Real World Assessment of Dual-Task Performance After Stroke

中风后双任务表现的真实世界评估

• 批准号: 8773018
• 负责人: PRUDENCE PLUMMER
• 金额: $ 24.28万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-23 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8773018
• 关键词: Adult; Age; Attention; Behavior; Biomedical Engineering; Characteristics; Clinic; Clinical; Cognition; Cognitive; Communities; Community Integration; Community Participation; Complex; Data; Environment; Environmental Impact; Gait; Gender; Goals; High Prevalence; Hospitals; Impairment; Individual; Intervention; Intervention Studies; Knowledge; Laboratories; Laboratory Research; Lead; Life; Literature; Lobbying; Measures; Methods; Motor; Nature; Patients; Performance; Persons; Physical therapy; Psycholinguistics; Public Health; Readiness; Relative (related person); Research; Research Personnel; Resources; Safety; Stroke; Survivors; Task Performances; Training; Walking; Wireless Technology; base; clinically significant; community living; design; disability; distraction; executive function; experience; falls; flexibility; improved; innovation; interdisciplinary collaboration; neighborhood safety; public health relevance; skills

DESCRIPTION (provided by applicant): Community ambulation for stroke survivors is a highly complex skill, requiring the ability to adapt not only to increased environmental complexity (relative to the clinic), but also to dual-tasking situations, such as walking while conversing. Indeed, the ability to walk in the community is a key determinant of community integration and participation. Very little is known about the impact of the environment on single-task and dual-task gait after stroke, even though it is well established that community-dwelling individuals with stroke experience profound cognitive-motor interference during dual-task walking and restricted community participation due to mobility limitations. The goals of the proposed research are to identify the differences between single and dual-task walking in the laboratory and single and dual-task walking in a real-world context (Aim 1), to determine whether the ability to flexibly prioritize attention during dual-task walking after stroke is impaired relative to matched healthy adults, and whether this ability is impacted by environmental setting (Aim 2), and to determine minimal clinically important effect sizes for dual-task interference effects in community-dwelling stroke survivors and matched healthy adults (Aim 3). The proposed research is an interdisciplinary collaboration involving experienced investigators in physical therapy, biomedical engineering, and psycholinguistics. Using a repeated measures design, gait and cognitive performance of 30 adults with stroke and 30 matched healthy adults will be assessed in single and three different variable-priority dual-task conditions (no-priority, gait-priority, cognitive-priority) in the laboratory and a real-world context (hospital lobby), and in two different dual-tak combinations (walking while talking, walking while performing an executive function task). We will use anchor-based and distribution-based approaches to estimate minimal clinically important difference (MCID) values of gait- related dual-task effects. This project will help us achieve our long-term goal to develop interventions to improve the locomotor adaptability and safety of community-dwelling stroke survivors. The proposed research will also enable us to identify the individuals most susceptible to clinically significant mobility disability in the realworld and acquire the data needed to adequately power a subsequent R01 intervention study targeting those most in need. This innovative study, concerned with stroke survivors' ability to walk in real-world environments, will yield crucial data currently unavailable in the literature.

描述（由申请人提供）：中风幸存者的社区救护是一项高度复杂的技能，不仅需要适应日益复杂的环境的能力， （相对于诊所），但也适用于双重任务的情况，如边走边交谈。事实上，在社区中行走的能力是社区融合和参与的一个关键决定因素。关于中风后环境对单任务和双任务步态的影响知之甚少，尽管已经确定社区居住的中风患者 中风患者在双任务行走过程中经历了严重的认知运动干扰，并且由于移动性限制而限制了社区参与。拟议研究的目标是确定实验室中的单任务和双任务步行与现实环境中的单任务和双任务步行之间的差异（目标1），以确定中风后双任务步行期间灵活优先注意力的能力是否受损相对于匹配的健康成人，以及这种能力是否受到环境设置的影响（目标2），并确定在社区居住的卒中幸存者和匹配的健康成人中双任务干扰效应的最小临床重要效应量（目标3）。 拟议的研究是一个跨学科的合作，涉及经验丰富的研究人员在物理治疗，生物医学， 工程学和心理语言学采用重复测量设计，在单一和三种不同的变量优先级双任务条件下评估30名中风成年人和30名匹配的健康成年人的步态和认知性能（无优先级，步态优先级，认知优先级）在实验室和现实世界的情况下（医院大厅），并在两个不同的双tak组合（行走，同时说话，行走，同时执行执行功能任务）。我们将使用基于锚点和基于分布的方法来估计步态相关双任务效应的最小临床重要差异（MCID）值。这个项目将帮助我们实现我们的长期目标，开发干预措施，以改善社区居住的中风幸存者的运动适应性和安全性。拟议的研究还将使我们能够确定现实世界中最容易出现临床显著行动障碍的个体，并获得所需的数据，以充分支持随后针对最需要的人的R01干预研究。这项创新的研究，关注中风幸存者在现实世界环境中行走的能力，将产生目前文献中无法获得的关键数据。