REDUCING FALLS USING TASK-SPECIFIC TRAINING

描述(摘自申请人的摘要)：与跌倒有关的老年人受伤和死亡是一个相当大的社会问题，这是目前拟议的研究的重点，该研究建立在本实验室以前的经验基础上。这项研究使用简单的受试者内和受试者之间的实验设计来确定特定任务训练对减少旅行相关跌倒的发生率的有效性。在老年人跌倒相关的髋部和上肢骨折中，TRIPS分别占高达50%和50%以上。避免摔倒的一个关键因素是控制后备箱的运动。这项简单而针对任务的训练包括传递一个大的、指向前方的姿势干扰，要求采取阶梯式反应以避免摔倒。这些干扰已被证明模拟了使用创新的跳闸协议的实际跳闸事件引起的干扰以及从实际跳闸事件恢复的要求。全球假设是，与对照组相比，参加过特定任务训练的受试者摔倒的几率会更小。为了验证这一假设，215名老年女性将在三年内被招募，以解决两个特定目标和三个主要假设。在具体目标1中，运动技能学习的程度将在四周内确定，以及训练后运动技能保留的程度。假设在跑步机干扰后，技能水平的提高将与明显较小的躯干屈曲角度和躯干屈曲加速度相关。此外，假设在暂停训练的四周后，技能水平不会显著下降。在具体目标2中，将量化学习到的运动技能在多大程度上减少了诱导前向行走后摔倒的发生率。它假设，与未受过训练的控制组相比，参加了技能特定训练方案的受试者跌倒的发生率将显著降低。这些假设的支持将提供证据，证明特定任务的锻炼可以对跌倒预防计划做出有意义和有效的贡献。这些证据将为进一步研究分级特定任务锻炼提供跳板，将其作为针对有跌倒恐惧、身体损伤和残疾的老年人跌倒预防计划的组成部分。

DESCRIPTION (adapted from applicant's abstract): Fall-related injuries to, and deaths of older adults are a considerable societal problem that is the focus of the presently proposed research that builds upon the previous experience in this laboratory. The research uses a simple within- and between-subject experimental design to determine the effectiveness of task-specific training to decrease the incidence of trip-related falls. Trips account for up to, and greater than 50% of fall-related hip and upper extremity fractures, respectively, in older adults. A key element of avoiding a fall after a trip is controlling the motion of the trunk. The simple and task-specific training involves delivery of a large, forward directed postural disturbance that requires stepping responses to avoid falling. These disturbances have been shown to mimic the disturbances induced by, and the recovery requirements from an actual tripping event using an innovative tripping protocol. The global hypothesis is that fall incidence will be smaller in subjects who have participated in task-specific training compared to controls. To test the hypothesis, 215 older women will be recruited over a three-year period to address two specific aims and three primary hypotheses. In Specific Aim 1 the extent to which motor skill learning occurs will be characterized over a four-week period and the extent to which the motor skill is retained after training is withheld. The hypothesis is that increased skill level will be associated with significantly smaller trunk flexion angle and trunk flexion acceleration after the treadmill disturbance. Also, the hypothesis is that skill level will not degrade significantly after four weeks during which training is withheld. In Specific Aim 2 the extent to which the learned motor skill reduces the incidence of falls after inducing forward-directed trip will be quantified. It is hypothesized that subjects who participated in the skill specific training protocol will have a significantly lower incidence of falls compared to the untrained control group. Support of the hypotheses will provide evidence that task-specific exercise can contribute meaningfully and efficiently to fall prevention programs. Such evidence will provide a springboard for further study of graded task-specific exercise as a component of fall prevention programs targeting older adults with documented fear of falling, physical impairments, and disabilities.