The peripheral motor repertoire as a neuromuscular constraint on walking balance integrity in age-related falls risk

外周运动指令作为神经肌肉约束对年龄相关跌倒风险中步行平衡完整性的影响

• 批准号: 10266818
• 负责人: Jason R Franz
• 金额: $ 23.17万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10266818
• 关键词: Address; Affect; Age; Area; Benchmarking; Communities; Complex; Cross-Sectional Studies; Data; Development; Diagnosis; Diagnostic; Diagnostic tests; Elderly; Equilibrium; Fall prevention; Financial Hardship; Fright; Future; Gait; Goals; Guidelines; Impulsivity; Individual; Laboratories; Libraries; Link; Measurement; Measures; Mechanics; Motor; Muscle; Neurodegenerative Disorders; Neuropsychology; Optics; Peripheral; Predisposition; Prevention; Productivity; Prospective Studies; Public Health; Quality of life; Recording of previous events; Recurrence; Rehabilitation therapy; Retirement; Risk; Self Efficacy; Sensory; Speed; Surveys; Testing; Training; Walking; age related; aging population; design; equilibration disorder; evidence base; fall risk; falls; high risk; innovation; insight; interdisciplinary collaboration; locomotor tasks; neuromuscular; novel; novel strategies; preservation; prospective; response; synergism; treadmill; young adult

PROJECT SUMMARY Despite conventional diagnostic and rehabilitative efforts, and a rich understanding of standing balance control, our rapidly aging population remains at an exceptionally high risk of debilitating falls. A major contributor to this continued risk is that most falls occur during everyday walking tasks which are much less well understood and require more complex neuromuscular coordination. Our long-term goal is to introduce a novel neuromuscular mechanism for age-associated walking balance impairment as a strategic target for diagnostic testing, earlier prevention, and rehabilitation to prevent falls in older adults. We posit that all individuals rely on a principal number of peripheral neuromuscular commands – a “peripheral motor repertoire” – to accomplish everyday walking tasks during which falls may occur (e.g., walking, turning, gait initiation, precision stepping). Supported by promising pilot data, the objective of this R21 is to rigorously test the overarching hypothesis that a reduced peripheral motor repertoire used for everyday walking tasks represents a neuromuscular constraint on older adults’ ability to successfully respond to walking balance perturbations and thereby prevent falls in the community. This cross-sectional study has three aims. Specific Aim 1 will test the hypothesis that the peripheral motor repertoire (i.e., number of motor modules or muscle synergies) used to accomplish everyday walking tasks is reduced by falls history more than by age alone and negatively correlates with the number falls in the prior year. Specific Aim 2 will quantify the association between the peripheral motor repertoire, functional balance integrity, and fear of future falls. Here, we will test the hypothesis that the size of the peripheral motor repertoire used during everyday walking tasks associates more with functional balance integrity than fear of future falls. We will interpret this finding as evidence that a reduced peripheral motor repertoire represents a neuromuscular constraint that precipitates poor balance control versus an emergent strategy associated with a fear of recurrent falls. Specific Aim 3 will test the hypothesis that a reduced peripheral motor repertoire associates with larger susceptibility to a diverse combination of sensory and mechanical balance perturbation paradigms applied during walking. We will interpret this finding as a critical mechanistic link between the peripheral motor repertoire used during everyday walking tasks and ability to accommodate balance challenges relevant to falls in the community. The proposed study is innovative, and the first to combine: (1) state-of-the-art electromyographic analyses across everyday walking tasks during which falls may occur in young adults and in older adults with and without a history of falls, (2) functional and neuropsychological measures of walking balance integrity, balance self- efficacy, and fear of future falls, and (3) a combination of sensory and mechanical balance perturbation paradigms applied during walking. This project will provide pivotal insight into a very specific and innovative feature of neuromuscular control as a mechanism for age-related balance impairment while paving the way for planned prospective studies toward more effective targets for diagnostics and rehabilitation to prevent falls.

项目概要 尽管进行了传统的诊断和康复工作，并且对站立平衡控制有丰富的了解， 我们人口迅速老龄化，跌倒的风险仍然极高。这其中的一个主要贡献者 持续的风险是，大多数跌倒发生在日常步行任务中，而人们对此的了解要少得多，并且 需要更复杂的神经肌肉协调。我们的长期目标是引入一种新型的神经肌肉 与年龄相关的步行平衡障碍的机制作为诊断测试的战略目标，较早 预防和康复，以防止老年人跌倒。我们假设所有个人都依赖于一个委托人 每天要完成的外周神经肌肉命令（“外周运动指令”）的数量 可能发生跌倒的步行任务（例如步行、转身、开始步态、精确迈步）。支持 通过有希望的试点数据，R21 的目标是严格测试总体假设，即减少 用于日常行走任务的外周运动指令代表了老年人的神经肌肉限制 成人成功应对行走平衡扰动从而防止跌倒的能力 社区。这项横断面研究有三个目标。具体目标 1 将检验以下假设：外围设备 用于完成日常步行任务的运动指令（即运动模块的数量或肌肉协同作用） 跌倒史所减少的程度比单独年龄所减少的要多，并且与之前的跌倒次数呈负相关 年。具体目标 2 将量化外周运动指令、功能平衡之间的关联 诚信，以及对未来堕落的恐惧。在这里，我们将检验以下假设：外围运动能力的大小 在日常步行任务中使用它更多地与功能平衡完整性相关，而不是对未来跌倒的恐惧。 我们将这一发现解释为外周运动功能减少代表神经肌肉功能减弱的证据。 导致平衡控制不佳的约束与与担心复发相关的紧急策略 瀑布。具体目标 3 将检验以下假设：外围运动能力的减少与更大的运动能力相关。 对感官和机械平衡扰动范式的多种组合的敏感性 步行。我们将把这一发现解释为所使用的外围运动指令之间的关键机制联系 在日常步行任务中以及适应与社区跌倒相关的平衡挑战的能力。 拟议的研究具有创新性，并且是第一个结合了：（1）最先进的肌电图分析 日常步行任务中，年轻人和老年人都可能发生跌倒 跌倒史，（2）行走平衡完整性、平衡自我的功能和神经心理学测量 功效和对未来跌倒的恐惧，以及（3）感觉和机械平衡扰动的结合 步行期间应用的范式。该项目将为一个非常具体和创新的项目提供关键的见解 神经肌肉控制的特征作为与年龄相关的平衡障碍的机制，同时为 计划进行前瞻性研究，以实现更有效的诊断和康复目标，以预防跌倒。