Protective Step Training in People with Multiple Sclerosis

项目概要：大约28，000名患有多发性硬化症（MS）的退伍军人接受VA的护理， 年这些退伍军人大多数平衡能力差，经常摔倒。这些福尔斯的坠落严重影响了 退伍军人的生活质量和增加护理费用。目前预防福尔斯跌倒的康复策略包括 不足保护性台阶训练是一种新颖且有前途的治疗方法， 反复的滑倒这项训练旨在提高自动姿势控制，包括快速，保护性的步骤， 这是避免跌倒的一个关键方面，并且在患有MS的退伍军人中严重延迟。 已被证明可以预防健康老年人的福尔斯跌倒。然而，扰动训练的有效性 MS患者的情况不明。确定预防MS退伍军人跌倒的有效方法，例如 作为扰动训练，可以导致该群体中更少的福尔斯。 退伍军人与MS往往表现出相当大的变化，他们的“反应”康复。说 不同的是，通过培训提高业绩的情况因人而异。风暴预测 对治疗的反应性对临床医生来说是非常有益的;提高效率， 他们提供照顾。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，这些特征在多大程度上预示着 目前尚不清楚MS退伍军人的反应性。 因此，本项目的总体目标是了解1）MS退伍军人是否可以改善 姿势控制和减少福尔斯通过扰动训练，以及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实现这些目标 具体目标。目标1：确定患有MS的退伍军人是否可以提高保护性步骤，这是一项关键技能， 通过干扰训练预防跌倒。目的2：确定认知能力是否预测姿势 通过对患有MS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预测 通过训练改善姿势。收集到的成像数据也将使我们能够调查 MS相关的脑连接变化是否会导致姿势反应功能障碍。 扰动训练的有效性与MS退伍军人（目的1）将通过测量保护 在2周的扰动训练方案之前和之后的步进性能。业绩变动 将在此期间与2周基线期（培训前发生）进行比较，其中 参加者将继续日常活动。通过这种方式，我们将进行受试者内设计研究。在 此外，我们将通过福尔斯日历收集8周内的预期福尔斯数据， 以及扰动训练后8周，以获得关于该训练对 福尔斯。为了确定哪些基线特征可以预测对训练的“反应性”（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（通过弥散张量成像; DTI）。 我们将确定这些基线参与者特征是否能预测哪些参与者表现出 大部分的改进都是通过培训来实现的。 总之，这个项目将提供深入了解1）有效的一个有前途的跌倒预防 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 知识将是改善对有福尔斯风险的MS退伍军人护理的重要一步。 重要的是，为这个奖项而组建的环境和导师团队也将指导彼得森博士 他的目标是成为一名独立资助的退伍军人管理局科学家。

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.