Remote dynamic cycling for the customized off-site rehab in Parkinson’s disease.

用于帕金森病定制场外康复的远程动态循环。

• 批准号: 10609837
• 负责人: Aasef G Shaikh
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10609837
• 关键词: Affect; Area; Artificial Intelligence; Caring; Clinic; Clinic Visits; Clinical; Cognition; Cognitive; Communication; Communities; Data; Deterioration; Development; Devices; Dopamine; Dose; Equilibrium; Exercise; Exercise Therapy; Feedback; Future; Goals; Group Homes; Health Insurance Portability and Accountability Act; Health Personnel; Home; Hour; Independent Living; Individual; Intervention; Laboratories; Levodopa; Location; Logistics; Longterm Follow-up; Measures; Mental Depression; Monitor; Motor; Movement Disorder Society Unified Parkinson' s Disease Rating Scale; Movement Disorders; Nerve Degeneration; Nursing Homes; Ohio; Outcome; Outcome Measure; Outpatients; Parkinson Disease; Participant; Patients; Performance; Persons; Pharmaceutical Preparations; Phase; Progressive Disease; Quality of life; Regimen; Rehabilitation therapy; Research; Resources; Safety; Schedule; Secure; Self Direction; Site; Social support; Speed; Strategic Planning; Symptoms; System; Techniques; Technology; Testing; Time; Titrations; Torque; Travel; Veterans; Vision; Visit; artificial intelligence algorithm; awake; cost effective; cost effectiveness; data exchange; effectiveness testing; efficacy evaluation; efficacy testing; exercise regimen; experience; frailty; functional decline; functional improvement; improved; individualized medicine; instrument; motor deficit; motor function improvement; motor symptom; novel; operation; pandemic disease; participant safety; post intervention; provider intervention; remote assessment; remote delivery; remote health care; remote monitoring; response; safety supervision; sensor; therapy outcome; user-friendly; virtual; wearable device; wearable sensor technology; wireless fidelity; wireless sensor

Parkinson’s disease (PD) progressively deteriorates motor function. Successful rehabilitation, leading to a favorable course of movement disorders in PD, is contingent upon frequent, regular, and patient-specific exercise regimen that is customized to the individual needs. Latter requires regular interventions from the provider and frequent visits to the rehab facility. Lack of access, poor social support, inability to travel, home-bound status, or pandemics are significant hurdles in delivering effective rehab to the PD patients. Our vision is to offer customized and cost-effective PD rehab using a remotely operated technology near or at the patients’ homes. This technology would be remotely monitored and customized online to titrate therapeutic outcomes optimized for each patient. The proof of this concept was already established in our laboratory, a technology called dynamic cycling. The highlight of this technology is a stationary bike operating at a rapid speed (cadence) with programmable variability in speed and power/torque hence promoting motor performance superior to traditional motorized bikes (i.e. static cycling). The next step towards our ultimate vision of at-home exercise therapy is remotely operated dynamic bike. We have already built remotely operated dynamic bike; the current proposal will objectively examine the efficacy of a novel, remotely delivered and remotely adjusted dynamic cycling paradigm using remotely monitored motor outcomes. Comparison will be made with remote static cycling. The study will be launched at three community based wellness locations to assure the subject safety, ease of access, compliance, and as needed support. Aim 1 will examine the hypothesis that dynamic cycling will immediately improve the motor function in PD. The effects will be prominent on the dopamine-sensitive motor deficits. The repetition will enhance motor improvement. The participants will use wearable sensors for the remote assessments of motor symptoms in PD before and immediately after each exercise session. The information from the wearable sensors and the bike will be utilized to further adjust the bike parameters for the next dynamic cycling session. We will also measure effects on subjective ratings of motor function, cognition and balance before, and at 0, 3, and 6 months after the cycling intervention. Aim 2 will analyze the effects of dynamic cycling on motor fluctuations, declining response to levodopa in an early and unpredictable manner significantly affecting the quality of life in the PD. We hypothesize that dynamic cycling will reduce the motor fluctuations in PD. The efficacy of dynamic cycling on improvement in motor fluctuation over a 12-hour awake period will be measured every day with the wearable sensors that communicate via secure cloud. The immediate clinical impact is that the technology will be immediately deployed to the Veteran’s group homes, nursing homes, and community based VA clinics. The project will provide sufficient information to carry our ultimate vision, at-home dynamic cycling serving three critical needs: 1) customized therapy, 2) easy access, and 3) safety and cost-effectiveness.

帕金森氏病(PD)会逐渐恶化运动功能。成功的康复，导致了 帕金森病患者运动障碍的良好病程取决于频繁的、有规律的和患者特有的运动 根据个人需要定制的养生法。后者需要提供者的定期干预，并且 经常去戒毒所。缺乏通道，社会支持不足，无法旅行，无法回家，或者 流行病是为帕金森病患者提供有效康复的重大障碍。我们的愿景是提供 在患者家附近或在患者家中使用远程操作技术进行定制且经济高效的PD康复。 这项技术将被远程监测并在线定制，以滴定优化的治疗结果 对每个病人来说。这一概念的证明已经在我们的实验室中得到了证实，这项技术被称为动态 骑自行车。这项技术的亮点是以快速(节奏)运行的固定自行车 速度和功率/扭矩的可编程变化，从而提升电机性能，超越传统 机动自行车(即静态自行车)。迈向我们终极愿景的家庭运动疗法的下一步是 遥控动力自行车。我们已经制造了远程操作的电动自行车；目前的提议 将客观地检验一种新的、远程交付和远程调整的动态自行车的效果 使用远程监测运动结果的范例。将与远程静态循环进行比较。这个 研究将在三个以社区为基础的健康地点启动，以确保受试者的安全、便捷、 合规性，并根据需要提供支持。目标1将检验这样一种假设，即动态自行车将立即 改善帕金森病患者的运动功能。对多巴胺敏感的运动缺陷的影响将是突出的。这个 反复练习会促进运动能力的提高。参与者将使用可穿戴传感器作为遥控器 在每次运动前和运动后立即评估帕金森病患者的运动症状。这些信息 来自可穿戴的传感器和自行车将被用来进一步调整自行车的参数，为下一步的动力 自行车赛。我们还将测量对运动功能、认知和平衡的主观评级的影响 在骑行干预前、干预后0、3和6个月。目标2将分析动态自行车的效果 关于运动波动，左旋多巴早期和不可预测的反应下降显著影响 警察局的生活质量。我们假设动力自行车可以减少帕金森病患者的运动波动。这个 将测量动态自行车在12小时清醒期间改善运动波动的效果 每天使用通过安全云通信的可穿戴传感器。直接的临床影响是 这项技术将立即部署到退伍军人的集体之家、疗养院和社区 总部设在退伍军人管理局的诊所。该项目将提供足够的信息来实现我们的终极愿景，在家中充满活力 自行车运动满足三个关键需求：1)定制治疗，2)方便使用，3)安全和成本效益。