High-Intensity, dynamic-stability gait training in people with multiple sclerosis

项目摘要 这项I/II期多中心临床试验的目标是改善步行功能、动态稳定性和 使用一种新的高强度训练组合对多发性硬化症患者的社区活动能力 以及一个挑战动态平衡的环境。该提案有两个关键要素：1) 在跑步机行走中应用平衡扰动将使参与者发展神经肌肉 保持直立姿势的策略，将随着反复练习而得到改进和加强，以及2) 患者进行高强度训练将改善他们的神经肌肉和心肺功能 以促进走得更快更远的能力。事实上，轻度或中度多发性硬化症患者存在改变。 运动和姿势控制，这种2X2因素设计将描绘出单独的和综合的影响 在步行和高强度运动中反复暴露于姿势扰动，这可能会增强 运动和平衡控制在实验室条件下和在真实世界中，运动和平衡控制 姿势上的要求是巨大的。这项研究是基于调查人员之前的经验进行的 其他神经疾病患者的高强度训练和先导研究的可喜结果 论证了在多发性硬化症患者中进行动态平衡跑步机训练的可行性。 试图描述步行后临床和实验室运动能力的变化- 跑步机上高强度与低强度、有或无姿势扰动的专项运动训练 踏步(目标1)。目标2将演示这些策略在动态姿势控制方面的相对有效性 (即，平衡)以及对社区二级措施的扰动反应的改进 瀑布。最后，目标3将描述在这些变化之后社区流动性和参与性的变化 锻炼范例。我们认为，高强度的运动训练和姿势扰动将导致 运动和平衡结果的最大变化，这些综合收益将促进体能 在社区环境中的活动可以提高生活质量。

Project Summary The goal of this phase I/II multicenter clinical trial is to improve walking function, dynamic stability, and community mobility in people with multiple sclerosis (MS) using a novel combination of high-intensity training and an environment that challenges dynamic balance. There are two critical elements of this proposal: 1) balance perturbations applied during treadmill walking will allow participants to develop neuromuscular strategies to maintain upright posture, which will be refined and enhanced with repeated practice, and 2) patients who engage in high-intensity training will improve their neuromuscular and cardiorespiratory capacity to facilitate the ability to walk faster and further. Indeed, patients with mild or moderate MS present with altered locomotor and postural control, and this 2X2 factorial design will delineate the individual and combined effects of repeated exposure to postural perturbations during walking and high-intensity exercise that may enhance locomotor and balance control in both laboratory conditions and in the real-world, where the locomotor and postural demands are substantial. This study is predicated on the previous experience of the investigators with high-intensity training in patients with other neurological disorders and promising results of a pilot study demonstrating feasibility of dynamic balance treadmill training in people with MS. The present project will attempt to delineate changes in clinical and laboratory measures of locomotor capacity following walking- specific exercise training at high vs low intensity and with or without postural perturbations during treadmill stepping (Aim 1). Aim 2 will demonstrate the relative efficacy of these strategies on dynamic postural control (i.e., balance) and relate improvements in the response to perturbations to secondary measures of community falls. Finally, Aim 3 will delineate changes in community mobility and participation following these various exercise paradigms. We suggest that high-intensity locomotor training with postural perturbations will elicit the largest changes in both locomotor and balance outcomes, and these combined gains will boost physical activity in the community setting leading to improved quality of life.