Motor learning of protective responses to balance perturbations in persons with Parkinson's Disease

帕金森病患者平衡扰动保护性反应的运动学习

• 批准号: 10574010
• 负责人: Ruth Yetunde Akinlosotu
• 金额: $ 4.32万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10574010
• 关键词: Age; Agonist; Anterior; Balance training; Characteristics; Clinical Trials; Development; Doctor of Philosophy; Elderly; Equilibrium; Fatal injury; Future; Individual; Intervention; Learning; Measures; Methods; Motor; Motor Skills; Muscle; Musculoskeletal Equilibrium; Parkinson Disease; Parkinsonian Disorders; Patients; Performance; Persons; Population; Postural response; Posture; Process; Protocols documentation; Public Health; Recurrence; Rehabilitation therapy; Research; Schedule; Symptoms; Testing; Touch sensation; Training; Walking; antagonist; fall injury; fall risk; falls; flexibility; follow-up; habituation; improved; learning strategy; motor learning; pharmacologic; response; skill acquisition; treadmill

Project Summary Two-thirds of persons with Parkinson’s disease (PwPD) fall yearly, resulting in non-fatal and fatal injuries. Many of these patients are recurrent fallers, due primarily to parkinsonian symptoms that interfere with postural control and limit postural responses to both self-initiated and external perturbations. These symptoms cause excessive co-contraction of agonists and antagonist muscle groups, hypometria, delayed stepping, and postural set inflexibility (i.e., an inability to quickly change responses to different types, conditions, and intensities of postural disturbances). Even with pharmacological and rehabilitation interventions, postural and balance deficits persist, and the risk of falls remains intractable. Among older adults, balance perturbation training is emerging as an effective method to reduce fall related injuries. In PwPD, however, one of the challenges to balance training is that postural inflexibility may negatively impact motor skill acquisition, retention, and generalization. As a result, motor learning strategies that are effective in individuals without PD may not be effective in PwPD. The overall objective of this PhD dissertation proposal is to determine the effect of practice schedule on the acquisition, retention, and generalization of protective balance responses in PwPD. The central hypothesis is that PwPD will acquire and retain protective balance responses to treadmill perturbations through blocked, but not random, initial practice schedules, and will require a follow-up set of random practice to generalize improvements to overground perturbations. In specific aim 1, I will compare improvements in protective stepping stability after a single session of blocked versus random practice of 10 slips and 10 trips in PwPD and age-matched healthy controls. In specific aim 2, I will compare generalization of protective stepping stability to unpracticed overground slip perturbations after blocked, followed by random practice sessions (blocked-random) to random, followed by blocked (random-blocked) practice sessions of treadmill-induced perturbations (10 slips and 10 trips) in PwPD and controls. Together, these findings will provide a basis for developing balance rehabilitation protocols based on motor learning principles to mitigate falls in PwPD compared to age-matched controls.

项目摘要 三分之二的帕金森病（PwPD）患者每年都会摔倒，导致非致命性和致命性伤害。许多 这些患者的复发性跌倒，主要是由于帕金森症状干扰姿势控制 并限制对自我引发和外部扰动的姿势反应。这些症状会导致过度 激动肌群和拮抗肌群的共同收缩、测量不足、延迟踏步和姿势固定 可识别性（即，无法快速改变对不同类型、条件和强度的姿势的反应 干扰）。即使有药物和康复干预，姿势和平衡缺陷仍然存在， 并且福尔斯的风险仍然难以处理。在老年人中，平衡扰动训练正在成为一种 减少跌倒相关伤害的有效方法然而，在PwPD，平衡训练的挑战之一是 姿势不稳定性可能对运动技能的获得、保持和概括产生负面影响。因此，在本发明中， 在没有PD的个体中有效的运动学习策略在PwPD中可能无效。整体 这篇博士论文的目的是确定实践时间表对获取的影响， 保留和PwPD中保护性平衡反应的泛化。核心假设是，PwPD将 获得并保持对跑步机扰动的保护性平衡反应，通过阻断，但不是随机的， 最初的实践时间表，并将需要一个后续的随机实践，以推广改进， 地面扰动在具体目标1中，我将比较在保护性步进稳定性方面的改进， 在PwPD和年龄匹配的健康人中进行10次滑倒和10次绊倒的单次封闭与随机练习 对照在具体目标2中，我将比较保护性踏步稳定性的一般化与未练习过的地上 滑动扰动后，封锁，其次是随机练习会议（封锁随机），以随机，其次是 在PwPD中，对由球磨机引起的扰动进行封闭（随机封闭）练习（10次失误和10次跳闸） 和控制。总之，这些研究结果将为制定基于平衡的康复方案提供基础。 运动学习原则，以减轻福尔斯下降PwPD相比，年龄匹配的控制。