Combined Cognitive and Gait Training

认知和步态联合训练

• 批准号: 9172712
• 负责人: JANIS J. DALY
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2017-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9172712
• 关键词: Address; Adult; Aftercare; Age; American; Attention; Biomechanics; Body Weight; Cognitive; Day Care; Disabled Persons; Enrollment; Environment; Exercise; Gait; Healthcare Systems; Impairment; Institutionalization; Intervention; Korean War; Laboratories; Life; Measures; Medical Societies; Methods; Motor; Movement; Pathway interactions; Patients; Pattern; Phase; Population; Process; Protocols documentation; Quality of life; Randomized; Recovery; Reporting; Research; Residual state; Role; Self Care; Speed; Stimulus; Stroke; Survivors; Task Performances; Testing; Time; Training; Veterans; Vietnam; Visual; Walking; Work; acute stroke; base; chronic stroke; clinically significant; cognitive change; cognitive task; cognitive testing; cognitive training; cost; data acquisition; design; disability; distraction; functional disability; handicapping condition; improved; innovation; post stroke; response; restoration; success; tool; treadmill training

DESCRIPTION (provided by applicant): Combined Cognitive and Gait Training Problem: Recent research in gait training for chronic stroke survivors showed that gait coordination can be best restored using the following interventions together: exercise, over ground gait training, and body weight supported treadmill training (BWSTT). These results are important because, to our knowledge, there have been no other reports of the restoration of gait coordination for those with persistent gait deficits (> 6 months after stroke). However, a remaining problem was that the restored coordinated gait movements measured in the laboratory did not generalize for many subjects to the everyday environment. The known confluence of several factors can cause lack of generalization. First, it is known that dual task performance (walking and cognitive attention task) can degrade both gait speed and attention ability, even in healthy adults. Second, stroke can impair attention. Third, during walking in the everyday environment, attention is required in order to safely process normally occurring stimuli. Therefore, given the success of the new gait training protocol in the lab setting, it is important to address the problems remaining, for the generalization of recovered functional gait (gait speed) and gait coordination to the everyday environment. Purpose: Aim 1 is to test an innovative combination of motor and cognitive training that is designed to restore functional gait (gait speed) and gait coordination to the everyday environment. Hypothesis I: Combined cognitive and motor training will produce greater gains in gait speed in the dual task test condition, versus motor training alone. Primary measure: gait speed, measured under the dual task conditions of walking and dealing with a visual distraction (obstacles) in the gait pathway. Secondary measures include: gait coordination, time spent walking in everyday environment, and life role participation (quality of life). Aims 2 and 3 are t investigate the within-group, separate motor and cognitive changes in response to the respective treatments for each of the two study groups. Methods: For Aim 1, Hyp I, thirty-eight subjects (>6 months post stroke) will be enrolled and randomized to either 1) Gait Training + Cognitive Training; or 2) Gait Training alone. Subjects in both groups will receive treatment 5 times/wk, 3hrs/session, for 12wks. The Gait Training Protocol will include: exercise; body weight supported treadmill training (BWSTT); and over ground gait training. For Group 1, the cognitive training will be phased into the daily sessions, by first emphasizing cognitive training alone, and subsequently dual training (cognitive and motor). Aims 2 and 3 measures will include gait measures acquired both with and without a cognitive task, as well as cognitive measures acquired both with and without the gait task. Pre-/post-treatment comparisons will be made within each of the two treatment groups. Clinical Significance: The proposed intervention has the potential to restore safe, coordinated, functional walking in the every day environment.

描述（由申请人提供）： 认知和步态训练的组合：对慢性中风幸存者的步态训练的最新研究表明，步态协调可以通过以下干预措施一起恢复：锻炼，过度步态训练以及体重支持跑步机训练（BWSTT）。这些结果很重要，因为据我们所知，没有其他关于持续步态缺陷的人恢复步态协调的报道（中风后> 6个月）。但是，剩下的问题是，在实验室中测得的恢复的步态运动并未将许多受试者推广到日常环境。已知的几个因素汇合可能会导致缺乏概括。首先，众所周知，即使在健康的成年人中，双重任务表现（步行和认知注意任务）也会降低步态速度和注意力能力。其次，中风会损害注意力。第三，在日常环境中行走时，需要注意以安全地处理通常发生的刺激。因此，鉴于在实验室环境中新的步态训练方案的成功，要解决剩下的问题，对于回收的功能步态（步态速度）和对日常环境的步态协调的推广非常重要。目的：目标1是测试旨在恢复功能步态（步态速度）和步态协调到日常环境的运动和认知训练的创新组合。 假设I：仅在双重任务测试条件下，仅与运动训练相对于运动训练，认知和运动训练的组合将在步态速度方面提高。主要措施：步态速度，在步行和处理步态路径中视觉分散注意力（障碍）的双重任务条件下测量。次要措施包括：步态协调，在日常环境中花费的时间以及生活角色参与（生活质量）。目标2和3是研究两个研究组中每个治疗的组内，单独的运动和认知变化。方法：对于AIM 1，将招募三十八名受试者（> 6个月）的HYP I，并随机分配到1）步态训练 +认知训练；或2）步态训练。两组的受试者将接受12wks的5次/周，3小时/疗程的治疗。步态训练方案将包括：锻炼；体重支持跑步机训练（BWSTT）；和地面步态训练。对于第1组，认知培训将通过首先强调认知培训和 随后进行双重训练（认知和运动）。目标2和3措施将包括有没有认知任务的情况下获得的步态措施，以及在有没有步态任务的情况下获得的认知措施。在两个治疗组中的每个治疗组中，都会进行治疗前/治疗后的比较。临床意义：拟议的干预措施有可能在每天的环境中恢复安全，协调的功能性步行。