权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Assistive Device Training for Functional Mobility and Connectivity in MS

多发性硬化症患者功能移动性和连接性的辅助设备培训

基本信息

批准号：
9085130
负责人：
Michelle Hannah Cameron
金额：
--
依托单位：
PORTLAND VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-07-01 至 2017-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9085130
关键词：
Affect Architecture Auditory Biological Neural Networks Brain Canes Cerebrum Chronic Control Groups Data Devices Disease Progression Environment Evaluation Fall prevention Functional Magnetic Resonance Imaging Functional disorder Gait Gait speed Goals Impaired cognition Impairment Injury Intervention Medical center Methods Motor Multiple Sclerosis Pattern Pilot Projects Population Program Effectiveness Publishing Quality of life Randomized Randomized Controlled Trials Rehabilitation therapy Reporting Research Rest Risk Self-Help Devices Sensorimotor functions Services Surface Testing Time Training United States Veterans Visual Waiting Lists Walkers Walking base compare effectiveness design distraction experience fall risk falls foot functional disability gait rehabilitation improved indium arsenide insight motor disorder nervous system disorder neural correlate neuroimaging novel physical therapist pilot trial prevent programs prospective public health relevance relating to nervous system systematic review young adult

项目摘要

DESCRIPTION (provided by applicant): Multiple sclerosis (MS) is the most common progressive neurological disease of young adults, affecting over 400,000 people in the US and over 16,000 Veterans, approximately 6,000 of whom are service connected for MS. Impaired functional mobility can be the most disabling consequence of MS, limiting independence, resulting in falls, and reducing quality of life. MS is also associated with impaired locomotor neural network functional connectivity, as demonstrated by functional magnetic resonance imaging. Preliminary data suggest that impairment of functional connectivity of the locomotor network underlies impairment of functional mobility. Our long-term goal is to develop interventions to optimize functional mobilit in people with MS (PwMS). Assistive ambulatory devices such as canes and walkers are often used by PwMS to improve functional mobility and prevent falls. However, many studies and two recent systematic reviews report that use of ambulatory assistive devices is associated with a significantly increased risk for falls in PwMS. Improper and incorrect use and lack of training with these devices likely contribute to their ineffectiveness. Although training is recommended to optimize the benefits of assistive device use, no published studies have evaluated the impact of assistive device training in PwMS or in any other population. Neuroimaging has contributed substantially to our understanding of the neural correlates of cognitive and motor dysfunction in PwMS. Task-based functional magnetic resonance imaging (fMRI) has revealed that PwMS have alterations in neural regions associated with sensorimotor functioning. Resting-state fMRI can visualize patterns of functional connectivity associated with motor functioning and has the potential to greatly expand our understanding of changes in the intrinsic functional architecture of the brain in MS and how these changes are impacted by disease progression, motor dysfunction, and rehabilitation. The goals of this research are to evaluate the impact of assistive device training on functional mobility, falls and functional neural connectivity in peopl with MS. Specifically, the objectives of this research are, in people with MS: First, to assess, ina randomized controlled trial, the impact of assistive device training on functional mobility as determined by changes in Timed Up and Go and Timed 25 Foot Walk times, 2-minute Walk distance, and Multiple Sclerosis Walking Scale-12 scores; second, to assess the impact of assistive device training on falls and fall-related injuries as determined by prospective fall diares over 18 weeks; third, to assess the impact of assistive device training on functional neural connectivity of the locomotor network as demonstrated by functional magnetic resonance imaging. We will conduct a two group randomized controlled trial at Portland VA Medical Center to compare the effectiveness of assistive device training to a wait list control condition. The assistive device training will be a standard manualized program comprised of 6 weekly one-on-one sessions with a physical therapist to include gait evaluation, device selection and fitting, an training to use the device in different environments and conditions including level and unlevel surfaces and with and without visual and auditory distractions. Program effectiveness will be assessed by comparing changes in functional mobility, falls, and functional neural connectivity of the locomotor network between the treated and the wait list control groups. We expect to find greater improvements in functional mobility and functional neural connectivity of the locomotor network and greater reduction in falls and fall related injuries in subjects randomized to assistiv device training than in subjects randomized to the wait list control condition. This pilot trial wil provide the data and experience needed for a fully powered randomized controlled trial of assistive device training in Veterans with MS.

描述(由申请人提供)：多发性硬化症(MS)是年轻人最常见的进行性神经系统疾病，在美国影响着超过40万人和超过1.6万名退伍军人，其中约6000人与多发性硬化症的服务相连，功能活动障碍可能是多发性硬化症最致残的后果，限制了独立性，导致摔倒，并降低了生活质量。功能性磁共振成像显示，多发性硬化症还与运动神经网络功能连接受损有关。初步数据表明，运动网络的功能连通性受损是功能性移动性受损的基础。我们的长期目标是开发干预措施，优化多发性硬化症患者(PWMS)的功能活动。PWMS经常使用拐杖和助行器等辅助移动设备来改善功能活动能力和防止跌倒。然而，许多研究和最近的两项系统综述报告，使用非卧床辅助设备与PWMS跌倒的风险显著增加有关。不适当和不正确的使用以及缺乏对这些设备的培训可能会导致它们的无效。虽然建议通过培训来优化辅助设备使用的益处，但还没有发表的研究评估辅助设备培训对PWMS或任何其他人群的影响。神经成像对我们理解PWMS中认知和运动功能障碍的神经相关性有很大贡献。基于任务的功能磁共振成像(FMRI)显示，PWMS在与感觉运动功能相关的神经区域发生了变化。静息状态功能磁共振成像可以可视化与运动功能相关的功能连接模式，并有可能极大地扩展我们对多发性硬化症大脑内在功能结构变化的理解，以及这些变化是如何受到疾病进展、运动功能障碍和康复的影响的。本研究的目的是评估辅助器械训练对多发性硬化症患者功能活动能力、跌倒和功能神经连接的影响。具体地说，本研究的目标是：首先，在随机对照试验中，评估辅助器械训练对功能活动能力的影响，通过随机对照试验，评估辅助器械训练对功能活动能力的影响，根据定时起跳和行走时间的变化，确定25次步行时间、2分钟步行距离和多发性硬化症步行评分-12分；第二，评估辅助器械训练对跌倒和跌倒相关损伤的影响，根据18周的预期跌倒风险确定；第三，通过功能磁共振成像，评估辅助设备训练对运动网络功能神经连通性的影响。我们将在波特兰退伍军人医学中心进行一项两组随机对照试验，以比较辅助设备培训和等待名单控制条件的有效性。辅助设备培训将是一项标准的手工培训计划，包括每周与理疗师进行6次一对一的培训，包括步态评估、设备选择和配戴，以及在不同环境和条件下使用设备的培训，包括水平和不水平表面，以及有或没有视觉和听觉分心。将通过比较接受治疗的对照组和等待名单对照组之间运动网络的功能流动性、跌倒和功能神经连接的变化来评估计划的有效性。我们预计，与随机接受等待名单控制条件的受试者相比，随机接受Asstiv设备训练的受试者在运动网络的功能移动性和功能神经连接性方面会有更大的改善，摔倒和摔倒相关伤害的减少也会更大。这项试点试验将为对患有多发性硬化症的退伍军人进行辅助设备训练的全功率随机对照试验提供所需的数据和经验。