Perturbation training for enhancing stability and limb support control for fall-risk reduction among stroke survivors

本研究的长期目标是发展一种有效的训练模式，以增强中风幸存者对跌倒的防御机制，并可能降低医疗成本。美国疾病控制与预防中心估计，每年与跌倒有关的伤害的直接医疗费用为340亿美元。40%到70%居住在社区的中风幸存者每年都会经历有害的跌倒，髋部骨折的风险往往是健康人群的1.5到4倍；只有不到40%的人恢复了独立行动能力。因此，跌倒不仅会影响日常生活活动，还会降低行动能力，增加二次中风和死亡的风险。尽管跌倒对这一人群有潜在的经济和功能影响，但卫生保健人员在制定和验证干预措施以减少他们跌倒风险方面的能力有限。进一步强调运动训练，重点是增强双亲肢体功能。该项目设计包括一项随机对照试验，以检验慢性中风幸存者获得、推广和保持对滑移摄动训练的适应能力，这种适应能力不仅可以减轻跌倒风险，还可以改善行走功能。它还探讨了这种范式的翻译亚急性人口。该范式的新颖之处在于，它通过一个双侧训练范式，针对失亲肢体和非失亲肢体对跌倒风险的影响，先训练非失亲肢体，然后再训练失亲肢体，以促进失亲肢体预防跌倒技能的习得，否则可能需要更长的时间才能获得训练效果。这种针对四肢减少跌倒的扰动训练的长期效益将不仅在实验室中得到评估，而且将通过可穿戴传感器在现实生活中得到评估，同时改善社区行走功能。这项研究的假设如果得到结果的支持，将提供一个有证据支持的训练方案，不仅可以降低偏瘫性卒中患者的跌倒风险，还可以降低其他获得性单侧皮质病变幸存者的跌倒风险。

The long-term objective of this research is to develop an efficacious training paradigm to enhance stroke survivors' defense mechanisms against falls and possibly reduce healthcare cost. The Centers for Disease Control and Prevention estimates the direct medical cost for fall related injuries to be $34 billion annually. Forty percent to 70% of community-dwelling stroke survivors experience detrimental falls each year and tend to have 1.5 to 4 times higher risk of hip fracture than their healthy counterparts; with only less than 40% of those individuals regaining independent mobility. Falls, thus not only affect activities of daily living but also reduce mobility, increase risk of second stroke and mortality. Despite potential financial and functional implications of falls in this population, health-care personnel are limited in their ability to develop and validate interventions to reduce fall-risk for them. Further emphasis is placed on locomotor training with focus on enhancing paretic limb function. The project design consists of a randomized controlled trial to examine the ability of chronic stroke survivors to acquire, generalize and retain adaptations to slip-perturbation training for not only mitigating fall risk but also improving walking function. It also explores translation of this paradigm to the sub-acute population. The paradigm is novel in that it targets contributions of the paretic vs. non-paretic limbs on fall-risk through a bilateral training paradigm that involves training the non-paretic side first and then paretic to facilitate acquisition of fall-prevention skills on the paretic side, which may otherwise take longer to acquire training effects. The longer-term benefits of such perturbation training, targeting both limbs for reducing falls will be assessed not only in the laboratory but also in real life via wearable sensors, along with improved community walking function. The hypothesis of this study if supported by the results will provide an evidence-supported training protocol to reduce the fall-risk not only in people living with hemiparetic stroke but also among survivors of other acquired unilateral cortical lesions.