Design and development of a mixed reality system for skilled locomotor training in individuals with Parkinson's disease

项目总结/摘要 帕金森病（PD）患者最大的残疾限制之一是减少社区安全行走的障碍。具体而言，患有PD的人在管理独立进入社区所需的要素方面表现出困难，例如完成转弯，从一个地形平稳地移动到另一个地形，例如砾石到草地，以及避免和/或管理障碍物。事实上，被障碍物绊倒已被确定为社区居住的PD患者福尔斯跌倒的主要原因。通常情况下，PD患者通常不会应对在社区中行走的挑战，而是可能会辞职回家，并最大限度地降低环境中不良事件的风险，从而对他们的生活质量产生负面影响。然而，现在人们理解，PD患者有能力改善表现和学习运动技能。此外，它已被证明，这是特别重要的个人与PD的实践环境相匹配的现实生活环境，学习从实践环境转移到真实的世界。因此，关键是要让PD患者练习先进的行走技能，如在现实世界中转弯和避障，以最大限度地提高功能性行走能力。因此，拟议研究的主要目标是开发和测试一种训练系统，使PD患者能够练习在社区中独立所需的高级行走技能。为支持目前的建议而进行的初步研究证明了在跑步机上行走时使用该系统的可行性。PD患者能够耐受在沉浸式环境中行走，没有任何不良反应。为了实现这一提议的目标，将创建一个低成本、便携式步态训练系统，以促进PD患者练习高级运动技能（例如转弯、避障和双重任务）。重要的是，该系统将能够在多个平台上使用（标准跑步机、开放空间的地面跑步机，或与更新的全方位跑步机结合使用）。在开发过程中，将招募一批患有PD的个人样本，以体验培训环境的价值和意义，并提供反馈。次要目标是确定PD患者在发达环境中完成一组渐进式训练课程的可行性。可行性将通过参与者退出率、不良影响的发生率以及参与者对培训环境的感知价值来评估。这项研究将导致一种新的，创新的训练方法，将提高PD患者的熟练运动能力。此外，这项研究将创造一个独特的，低成本的，愉快的系统，可用于在诊所或在家里的训练和监测运动相关的功能障碍。

Project Summary/Abstract One of the most disabling limitations for individuals with Parkinson’s disease (PD) are impairments that reduce safe walking in the community. Specifically, people with PD demonstrate difficulty in managing the very elements required for independent access to the community such as completing turns, moving smoothly from one terrain to another such as gravel to grass and avoiding and/or managing obstacles. In fact, tripping over obstacles has been identified as the major cause of falls in community-dwelling people with PD. Commonly, rather than dealing with the challenges of walking in the community, individuals with PD may often be resigned to become home-bound and minimize their risk of adverse events in environment thus negatively impacting their quality of life. However, it is now understood that individuals with PD have the capacity for improved performance and learning of motor skills. Additionally, it has been shown that it is particularly important for individuals with PD that the practice environment matches the real-life environment for learning to transfer from the practice environment to the real world. Thus, it is critical to allow individuals with PD to practice advanced walking skills such as turning and obstacle avoidance in real-world scenarios to maximize functional walking ability. Therefore the primary objective of the proposed study is to develop and test a training system that will allow individuals with PD to practice the advanced walking skills necessary for independence in the community. A preliminary study conducted in support of the current proposal demonstrates the feasibility of using the system while walking on a treadmill. Individuals with PD tolerated walking in the immersive environment without any adverse effects. To accomplish the objectives of this proposal, a low-cost, portable, gait training system will be created to facilitate the practice of advanced locomotor skills (e.g. turning, obstacle avoidance, and dual-tasking) for individuals with PD. Importantly, the system will be capable of being used on multiple platforms (standard treadmills, over-ground in an open space, or in conjunction with newer, omni-directional treadmills). During development, a sample of individuals with PD will be recruited to experience and provide feedback on the value and meaningfulness of the training environments. The secondary objective is to determine the feasibility of individuals with PD completing a set of progressive training sessions in the developed environments. Feasibility will be assessed by participant drop-out rate, the prevalence of adverse effects, and the participant’s perceived value of the training environment. This study will result in a new, innovative training approach that will improve skilled locomotor ability in individuals with PD. Furthermore, this study will create a unique, low-cost, and enjoyable system that could be used in the clinic or at home for training and monitoring of movement-related dysfunction.