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

这项研究的长期目标是开发一种有效的训练范例，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。疾病控制和预防中心估计，每年与跌倒相关的伤害的直接医疗成本为340亿美元。40%到70%的社区中风幸存者每年都会经历有害的跌倒，而且髋部骨折的风险往往是健康人群的1.5%到4倍；这些人中只有不到40%的人恢复了独立活动。跌倒不仅影响日常生活能力，还会降低行动能力，增加二次中风的风险和死亡率。尽管跌倒对这一人群造成了潜在的经济和功能影响，但卫生保健人员在开发和验证干预措施以降低跌倒风险方面的能力有限。进一步强调运动训练，重点是增强瘫痪肢体功能。该项目设计包括一项随机对照试验，以检查慢性中风幸存者获得、推广和保持对滑移扰动训练的适应能力的能力，以不仅降低跌倒风险，而且改善步行功能。它还探索了这一范式对亚急性人群的翻译。这一模式是新颖的，因为它通过双边训练模式针对偏瘫和非偏瘫肢体在跌倒风险上的贡献，其中包括首先训练非偏瘫侧，然后训练偏瘫侧，以促进偏瘫侧预防跌倒技能的获得，否则可能需要更长的时间才能获得训练效果。这种针对双肢以减少跌倒为目标的摄动训练的长期好处将不仅在实验室进行评估，还将在现实生活中通过可穿戴传感器以及改善的社区步行功能进行评估。这项研究的假设如果得到结果的支持，将提供一种证据支持的训练方案，不仅可以降低偏瘫中风患者的跌倒风险，还可以降低其他后天性单侧皮质损伤的幸存者的跌倒风险。

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.