Training the brain with a robotic device for balance recovery in near-frail older adults

 描述(由申请人提供)：该项目的长期目标是通过提高老年人在跌倒或绊倒时恢复平衡的能力来减少跌倒。拟议的策略是使用Ames，这是一种FDA批准的非侵入性干预措施，已被证明可以提高健全成年人的运动能力，并减少中枢神经系统损伤患者的上肢和下肢的感觉运动障碍。根据以前的研究结果，我们现在假设Ames干预可以通过增加腿部力量、减少反应时间、改善腿部和轴向运动协调来减少几乎虚弱的老年人(65-95岁)的跌倒。该项目有以下具体目标：(1)修改Ames设备的硬件和软件，以提供本研究中建议的测试和培训，以及(2)为了测试概念验证，即每条腿上9小时的Ames培训足以减少接受Ames的研究参与者的跌倒。在拟议的概念验证研究中，Ames设备将用于训练阿肯色州费耶特维尔退伍军人之家(测试组)10名几乎虚弱的老年居民的双腿。另一个由10名参与者组成的可比小组也将参加，但不会接受Ames培训(对照组)。在基线状态下，所有20名参与者都将能够独立行走，无论有没有辅助设备。在为期3个月的训练开始和结束时，所有参与者都将接受感觉运动障碍(即踝关节力量、踝关节活动范围和关节位置控制以及踝关节本体感觉)和运动功能(即平衡和步态)的评估，在此期间，试验组将接受Ames训练，而对照组将不接受。在这3个月期间以及随后的3个月内(即总共6个月)，将跟踪所有参与者的跌倒发生率。试验组的参与者预计将经历腿部力量的增加，腿部反应时间的减少，腿部本体感觉的改善，同时腿部损伤的减少和腿部功能的改善。与控制组的参与者相比，测试组的参与者在6个月的跟踪期内跌倒的次数预计也会更少。

 DESCRIPTION (provided by applicant): The long-term goal of this project is to reduce falls in older adults by improving their ability to recover equilibrium during a slip or trip. The proposed strategy is to use AMES, an FDA-cleared, non-invasive intervention that has been shown to enhance motor performance in able-bodied adults and to reduce sensorimotor impairment in both the upper and lower limbs of people with CNS injuries. Based on results from previous studies, we now hypothesize that the AMES intervention can reduce falls in near-frail older adults (ages 65-95 years) by increasing leg strength, reducing reaction time, and improving leg and axial motor coordination. This project has the following specific aims: (1) to modify the hardware and software of the AMES device to deliver the testing and training proposed in this study, and (2) to test the proof-of-concept, that 9 hours of AMES training on each leg is sufficient to reduce falls in the study participants receiving AMES. In the proposed proof-of-concept study, an AMES device will be used to train both legs of 10 near-frail older residents in the Arkansas Veterans' Home of Fayetteville (Test Group). Another comparable group of 10 participants will also be enrolled, but will not receive AMES training (Control Group). At baseline, all 20 participants will be able to ambulate independently, with or without assistive devices. All participants will be evaluated for sensorimotor impairments (i.e., ankle strength, ankle range of motion and joint position control, and ankle proprioception) and motor function (i.e., balance and gait) at the beginning and end of a 3-month period during which the Test Group will receive AMES training and the Control group will not. During this 3- month period and also in the 3 months that follow (i.e., for a total of 6 months), the incidence of falls in all participants will be tracked. Participants in the Test Group are expected to experience an increase in leg strength, a decrease in leg reaction time, and an improvement in leg proprioception and, in parallel, a reduction in leg impairment and improvement in leg function. Participants in the Test Group are also expected to experience fewer falls over the 6-month tracking period, compared to the number of falls in the Control Group over this same time period.