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，可以减少跌倒的人 阿尔茨海默病(AD)及相关疾病。这个项目的总体目标是系统地检查人们 AD患者可以从一种新的范式-摄动训练中获得预防跌倒的技能。的具体目标 这个建议的项目是(1)测试AD患者是否能够适应跑步机上的干扰并学习摔倒 抵抗运动技能；(2)检查AD患者是否能将在目标1中学到的运动技能保留至少6年 几个月；以及(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 地面扰动和日常生活条件。我们将使用双臂随机、对照 实现这些目标的纵向设计。30名患有轻度阿尔茨海默病的老年人将被随机分成两组 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20次滑行(S1-S20)和20次在特殊跑步机上的旅行(T1-T20)。这些微扰试验将 与随机顺序的常规步行试验混合使用。B组将不受干扰地在跑步机上行走 在与A组相同的时间内，两组都将暴露于突然的地面滑动(初始地面 滑行)和行程(最初的地面行程)。参与者将在6个月后返回接受保留课程 另一次跑步机滑倒和绊倒(跑步机重滑和重滑)，随后是地面滑倒和绊倒(地面 重载和重载)。将确定滑移的摄动结果(坠落或非坠落)和动力稳定性 和旅行试验。在学习课程后的6个月内，将为两个人收集自我报告的真实生活情况 组。主要结果是滑移或绊倒之后的二元扰动结果。动态 滑倒和绊倒时的稳定性以及日常生活中各种原因造成的跌倒将是我们的次要变量。初级阶段 将比较A组内S1和S20之间以及T1和T20之间的结果和动态稳定性 测试AD患者是否能适应大规模的滑倒和绊倒(目标1)。以确定AD患者是否 能够保持在目标1中学到的技能至少6个月(目标2)、主要结果和动态稳定性 在跑步机上翻转和保留期间的重行将在不同组之间进行比较。初级阶段 还将比较在地面打滑和绊倒期间分组之间的结果和动态稳定性 用于测试AD患者是否可以立即将学到的技能 目标1至地面，以及这种转移是否能维持6个月(目标3)。此外，未来的下跌 将在不同组之间进行比较，以验证AD患者是否可以将获得的抗跌倒技能转移到 跑步机适应日常生活条件(目标3)。摄动法是一种很有前途的预防跌倒的方法 AD由于其固有的性质：安全性、任务专一性和内隐学习过程。这个项目将有一个 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.