Protective Step Training in People with Multiple Sclerosis

多发性硬化症患者的保护步骤训练

• 批准号: 9763359
• 负责人: Daniel Soren Peterson
• 金额: --
• 依托单位: PHOENIX VA HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9763359
• 关键词: Address; Adult; Affect; Award; Brain; Calendar; Caring; Characteristics; Clinical Treatment; Clinical Trials; Cognition; Corpus Callosum; Data; Diffusion Magnetic Resonance Imaging; Effectiveness; Elderly; Environment; Equilibrium; Exercise; Exhibits; Exposure to; Fall prevention; Functional Imaging; Functional disorder; Funding; Goals; Health Care Costs; Heterogeneity; Image; Individual; Intervention; Knowledge; Lead; Measures; Mentorship; Methods; Motor; Multiple Sclerosis; Musculoskeletal Equilibrium; Parkinson Disease; Participant; Patients; Performance; Pharmacology; Population; Postural response; Posture; Preventive Intervention; Protocols documentation; Quality of life; Rehabilitation therapy; Research; Research Design; Research Personnel; Scientist; Step training; Structure; Sum; Techniques; Training; Training Programs; Veterans; Work; base; care costs; career; career development; cognitive ability; cognitive capacity; cognitive function; cognitive testing; experience; fall risk; falls; follow-up; health care delivery; improved; insight; motor rehabilitation; neuroimaging; novel; prospective; rehabilitation strategy; relating to nervous system; response; skills; tool; treatment strategy; white matter

PROJECT SUMMARY: About 28,000 Veterans with multiple sclerosis (MS) receive care from the VA each year. Most of these Veterans have poor balance and fall frequently. These falls significantly affect Veterans’ quality of life and increase cost of care. Current rehabilitation strategies to prevent falls are inadequate. Protective step training is a novel and promising treatment in which people are exposed to repeated slips. This training aims to improve automatic postural control including quick, protective steps, which are a critical aspect of fall avoidance, and are severely delayed in Veterans with MS. This therapy has been shown to prevent falls in healthy older adults. However, the effectiveness of perturbation training in Veterans with MS is unknown. Identifying effective methods of fall prevention in Veterans with MS, such as perturbation training, can lead to fewer falls in this population. Veterans with MS often exhibit considerable variability in their “responsiveness” to rehabilitation. Said differently, improvement in performance through training is variable across individuals. The ability to predict responsiveness to treatment would be extremely beneficial for clinicians; improving the efficiency by which they provide care. Recent work suggests cognitive ability and structural brain connectivity may predict responsiveness to motor rehabilitation. However, the degree to which these characteristics predict responsiveness in Veterans with MS is currently unknown. Therefore, the overall goals of this project are to understand 1) whether Veterans with MS can improve postural control and reduce falls through perturbation training, and 2) whether we can predict (via cognitive testing and neuroimaging), who will benefit most from treatment. We will achieve these goals through three specific aims. Aim 1: identify whether Veterans with MS can improve protective stepping, a critical skill for fall prevention, through perturbation training. Aim 2: determine if cognitive capacity predicts postural improvement through training in Veterans with MS. Aim 3: determine if brain structural connectivity predicts postural improvements through training. The imaging data collected will also allow us to investigate whether MS-related changes in brain connectivity contributes to postural response dysfunction. The efficacy of perturbation training in Veterans with MS (Aim 1) will be studied by measuring protective stepping performance before and after a 2-week perturbation training protocol. Changes in performance over this period will be compared to a 2-week baseline period (occurring prior to training), in which participants will continue daily routine. In this way, we will conduct a within-subject design study. In addition, we will gather prospective falls data through a falls calendar over the course of 8 weeks prior to and 8 weeks after the perturbation training to gain preliminary data regarding the effect of this training on falls. To determine which baseline characteristics predict “responsiveness” to training (Aims 2 and 3), we will also assess baseline cognitive capacity and brain structural integrity (via diffusion tensor imaging; DTI). We will determine whether these baseline participant characteristics predict which participants exhibit the most improvement through the course of training. In sum, this project will provide insight into 1) the effectiveness of a promising fall prevention intervention, and 2) our ability to predict which patients will benefit most from the intervention. This knowledge will be an important step toward improving care of Veterans with MS who are at risk for falls. Importantly, the environment and mentorship team assembled for this award will also guide Dr. Peterson toward his goal of becoming an independently funded VA scientist.

项目摘要：大约 28,000 名患有多发性硬化症 (MS) 的退伍军人分别接受 VA 的护理 年。这些退伍军人大多平衡能力较差，经常摔倒。这些跌倒严重影响 退伍军人的生活质量和护理成本增加。目前预防跌倒的康复策略是 不足。保护性步骤训练是一种新颖且有前途的治疗方法，人们可以在其中接受 重复的失误。该培训旨在提高自动姿势控制，包括快速、保护性步骤、 这是避免跌倒的一个关键方面，并且在患有多发性硬化症的退伍军人中严重延迟。这种疗法 已被证明可以预防健康老年人跌倒。然而，扰动训练的有效性 患有多发性硬化症的退伍军人中的情况尚不清楚。确定预防多发性硬化症退伍军人跌倒的有效方法，例如 作为扰动训练，可以减少该人群的跌倒次数。 患有多发性硬化症的退伍军人对康复的“反应”往往表现出相当大的差异。说 不同的是，通过培训提高的绩效因人而异。预测能力 对治疗的反应对临床医生来说非常有益；提高效率 他们提供护理。最近的研究表明认知能力和大脑结构连接可以预测 对运动康复的反应。然而，这些特征预测的程度 患有多发性硬化症的退伍军人的反应目前尚不清楚。 因此，该项目的总体目标是了解 1) 患有多发性硬化症的退伍军人是否可以改善 姿势控制并通过扰动训练减少跌倒，2）我们是否可以预测（通过认知 测试和神经影像学），谁将从治疗中受益最多。我们将通过三个方面来实现这些目标 具体目标。目标 1：确定患有多发性硬化症的退伍军人是否可以提高保护性步伐，这是一项关键技能 通过扰动训练预防跌倒。目标 2：确定认知能力是否可以预测姿势 通过对患有多发性硬化症的退伍军人进行培训来改善。目标 3：确定大脑结构连接是否可以预测 通过训练改善姿势。收集的成像数据也将使我们能够调查 多发性硬化症相关的大脑连接变化是否会导致姿势反应功能障碍。 将通过测量保护性来研究扰动训练对患有多发性硬化症的退伍军人的功效（目标 1） 两周扰动训练方案前后的步进表现。性能变化 在此期间将与两周基线期（发生在培训之前）进行比较，其中 参与者将继续日常生活。这样，我们将进行受试者内设计研究。在 此外，我们将通过跌倒日历收集跌倒前 8 周内的预期跌倒数据 扰动训练后 8 周，以获得有关本次训练效果的初步数据 瀑布。为了确定哪些基线特征可以预测对训练的“响应性”（目标 2 和 3），我们 还将评估基线认知能力和大脑结构完整性（通过扩散张量成像；DTI）。 我们将确定这些基线参与者特征是否可以预测哪些参与者表现出 通过培训课程取得的最大进步。 总之，该项目将深入了解 1) 有前景的跌倒预防措施的有效性 干预，以及 2）我们预测哪些患者将从干预中受益最多的能力。这 了解这些知识将是改善对有跌倒风险的多发性硬化症退伍军人的护理的重要一步。 重要的是，为该奖项组建的环境和导师团队也将为彼得森博士提供指导 实现他成为一名独立资助的退伍军人事务部科学家的目标。