Motor learning of fall resistant skills from laboratory-induced falling among people with Alzheimer's disease

摘要 这项研究的长期目标是开发一种有效的方法，可以减少福尔斯的人， 阿尔茨海默病（AD）和相关病症。这个项目的总体目标是系统地检查人们是否 AD患者可以从一种新的范式-扰动训练中获得预防跌倒的技能。的具体目标 这个计划是（1）测试AD患者是否能适应跑步机上的干扰并学会跌倒 （2）检查AD患者是否能保持目标1中学习的运动技能至少6 （3）确定AD患者是否可以将在跑步机上获得的抗跌倒技能推广到 地面干扰和日常生活条件。我们将使用两组随机对照 纵向设计以实现这些目标。一组30名患有轻度AD的老年人将被随机分为两组， A组（训练组）和B组（安慰剂组）。A组将接受基于扰动训练的运动学习 包括在专用跑步机上的20次滑动（S1-S20）和20次行程（T1-T20）的会话。这些微扰试验将 与随机顺序的常规步行试验混合。组B将在跑步机上行走，没有干扰 时间与A组相同。然后，两个组将暴露于突然的地上滑移（初始地上滑移 滑动）和跳闸（初始地上跳闸）。参与者将在6个月后返回进行保留会话， 另一个跑步机打滑和绊倒（跑步机重新打滑和重新打滑），随后是地上打滑和绊倒（地上 重新滑动和重新启动）。扰动结果（下降或不下降）和动态稳定性将被确定为滑移 和Trip Trials。将收集学习课程结束后6个月内的自我报告真实福尔斯跌倒情况， 组主要的结果是二进制扰动的结果后，无论是滑或跳闸。动态 滑倒和绊倒期间的稳定性以及日常生活中的各种原因的福尔斯跌落将是我们的次要变量。主 将比较A组中S1和S20之间以及T1和T20之间的结局和动态稳定性， 测试AD患者是否能适应大规模滑倒和绊倒（目标1）。为了确定AD患者是否 能够将目标1中学到的技能保留至少6个月（目标2），主要结局和动态稳定性 将在组间比较保持期期间在跑步机上的重新滑动和重新启动。主 结果和动态稳定性也将比较组之间的地上滑移和旅行期间 获取和保留会话，以测试AD患者是否可以立即将在 目标1到地上，如果这种转移可以维持6个月（目标3）。此外，预期的福尔斯 将在各组之间进行比较，以验证AD患者是否可以将获得的抗跌倒技能转移到 跑步机到日常生活条件（目标3）。扰动是一种很有前途的预防福尔斯的方法 与AD由于其固有的性质：安全性，任务特异性和内隐学习过程。该项目将有一个 对AD患者和社会产生深远影响。

ABSTRACT The long-term objective of this research is to develop an effective approach that can reduce falls for people with Alzheimer’s disease (AD) and related disorders. This project’s overall goal is to systematically examine if people with AD can acquire fall prevention skills from a novel paradigm - perturbation training. The specific aims of this proposed project are (1) to test if people with AD can adapt to perturbations on a treadmill and learn fall resistant motor skills; (2) to inspect if people with AD can retain motor skills learned in Aim 1 for at least 6 months; and (3) to determine if people with AD can generalize fall resistant skills gained on the treadmill to overground perturbations and daily living conditions. We will use a two-arm randomized, controlled longitudinal design to achieve these goals. A group of 30 older adults with mild AD will be randomized into two groups: A (training) and B (placebo). Group A will undergo a perturbation training-based motor learning session including 20 slips (S1-S20) and 20 trips (T1-T20) on a special treadmill. These perturbation trials will be mixed with regular walking trials in random order. Group B will walk on the treadmill with no perturbations for the same time as group A. Then, both groups will be exposed to a sudden overground slip (initial overground slip) and trip (initial overground trip). Participants will return for a retention session 6 months later to undergo another treadmill slip and trip (treadmill reslip and retrip) followed by an overground slip and trip (overground reslip and retrip). The perturbation outcome (fall or non-fall) and dynamic stability will be determined for slip and trip trials. Self-reported real-life falls over 6 months after the learning session will be collected for both groups. The primary outcome is the binary perturbation outcome following either the slip or trip. Dynamic stability during slips and trips and the all-cause falls in daily living will be our secondary variables. The primary outcome and dynamic stability will be compared between S1 and S20 and between T1 and T20 within group A to test if people with AD can adapt to large-scale slips and trips (Aim 1). To determine whether people with AD can retain the skills learned in Aim 1 for at least 6 months (Aim 2), the primary outcome and dynamic stability on treadmill reslip and retrip during the retention session will be compared between groups. The primary outcome and dynamic stability will also be compared between groups on the overground slips and trips during the acquisition and retention sessions to test if people with AD can immediately transfer the skills learned in Aim 1 to overground and if this transfer can maintain for 6 months (Aim 3). In addition, the prospective falls will be compared between groups to verify if people with AD can transfer the acquired fall resistant skills on the treadmill to everyday living conditions (Aim 3). Perturbation is a promising modality to prevent falls for people with AD due to its inherent natures: safety, task-specific, and implicit learning process. This project will have a profound impact on people with AD and society.