Effects of cognitive challenge on gait control in elderly fallers

认知挑战对老年跌倒者步态控制的影响

• 批准号: 7989738
• 负责人: Leslie M Decker
• 金额: $ 8.06万
• 依托单位: UNIVERSITY OF NEBRASKA OMAHA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7989738
• 关键词: Accounting; Address; Adopted; Adult; Affect; Aging; American; Animals; Attention; Auditory; Biomechanics; Boston; Brain; Categories; Characteristics; Cognitive; Communities; Complex; Cross-Sectional Studies; Disease; Ear; Early identification; Elderly; Equilibrium; Exclusion; Fall prevention; Future; Gait; Gait abnormality; Geriatrics; Hand; Health; Impaired cognition; Impairment; Individual; Individual Differences; Intelligence; Intervention; Investigation; Knowledge; Left; Length; Letters; Linguistics; Link; Literature; Measures; Methods; Modality; Modeling; Morbidity - disease rate; Names; Nature; Neuraxis; Participant; Pathologic Processes; Pathway interactions; Patients; Performance; Phase; Play; Process; Randomized; Randomized Controlled Trials; Reading; Recording of previous events; Recruitment Activity; Relative (related person); Reporting; Research; Research Proposals; Risk; Role; Screening procedure; Semantics; Sensory; Shapes; Short-Term Memory; Speed; Staging; Stimulus; Structure; Task Performances; Testing; Therapeutic; Therapeutic Intervention; Time; Training; Trees; Variant; Vocabulary; Walking; Width; Work; age related; arm; auditory stimulus; base; disability; executive function; fall risk; falls; fear of falling; flexibility; follow-up; improved; intervention effect; mortality; novel; novel therapeutic intervention; phonology; pre-clinical; public health relevance; research study; response; skills; sound; tool; young adult

DESCRIPTION (provided by applicant): The long-term objective of this proposal is to develop screening tools for early identification of future fall risk in the elderly and to evaluate new therapeutic interventions that would counteract the underlying pathological process. Falls are a major health concern and efforts are needed to address the causes of gait unsteadiness in elderly fallers. It is increasingly clear that walking is tightly linked to executive functioning. Investigations using dual-tasking paradigms, where performance on attention-demanding tasks and walking is evaluated when they are performed separately and concurrently, suggest that executive changes play a role in the causal pathway of falls. Furthermore, the subtle but important fluctuations present from one stride to the next during walking seem to be sensitive markers of fall risk. It is possible that cognitive decline is responsible for these changes in stride-to-stride variability, but this has not been investigated. Objectives. Through the use of dual-task paradigms, this proposal will: 1/ investigate the viability of the U-shaped relationship between stride-to-stride variability during gait and difficulty of concurrent cognitive tasks, 2/ disentangle the interrelationships between specific aspects of stride-to-stride variability (e.g., stride width variability vs. step length variability) and components of executive function (e.g., working memory, response inhibition, and cognitive flexibility), and 3/ compare the efficiency of different training strategies to understand the mechanisms underlying training-related changes in stride-to-stride variability control of elderly fallers and develop targeted intervention for preventing falls. K99 phase (cross-sectional study). Forty two healthy young adults, forty two elderly non-fallers, and forty two elderly fallers will be assessed with cognitive tasks involving different levels of difficulty and challenging various executive functioning abilities. Participants will be tested with auditory and linguistic tasks without and with walking on the treadmill. We predict that 1/ each complementary aspect of stride-to-stride variability is related in a U- shaped manner to cognitive load and that the turning point of the function occurs at a lower cognitive load for elderly fallers than for young and elderly non-fallers, and 2/ fallers more "centrally" impaired would show different walking profiles than fallers more "sensory" impaired under both single and dual-task walking conditions. R00 phase (two-arm randomized controlled trial). One hundred more individuals will be recruited for a total of 142 elderly fallers and randomly assigned to a single-task walking training and a dual-task training combining walking and cognitive loading. All subjects will be evaluated before and after a three-month training period, and after a six-month follow-up period under the conditions utilized in Experiment 1 with the addition of novel dual tasks. We predict that dual-task training will be better than single-task training in defining fall-risk profiles and developing therapeutic strategies that are relevant to specific executive function deficits. Methods. Walking performance will be assessed using stride-to-stride variability and traditional biomechanical measures. For the R00 trial, walking performance assessment will be based on two selected measures, one primarily related to central nervous impairments and another one primarily related to sensory impairments that are strongly correlated with the risk of falling, as determined during the K99 study. PUBLIC HEALTH RELEVANCE: Risk of falls may be related to changes in certain aspects of brain function. This research seeks to develop tools to identify older people at risk for falls. Walking under dual-task conditions could be helpful in detecting walking disorders at a preclinical stage and planning targeted therapeutic interventions to prevent falls.

描述（由申请人提供）：该提案的长期目标是开发筛查工具，以早期识别老年人未来跌倒的风险，并评估能够抵消潜在病理过程的新治疗干预措施。跌倒是一个主要的健康问题，需要努力解决老年跌倒者步态不稳的原因。越来越明显的是，步行与执行功能密切相关。使用双任务范式的研究表明，执行力的变化在跌倒的因果路径中发挥了作用，其中对需要注意力的任务和步行的表现进行了单独和同时的评估。此外，步行过程中从一步到下一步出现的微妙但重要的波动似乎是跌倒风险的敏感标志。认知能力下降可能是导致步幅变异性变化的原因，但这尚未得到研究。目标。通过使用双任务范式，该提案将： 1/ 研究步态期间步幅变异性与并发认知任务难度之间 U 形关系的可行性，2/ 理清步幅变异性的特定方面（例如，步幅变异性与步长变异性）与执行功能组成部分（例如，工作记忆、反应）之间的相互关系 抑制和认知灵活性），3/比较不同训练策略的效率，以了解老年跌倒者步幅变异性控制中训练相关变化的机制，并制定有针对性的干预措施来预防跌倒。 K99 阶段（横断面研究）。 42 名健康的年轻人、42 名未摔倒的老年人和 42 名老年摔倒者将接受涉及不同难度级别和挑战各种执行功能能力的认知任务的评估。参与者将在没有或在跑步机上行走的情况下接受听觉和语言任务的测试。我们预测 1/ 步幅变异性的每个互补方面都以 U 形方式与认知负荷相关，并且该功能的转折点发生在老年跌倒者的认知负荷低于年轻和老年非跌倒者的情况下，并且 2/ 在单任务和双任务步行条件下，“中枢”受损程度更高的跌倒者将表现出与“感觉”受损程度更高的跌倒者不同的行走轨迹。 R00 期（双臂随机对照试验）。将再招募 100 名受试者，总共 142 名老年跌倒者，并随机分配进行单任务步行训练和步行与认知负荷相结合的双任务训练。 所有受试者将在三个月的训练期前后以及六个月的随访期后在实验 1 中使用的条件下进行评估，并添加新的双重任务。我们预测，在定义跌倒风险概况和制定与特定执行功能缺陷相关的治疗策略方面，双任务训练将比单任务训练更好。方法。将使用步幅变异性和传统的生物力学测量来评估步行表现。对于 R00 试验，步行表现评估将基于两项选定的指标，一项主要与中枢神经损伤有关，另一项主要与与跌倒风险密切相关的感觉损伤有关，正如 K99 研究期间确定的那样。 公共卫生相关性：跌倒的风险可能与大脑功能某些方面的变化有关。这项研究旨在开发工具来识别有跌倒风险的老年人。在双重任务条件下行走可能有助于在临床前阶段检测行走障碍并规划有针对性的治疗干预措施以预防跌倒。