Cues from touch to aid posture and gait in individuals with Parkinson's disease

描述（由申请人提供）：帕金森病（PD）影响姿势和步态的控制，并导致跌倒，导致活动减少、生活质量降低、抑郁、社会孤立和死亡。大多数涉及使用视觉或听觉感官线索来改善姿势和步态的干预措施不会从诊所延续到日常生活中，并且性能恢复到干预前的水平。PI的长期目标是克服使用便携式、移动的交互式辅助设备保留干预的缺点，提供触觉提示以改善平衡和移动性，特别是在帕金森病患者的步态启动和步态冻结领域。触觉提示在这个竞技场中具有巨大的潜力，因为对健康受试者的研究表明触觉提示参与姿势反射以稳定姿势，并且不需要学习。然而，在姿势和步态的背景下，PD患者使用触觉提示并不被理解。因此，所提出的研究的直接目标是检查姿势和步态的触觉线索的临床价值，以及检查机制，电机控制使用触觉线索。具体的目的是测试的假设，触觉提示可以改善方面（1）姿势和（2）步态控制与PD和年龄匹配的控制对象，并表征的时间协调的感觉运动机制，在这两个主题组从事这些线索。PI建议：（1）在与静止表面进行非支撑性手动接触（<1 N）的情况下，尽可能静止站立时，比较姿势摇摆的幅度和时间，以及（2）比较步态参数、步态参数的步幅变化以及无辅助行走与使用独特的“移动扶手”行走时的EMG活动时间，“它正接触着一条改良过的齐腰高传送带的移动表面。初步结果表明，触觉提示是有益的个人与PD的姿势和步态控制。PD患者在没有实践的情况下使用触觉提示进行药物测试，显示出与健康受试者相同的姿势控制和姿势反应时间的改善。与无辅助行走相比，触摸移动扶手时行走增加了步幅和节奏，并减少了PD患者药物治疗时步幅的变异性。建议的实验代表了一个开始的查询线的运动控制使用触觉（隐式，速度）的线索，其结果可以被翻译为辅助设备的发展，提供触觉线索，以控制个人与PD的姿势和步态。 公共卫生相关性：拟议的研究将测试以下假设：帕金森病患者在手动触摸静止物体时具有更好的姿势控制，并且当手动触摸以所需步行速度移动的物体时，他们的步态控制得到改善。这项研究的结果可以建立一个基础，设计一个便携式，移动的，互动的步行和平衡辅助设备，以提供线索，以提高流动性和生活质量，并防止个人与帕金森氏症，以及健康的老年人跌倒。

DESCRIPTION (provided by applicant): Parkinson's disease (PD) affects the control of posture and gait, and leads to falling which contributes to reduced activity, reduced quality of life, depression, social isolation and mortality. Most interventions involving use of visual or auditory sensory cues to improve posture and gait do not carry over from the clinic to everyday living, and performance returns to pre-intervention levels. The PIs' long-term objective is to overcome the shortcomings of retention of interventions with portable, mobile interactive assistive devices, delivering haptic cues to improve balance and mobility, particularly in the realm of gait initiation and freezing of gait in individuals with Parkinson's disease. Haptic cues from touch hold great potential in this arena because studies in healthy subjects show haptic cues engage postural reflexes to stabilize posture and require no learning. However, the use of haptic cues by individuals with PD is not understood in the context of posture and gait. Thus, the immediate objectives of the proposed research is to examine the clinical value of haptic cues on posture and gait, as well as examine mechanisms governing motor control using haptic cues. The specific aims are to test the hypotheses that haptic cues can ameliorate aspects of (1) posture and (2) gait control associated with PD and age-matched control subjects, and to characterize the temporal coordination of sensory-motor mechanisms in both subject groups that are engaged by these cues. The PIs propose (1) to compare amplitudes and timing of postural sway while standing as still as possible with vs. without non-supportive manual contact (<1 N) with a stationary surface, and (2) to compare gait parameters, stride-to-stride variance of gait parameters, and timing of EMG activity of unassisted walking vs. walking while using a unique "moving hand rail," that is touching the moving surface of a modified waist-high conveyor belt. Preliminary results suggest haptic cues are beneficial to posture and gait control of individuals with PD. Individuals with PD tested off medication using haptic cues without practice showed the same improvements in postural control and timing of postural responses as previously reported in healthy subjects. Walking while touching the moving hand rail increased stride length and cadence, and reduced stride length variability of individuals with PD on medication, compared to walking unassisted. The proposed experiments represent a beginning of a line of inquiry about the control of movement using haptic (implicitly, speed) cues, the results of which can be translated to the development of assistive aids to deliver haptic cues to control posture and gait for individuals with PD. Public Health Relevance: The proposed research will test the hypotheses that individuals with Parkinson's disease have better postural control when manually touching something stationary, and that their gait control is improved when walking while manually touching something moving at the desired walking speed. Outcomes of this research can establish a basis for designing a portable, mobile, interactive walking and balance assistive device to provide cues to enhance mobility and quality of life, and prevent falling in individuals with Parkinson's disease, as well as healthy older individuals.