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

帕金森病（PD）使运动功能逐渐恶化。成功的康复， PD运动障碍的良好病程取决于频繁、定期和患者特异性运动 根据个人需求定制的方案。后者需要提供者的定期干预， 经常去戒毒所缺乏机会，社会支持差，无法旅行，家庭束缚状态，或 流行病是向PD患者提供有效康复的重大障碍。我们的愿景是提供 在患者家中或附近使用远程操作技术进行定制且具有成本效益的PD康复。 这项技术将被远程监控和在线定制，以优化治疗效果 对于每一个病人。这个概念的证明已经在我们的实验室中建立起来了，一种叫做动态的技术 骑自行车这项技术的亮点是一个固定自行车在一个快速的速度（节奏）操作， 速度和功率/扭矩的可编程可变性，因此提升了电机性能，上级传统的 电动自行车（即静态自行车）。我们对家庭运动疗法的终极愿景的下一步是 遥控动感单车我们已经建立了远程操作的动态自行车;目前的建议 将客观地检验一种新颖的、远程传递和远程调节的动态循环的功效 使用远程监控的运动结果的范例。将与远程静态循环进行比较。的 研究将在三个社区健康场所启动，以确保受试者的安全性，方便访问， 合规性，以及所需的支持。目标1将检验动态循环将立即 改善PD患者的运动功能。对多巴胺敏感性运动缺陷的影响将是突出的。的 重复将增强运动改进。参与者将使用可穿戴传感器进行远程控制， 在每次运动之前和之后立即评估PD的运动症状。的信息 从可穿戴传感器和自行车将被用来进一步调整自行车参数的下一个动态 自行车赛我们还将测量对运动功能、认知和平衡的主观评分的影响 在骑自行车干预之前以及在骑自行车干预之后的0、3和6个月。目标2将分析动态循环的影响 对运动波动的影响，对左旋多巴的反应以早期和不可预测的方式下降， 在PD的生活质量我们假设，动态循环将减少PD的电机波动。的 将测量动态循环在12小时清醒期内对运动波动改善的功效 通过安全云进行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 在诊所里。该项目将提供足够的信息来承载我们的最终愿景，在家里动态 自行车服务三个关键需求：1）定制治疗，2）易于访问，3）安全性和成本效益。

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.