The Impact of Cognition on Rehabilitative Treatment for Slow Gait Speed

缓慢行走和认知障碍在老年退伍军人中普遍存在，是独立的预测因素 随后的住院治疗残疾和死亡最近的科学证据表明， 认知是相互关联的，因此它们的下降可能具有共同的潜在神经生物学病理学。 因此，治疗缓慢的步行速度不仅可以改善移动性，还可以改善认知。Live Long Walk Strong （LLWS）是一项针对步行速度缓慢的退伍军人（≥ 50岁）的创新康复护理计划。 LLWS治疗主要集中在移动性问题上。然而，据估计，40%的LLWS 参与者表现出认知缺陷;因此，目前尚不确定LLWS治疗是否 旨在最佳地服务于有认知问题的退伍军人的独特特征。比如说， 我们不知道有认知障碍的退伍军人是否会坚持康复计划。同样地， 我们不确定治疗反应是否在不同认知状态下是相同的。因此研究 目的是了解老年退伍军人的治疗依从性、依从性和反应， 没有认知问题的人参加LLWS临床试验。本研究将（1）深入了解 是否需要修改LLWS治疗以增加依从性和依从性，2）检查 基线认知状态与LLWS治疗后步态速度变化之间的相关性，以及3）发现 LLWS治疗对认知的影响。职业发展的长期目标是 奖项（CDA-1）是为了促进研究和教育培训，以使PI建立一个独立的 研究开发个性化康复治疗，以保持安全的流动性和认知之间的线 具有不同功能能力的老年退伍军人。PI之前是NIH的研究协调员 她支持R21运动治疗研究，后来进行了自己的可行性和准实验性研究。 问题研究目前，她的导师是哈佛医学院PM&R教授、医学博士、公共卫生硕士Jonathan Bean 学校和新英格兰GRECC在弗吉尼亚州波士顿医疗保健系统主任。短期目标是 CDA-1将获得以下方面的经验：1）康复科学，2）活动评估和治疗，3） 神经心理学评估和分析，4）个性化康复治疗（老年护理 原则），以及5）研究方法和授予写作技能，为VA研究奠定坚实的基础 事业PI将使用从丰富的学术研究提供的教学课程的组合 环境，实践研究培训，以及来自专家团队的指导，他们可以提供广泛的 知识和支持她的研究。这项研究具有重要意义和创新性，因为它提供了 关于如何定制创新的康复护理，以更好地满足退伍军人的个人需求的信息。

Slow walking and cognitive impairment are prevalent among aging Veterans and are independent predictors for subsequent hospitalization, disability, and death. Recent scientific evidence suggests that walking and cognition are interrelated whereby their declines may share a common underlying neurobiological pathology. Thus, treating slow walking speed may not only improve mobility but also cognition. Live Long Walk Strong (LLWS) is a new innovative rehabilitative care program targeting Veterans (≥50yrs) with slow walking speed. LLWS treatment primarily focuses on mobility problems. However, it is estimated that 40% of LLWS participants have manifested cognitive deficits; thus, it is uncertain whether current LLWS treatment is designed to optimally serve the unique characteristics of Veterans who have cognitive problems. For example, we do not know whether Veterans with cognitive challenges will adhere to the rehabilitative program. Likewise, we are unsure whether the treatment response will be the same across cognitive status. Therefore, the study objective is to understand the treatment adherence, compliance, and response among older Veterans with and without cognitive problems participating in the LLWS clinical trial. The present study will 1) provide insight into whether LLWS treatment needs to be modified to increase compliance and adherence, 2) examine the association between baseline cognitive status and change in gait speed after LLWS treatment, and 3) discover the influence of LLWS treatment on cognition. The long-term goal of this proposed Career Development Award (CDA-1) is to advance research and educational training in order for the PI to establish an independent line of research developing personalized rehabilitative treatment to maintain safe mobility and cognition among aging Veterans with varying functional abilities. The PI previously was the study coordinator of a NIH supported R21 exercise treatment study and later conducted her own feasibility and quasi-experimental studies. Currently, she is mentored by Jonathan Bean, MD, MPH, a professor of PM&R at Harvard Medical School and Director of New England GRECC at VA Boston Healthcare System. The short-term goals of this CDA-1 are to acquire experience in 1) rehabilitation science, 2) mobility assessment and treatment, 3) neuropsychological assessment and analysis, 4) personalized rehabilitation treatment (geriatric care principles), and 5) research methods and grant writing skills to establish a strong foundation for a VA-research career. The PI will use the combination of didactic coursework provided from a rich academic research environment, hands-on research training, and mentorships from a team of experts who can offer extensive knowledge and support her research. The proposed research is significant and innovative as it provides information about how to tailor innovative rehabilitative care to better suit the individual needs of Veterans.