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

到目前为止，福尔斯是老年人意外伤害和死亡的主要原因。退伍军人是 更严重地受到福尔斯的影响，因为它比总人口年龄大得多（65岁以上的45%）。 年龄与13%）;退伍军人将从跌倒的准确诊断和治疗中受益更多 倾向尽管它的重要性，很多仍然是未知的方式，其中平衡控制是 受到年龄和疾病的影响对有跌倒风险的人的治疗干预已经证明 是有限的效用。工程方法非常适合研究和评估平衡;但迄今为止， 被应用于过于简化的场景，缺乏复杂性，以探测肌肉骨骼和 平衡和福尔斯的神经生理学基础。 这项研究的长期目标是从VA康复研究与开发开始， (RR&D）职业发展奖（CDA-2），是制定改进的指令和协议的诊断 以及治疗与平衡相关的姿势和运动协调问题。这一建议意义重大 先进的工程方法，以解决现有的差距，在诊断和治疗的平衡 通过制定平衡伸展训练协议（BRTP）来减少障碍。关于BRTP 持续挑战受试者在其平衡的极限下执行延伸任务， 一段时间，并增加这些限制，因为受试者表现出改善的性能。这个目标 工具是定量评估和提高风险个体在受到干扰时保持平衡的能力 身体及其部分的意志运动- 日常生活活动可能导致福尔斯。BRTP侧重于性能， 平衡的极限，不像大多数这样的测试和训练协议，不以这种方式挑战科目。的 BRTP最直接和最突出的指标是站立范围的限制边界;我们假设 扩大这一界限，正如BRTP的设计所做的那样，将改善平衡，使个人更加 抗福尔斯（在预期平衡干扰的情况下）。 证实这一假设可以提供一个新的角度对现有的训练协议的适度 成功率，以及设计新协议的方向，有可能显着改善这些 rates. [虽然BRTP是一个培训平台，但我们也认为， 它产生的结果可以形成新的诊断措施的基础， 量化和解释平衡性能问题;并跟踪它们随时间的变化。]等 诊断和治疗方案将特别有利于VA医疗保健系统，因为它 将导致改善：病人吞吐量，护理质量和治疗成本。虽然这 建议针对老龄化的退伍军人人口，BRTP是一个通用工具，可以帮助诊断和 治疗由老化以外的情况引起的平衡障碍。包括肥胖症，糖尿病 （这常常导致下肢肌肉变性和周围神经病变），肌肉减少症， 前庭障碍和神经障碍如中风。退伍军人，他们的平衡一直是 创伤性脑损伤（TBI）（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.