Improving Lateral Stepping Control to Reduce Falls in the Elderly
改善横向迈步控制以减少老年人跌倒
基本信息
- 批准号:9920636
- 负责人:
- 金额:$ 37.72万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2016
- 资助国家:美国
- 起止时间:2016-05-15 至 2023-04-30
- 项目状态:已结题
- 来源:
- 关键词:3-DimensionalAddressAdoptedAdultAgeAgingBalance trainingCessation of lifeClinicalClinical assessmentsCognitiveComputer ModelsCrowdingDangerousnessEducational InterventionEffectivenessElderlyEquilibriumEventEvidence based treatmentExhibitsFall preventionFoundationsGaitGoalsHealthcareHealthy People 2020Hip FracturesHumanImpairmentIndividualInjuryInterventionKnowledgeLateralLawsLocomotor RecoveryMediationModelingMotorMovementNeuronsNoisePatientsPerformancePhysical activityPhysiologicalPoaceaePopulations at RiskPositioning AttributeRanaRandomizedRecoveryRehabilitation therapyRiskSideTestingTrainingTranslatingWalkingWidthWorkactive controlauthoritybaseclinical practicecontrol theorycostdesignexperienceexperimental analysisexperimental studyfall injuryfall riskfallsgait rehabilitationhuman old age (65+)improvedmodels and simulationmotor controlneuromuscularnovelpost interventionprogramspublic health relevancesimulationtheoriestreatment strategytreatment trialvirtual realityvirtual reality environment
项目摘要
DESCRIPTION (provided by applicant): Falls are very common and extremely dangerous events for the elderly, constituting the leading cause of injury and incurring costs likely to exceed $68 Billion by 2020. Falls cause more than 95% of hip fractures and lateral falls (to the side) in particular contribute to 76% of all hip fractures. Most falls occur while walking and humans are inherently more unstable laterally when walking. Also, very limited scientific evidence exists to guide de- sign of interventions to improve walking function in the elderly. Thus, there is a clear need to identify the control strategies elderly use to maintain lateral balance while walking and to develop effective, evidence-based treatment strategies to improve lateral balance control in high fall risk elderly to reduce their risk of falls. The primary goal f this study is to develop interventions to help prevent falls. This requires intervening before fall occur. As people age, multiple physiological changes increase intrinsic physiological (neuromuscular) noise and decrease control authority (the ability to effectively regulate movements). Either or both of these can increase walking variability, which may contribute to falls. However, not all variability is detrimental. Increasing variability can sometimes even facilitate adaptability and improve recovery in locomotor rehabilitation. We recently developed novel computational control theory models that separate physiological noise from control authority to identify how walking humans exploit redundancy to regulate variability in the sagittal
plane. We have now extended this work to determine how humans control lateral stepping movements in the frontal plane. Real-world walking tasks require humans both to be able to respond to changing task goals and also to choose effective strategies. Here, Aim 1 will determine how elderly with Low Fall Risk or High Fall Risk respond to externally imposed challenges (enforced step width and/or lateral perturbations). We will integrate our theoretical framework with computational models and experiments to differentiate effects of control from those of variability. Separately, Aim 2 will determine how elderly make (cognitive) internal choices to either avoid risk or fortify themselves against potential risk. We will again integrate experiments, models, and analyses to identify how Low and High Fall Risk elderly choose different risk-sensitive strategies. Aim 3 will determine if a targeted virtual reality based intervention that challenges people to both respond to imposed changes in lateral position, and also to choose effective strategies for doing so, can improve lateral stepping control and walking balance in High Fall Risk elderly. In a randomized, active control treatment trial, we will compare
pre- and post-intervention changes in walking ability both with and without lateral perturbations, performance in a novel real-world-like navigation task, and established clinical assessments of walking and balance function. This study will apply novel experimental and rigorous computational and analytical approaches to greatly improve our understanding of how elderly individuals walk. We will translate this knowledge into clinical practice by implementing novel VR-based interventions that promise to improve walking function in high fall risk elderly.
描述(由申请人提供):福尔斯对老年人来说是非常常见和极其危险的事件,是造成伤害的主要原因,到2020年,造成的损失可能超过680亿美元。福尔斯跌倒导致超过95%的髋部骨折,而侧向福尔斯跌倒(向侧面)尤其导致76%的髋部骨折。大多数福尔斯跌倒发生在行走时,而人类在行走时天生就更不稳定。此外,存在非常有限的科学证据来指导干预措施的设计,以改善老年人的步行功能。因此,有一个明确的需要,以确定老年人使用的控制策略,以保持横向平衡,而步行和发展有效的,基于证据的治疗策略,以改善高跌倒风险的老年人的横向平衡控制,以减少他们的福尔斯的风险。 本研究的主要目标是开发干预措施以帮助预防福尔斯。这需要在跌倒发生之前进行干预。随着年龄的增长,多种生理变化会增加内在生理(神经肌肉)噪音,降低控制权威(有效调节运动的能力)。这两种情况中的一种或两种都会增加行走的变异性,这可能会导致福尔斯。然而,并非所有的可变性都是有害的。增加变异性有时甚至可以促进适应性并改善运动康复中的恢复。我们最近开发了新的计算控制理论模型,将生理噪声与控制权分开,以确定行走的人类如何利用冗余来调节矢状面的可变性。
飞机我们现在已经扩展了这项工作,以确定人类如何控制额面的横向步进运动。 现实世界的步行任务要求人类既能够对不断变化的任务目标做出反应,又能够选择有效的策略。在这里,目标1将确定低跌倒风险或高跌倒风险的老年人如何应对外部施加的挑战(强制步长和/或横向扰动)。我们将把我们的理论框架与计算模型和实验相结合,以区分控制的影响和可变性的影响。另外,目标2将确定老年人如何做出(认知)内部选择,以避免风险或加强自己对潜在风险的防范。我们将再次整合实验,模型和分析,以确定低和高跌倒风险的老年人如何选择不同的风险敏感策略。目标3将确定是否有针对性的基于虚拟现实的干预,挑战人们对横向位置的变化做出反应,并选择有效的策略来这样做,可以改善高跌倒风险老年人的横向步进控制和行走平衡。在一项随机、活性对照治疗试验中,我们将比较
有和没有横向扰动的步行能力的干预前后变化,在新的真实世界般的导航任务中的表现,以及步行和平衡功能的既定临床评估。这项研究将采用新的实验和严格的计算和分析方法,大大提高我们对老年人如何走路的理解。我们将通过实施新的基于VR的干预措施将这些知识转化为临床实践,这些干预措施有望改善高跌倒风险老年人的行走功能。
项目成果
期刊论文数量(14)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
Rethinking margin of stability: Incorporating step-to-step regulation to resolve the paradox.
- DOI:10.1016/j.jbiomech.2022.111334
- 发表时间:2022-11
- 期刊:
- 影响因子:2.4
- 作者:Kazanski, Meghan E.;Cusumano, Joseph P.;Dingwell, Jonathan B.
- 通讯作者:Dingwell, Jonathan B.
Walking humans trade off different task goals to regulate lateral stepping.
- DOI:10.1016/j.jbiomech.2021.110314
- 发表时间:2021-04-15
- 期刊:
- 影响因子:2.4
- 作者:Render AC;Kazanski ME;Cusumano JP;Dingwell JB
- 通讯作者:Dingwell JB
Adaptive multi-objective control explains how humans make lateral maneuvers while walking.
- DOI:10.1371/journal.pcbi.1010035
- 发表时间:2022-11
- 期刊:
- 影响因子:4.3
- 作者:
- 通讯作者:
How Healthy Older Adults Enact Lateral Maneuvers While Walking.
健康的老年人如何在行走时进行横向动作。
- DOI:10.1101/2023.02.24.529927
- 发表时间:2023
- 期刊:
- 影响因子:0
- 作者:Desmet,DavidM;Kazanski,MeghanE;Cusumano,JosephP;Dingwell,JonathanB
- 通讯作者:Dingwell,JonathanB
Effects of age, physical and self-perceived balance abilities on lateral stepping adjustments during competing lateral balance tasks.
- DOI:10.1016/j.gaitpost.2021.05.025
- 发表时间:2021-07
- 期刊:
- 影响因子:2.4
- 作者:Kazanski ME;Dingwell JB
- 通讯作者:Dingwell JB
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Jonathan B Dingwell其他文献
Jonathan B Dingwell的其他文献
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{{ truncateString('Jonathan B Dingwell', 18)}}的其他基金
Improving Lateral Stepping Control to Reduce Falls in the Elderly
改善横向迈步控制以减少老年人跌倒
- 批准号:
9271845 - 财政年份:2016
- 资助金额:
$ 37.72万 - 项目类别:
Improving Dynamic Walking Stability in Traumatic Amputees
提高创伤性截肢者的动态行走稳定性
- 批准号:
8181373 - 财政年份:2011
- 资助金额:
$ 37.72万 - 项目类别:
Improving Dynamic Walking Stability in Traumatic Amputees
提高创伤性截肢者的动态行走稳定性
- 批准号:
7782313 - 财政年份:2010
- 资助金额:
$ 37.72万 - 项目类别:
Improving Dynamic Walking Stability in Traumatic Amputees
提高创伤性截肢者的动态行走稳定性
- 批准号:
8431350 - 财政年份:2010
- 资助金额:
$ 37.72万 - 项目类别:
Improving Dynamic Walking Stability in Traumatic Amputees
提高创伤性截肢者的动态行走稳定性
- 批准号:
8015584 - 财政年份:2010
- 资助金额:
$ 37.72万 - 项目类别:
Improving Dynamic Walking Stability in Traumatic Amputees
提高创伤性截肢者的动态行走稳定性
- 批准号:
8607057 - 财政年份:2010
- 资助金额:
$ 37.72万 - 项目类别:
Improving Dynamic Walking Stability in Traumatic Amputees
提高创伤性截肢者的动态行走稳定性
- 批准号:
8206285 - 财政年份:2010
- 资助金额:
$ 37.72万 - 项目类别:
Changes in Control of Movement Timing and Stability With Muscle Fatigue
肌肉疲劳时运动时机和稳定性控制的变化
- 批准号:
7667946 - 财政年份:2008
- 资助金额:
$ 37.72万 - 项目类别:
Dynamic Stability in Human Walking: From Small to Large Perturbations
人类行走的动态稳定性:从小扰动到大扰动
- 批准号:
7473542 - 财政年份:2008
- 资助金额:
$ 37.72万 - 项目类别:
Dynamic Stability in Human Walking: From Small to Large Perturbations
人类行走的动态稳定性:从小扰动到大扰动
- 批准号:
7570706 - 财政年份:2008
- 资助金额:
$ 37.72万 - 项目类别:
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