts—an important class of balance disturbances integral to many activities of daily living that can precipitate falls. The BRTP focuses on performance at and just beyond the limits of balance, unlike most such tests and training protocols that do not challenge subjects in this way. The BRTP's most immediate and salient metric is the limiting boundary of standing reach; and we hypothesize that expanding this boundary, as the BRTP is designed to do, will improve balance and make individuals more resistant to falls (in the context of expected balance disturbances). Confirmation of this hypothesis could provide a new perspective on existing training protocols' modest success rates, and direction for the design of new protocols with the potential to significantly improve these rates. [Though the BRTP is a training platform, we also believe that the performance metrics and analytical results produced by it can form the basis for new diagnostic measures that more reliably and precisely quantify and explain balance performance problems; and track changes in them over time.] Such diagnostic and treatment protocols would be particularly beneficial to the VA Health Care System, as it would lead to improvements in: patient throughput, quality of care, and treatment costs. Though this proposal targets the aging Veteran population, the BRTP is a general tool that can aid in the diagnosis and treatment of balance disorders arising from conditions other than aging. These include obesity, diabetes (which often leads to lower extremity muscle degeneration and peripheral neuropathy), sarcopenia, vestibular disorders, and neurological disorders such as stroke. Veterans whose balance has been compromised by Traumatic Brain Injury (TBI) (whether combat-related or not) may also benefit from the BRTP.