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

项目摘要/摘要 帕金森氏病(PD)患者最大的残疾限制之一是减少了在社区中的安全行走。具体地说，帕金森病患者在管理独立进入社区所需的要素方面存在困难，如完成转弯，从一种地形平稳地移动到另一种地形，如砾石到草地，以及避开和/或管理障碍。事实上，被障碍物绊倒已被确定为社区居住的帕金森病患者跌倒的主要原因。通常情况下，帕金森病患者可能会辞职，而不是应对在社区中行走的挑战，变得呆在家里，最大限度地减少他们在环境中发生不良事件的风险，从而对他们的生活质量产生负面影响。然而，现在人们了解到，帕金森氏症患者有能力改善运动技能的表现和学习。此外，研究表明，对于帕金森病患者来说，练习环境与现实生活环境相匹配，对于学习从练习环境转移到现实世界尤为重要。因此，让帕金森病患者在现实生活中练习转弯和避障等高级步行技能，以最大限度地提高功能性步行能力，是至关重要的。因此，拟议研究的主要目标是开发和测试一种训练系统，使帕金森氏症患者能够练习在社区中独立所需的高级行走技能。为支持目前的提议而进行的初步研究表明，在跑步机上行走时使用该系统是可行的。帕金森病患者可以忍受在沉浸式环境中行走，没有任何不良影响。为了实现本提案的目标，将创建一个低成本、便携的步态训练系统，以促进帕金森病患者练习高级运动技能(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较新的全方位跑步机配合使用)。在发展过程中，将招募帕金森病患者样本，以体验和提供关于培训环境的价值和意义的反馈。第二个目标是确定帕金森病患者在发达环境中完成一套循序渐进的培训课程的可行性。可行性将通过参与者退学率、不良影响的流行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，将提高帕金森病患者的熟练运动能力。此外，这项研究将创造一种独特的、低成本的、令人愉快的系统，可以在临床或家庭中用于运动相关功能障碍的训练和监测。

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.