Protective Step Training in People with Multiple Sclerosis

项目摘要：约28,000名患有多发性硬化症(MS)的退伍军人每人接受退伍军人管理局的护理 年。这些退伍军人中的大多数平衡能力很差，经常摔倒。这些跌落严重影响了 提高了退伍军人的生活质量，增加了护理成本。目前预防跌倒的康复策略是 不够充分。保护性步骤训练是一种新的和有希望的治疗方法，在这种治疗中，人们暴露在 一次次的滑倒。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，在患有多发性硬化症的退伍军人中，这种疗法会严重延迟。 已被证明可以防止健康的老年人跌倒。然而，扰动训练的有效性 退伍军人是否患有多发性硬化症尚不清楚。确定患有多发性硬化症的退伍军人预防跌倒的有效方法，如 作为摄动训练，可以使这个群体中的跌倒更少。 患有多发性硬化症的退伍军人对康复的“反应”经常表现出相当大的变异性。说 不同的是，通过培训提高绩效的情况因个人而异。预测的能力 对治疗的反应将对临床医生极其有益；通过以下方式提高效率 他们提供护理。最近的研究表明，认知能力和大脑结构的连通性可以预测 对运动康复的反应。然而，这些特征预测的程度 退伍军人对多发性硬化症的反应性目前尚不清楚。 因此，本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 通过干扰训练控制姿势和减少跌倒，以及2)我们是否能够(通过认知)预测 测试和神经成像)，谁将从治疗中受益最大。我们将通过三个方面实现这些目标 明确的目标。目标1：确定患有多发性硬化症的退伍军人是否可以改善保护性步进，这是一项关键技能 通过摄动训练防止跌倒。目标2：确定认知能力是否能预测姿势 通过对退伍军人进行MS培训的改进目标3：确定大脑结构连通性是否可以预测 通过训练改善姿势。收集的成像数据还将使我们能够调查 与多发性硬化症相关的大脑连通性改变是否会导致姿势反应障碍。 干扰训练对患有多发性硬化症的退伍军人的有效性(目标1)将通过测量保护性来研究 在为期2周的扰动训练方案前后进行踏步表现。性能的变化 将这一期间与两周基准期(在培训之前)进行比较，在此期间 参赛者将继续日常工作。这样，我们将进行一项学科内的设计研究。在……里面 此外，我们将在8周前通过跌倒日历收集未来跌倒数据。 在扰动训练后8周，以获得关于该训练对 瀑布。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(通过扩散张量成像；DTI)。 我们将确定这些基准参与者特征是否可以预测哪些参与者表现出 最大的进步是通过培训过程。 总而言之，这个项目将提供对1)有希望的预防跌倒的有效性的洞察 干预，以及2)我们预测哪些患者将从干预中受益最大的能力。这 知识将是改善多发性硬化症退伍军人护理的重要一步，这些退伍军人有跌倒的风险。 重要的是，为这个奖项召集的环境和指导团队也将指导彼得森博士 朝着成为一名独立资助的退伍军人管理局科学家的目标前进。

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.