The Use of Virtual Manipulations to Assess Fall Risk and the Mechanisms of Postural Instability that Occur with Age

使用虚拟操作评估跌倒风险以及随年龄增长而发生的姿势不稳定的机制

• 批准号: 10368105
• 负责人: James Robert Chagdes
• 金额: $ 7.23万
• 依托单位: MIAMI UNIVERSITY OXFORD
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-15 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10368105
• 关键词: Address; Affect; Age; Age-Years; Aging; Attention; Attenuated; Brain Concussion; Clinical; Clinical assessments; Data; Detection; Development; Elderly; Environment; Equilibrium; Fall prevention; Feedback; Gender; Goals; Height; Human; Impairment; Individual; Injury; Investigation; Knowledge; Lead; Measures; Methods; Motor; Multiple Sclerosis; Muscle; Musculoskeletal Equilibrium; Neurologic; Parkinson Disease; Participant; Patients; Perception; Performance; Persons; Pharmaceutical Preparations; Posture; Process; Quality of life; Recording of previous events; Recovery; Rehabilitation therapy; Research; Self-Help Devices; Sensory; Signal Transduction; Source; System; Testing; Thinness; Training; Visual; Walking; Weight; Work; attenuation; base; design; detection method; economic cost; equilibration disorder; experimental study; fall risk; falls; fear of falling; human model; improved; innovation; insight; mathematical model; muscle strength; neuromuscular; posture instability; predictive modeling; prevent; preventive intervention; sensory feedback; sex; skeletal; theories; tool; virtual; virtual environment; virtual reality; virtual reality headset; visual information

Project Summary The risk of falling increases with age, occurring each year in approximately 28-35% of people over 65 years of age and increasing to 32-42% for people 70 years and over. Finding effective methods capable of detecting a manifestation of impaired balance when there are no apparent signs of instability can thus improve the quality of life of billions of people, reducing their fall risk, helping them prevent injuries, and maintain independence. One of the fundamental limitations is that postural instability is rarely identified before a fall occurs, and only then does a patient receive appropriate attention for improving balance. Such an advancement would help to limit falls by indicating a need for preventative interventions such as rehabilitation or the use of assistive technologies. The long-term goal of this work is twofold. The first is to determine if unique instability predicted by mathematical models of human balance when neuromuscular control changes exist experimentally. The second is to determine if subtle manipulation in virtual reality can be used to detect balance impairment and the mechanisms behind such deficiencies. These goals are tested in two Specific Aims. In Specific Aim 1, we will determine the perception of magnified and delayed postural deviations through virtual reality will lead to a unique oscillatory instability for healthy participants with no previous signs of postural instability. This will provide an understanding of the relationship increased neuromuscular feedback gain and delay have on postural instability, allowing insight into the unique instability encounter through these mechanisms. In Specific Aim 2, we will determine if the perception of attenuated postural deviations through virtual reality will lead to a leaning instability for healthy participants with no previous signs of postural instability. This will provide an understanding of the relationship decrease neuromuscular feedback gain have on postural instability, allowing insight into the unique instability encountered through this mechanism. Investigation of these Specific Aims will allow us to determine if the amount of manipulation to the perception of postural deviation in virtual reality to induce instability correlates with clinical assessment methods. The underlying hypothesis of this Specific Aim is that individuals with a low fall-risk will require the largest amount of manipulation in VR with the opposite being true for individuals with a high fall-risk and will directly correlate with fall-risk as assessed by the Berg Balance Scale and the Timed Up and Go test. This proposed work will lead to an increased fundamental understanding of the mechanisms responsible for postural instability and their relationship to factors such as age, sex, height, weight, fall-risk, fall history, and fear of falling. An additional benefit is the development of an object method for assessing balance and provides critical insights into deficient mechanisms of postural control, a significant advancement towards improved methods of fall prevention. Identifying an individual's proximity to postural instability could lead to personalized training, more efficiently addressing their specific needs. The development of virtual reality strategies to assess and rehabilitate postural instability could help to reduce the substantial economic cost associated with falls.

项目摘要 跌倒的风险随着年龄的增长而增加，每年约有28-35%的65岁以上的人发生跌倒。 70岁及以上的人增加到32-42%。寻找能够检测出 当没有明显的不稳定迹象时，平衡受损的表现可以提高质量 这是数十亿人生命中最重要的一部分，可以降低他们的跌倒风险，帮助他们预防受伤，并保持独立。 一个基本的局限性是姿势不稳定很少在跌倒发生前被发现， 那么患者是否得到适当的关注以改善平衡。这样的进步将有助于 通过表明需要进行预防性干预，如康复或使用辅助工具，限制福尔斯 技术.这项工作的长期目标是双重的。第一个是确定预测的独特不稳定性 通过人体平衡的数学模型，当神经肌肉控制的变化存在实验。的 第二是确定虚拟现实中的微妙操纵是否可以用于检测平衡障碍， 这些缺陷背后的机制。这些目标在两个具体目标中得到检验。在具体目标1中， 将决定通过虚拟现实放大和延迟姿势偏差的感知将导致 健康参与者的独特振荡不稳定性，以前没有姿势不稳定的迹象。这将 了解神经肌肉反馈增益增加和延迟对 姿势不稳定，允许通过这些机制深入了解独特的不稳定性。在特定 目标2，我们将确定通过虚拟现实感知减弱的姿势偏差是否会导致 对于先前没有姿势不稳定迹象的健康参与者，这将提供一个 了解减少神经肌肉反馈增益对姿势不稳定的关系， 深入了解通过这种机制遇到的独特的不稳定性。对这些具体目标的研究将 让我们来确定是否操纵量的感知姿势偏差在虚拟现实， 诱导不稳定性与临床评估方法相关。这一具体目标的基本假设是 具有低跌倒风险的人将需要在VR中进行最大量的操纵， 对于具有高跌倒风险的个体，这一点是正确的，并且与贝格平衡评估的跌倒风险直接相关 规模和定时启动和运行测试。这项拟议的工作将加深人们的基本了解 姿势不稳定的机制及其与年龄、性别、身高、 体重、跌倒风险、跌倒史和害怕跌倒。另一个好处是开发了一个对象方法， 评估平衡，并提供了关键的见解不足的机制，姿势控制，一个重要的 改进预防跌倒的方法。识别个人的接近姿势 不稳定可能导致个性化培训，更有效地满足他们的具体需求。的 开发虚拟现实策略来评估和恢复姿势不稳定可能有助于减少 与福尔斯相关大量经济成本。