Optimizing motor training in Parkinson disease through neural mechanisms

描述 患有帕金森病（PD）的退伍军人活动能力受损，这对他们的生活质量产生了不利影响。候选人已经证明了适应探戈舞的有效性，其中参与者都领导（内部指导：IG）和遵循（外部指导：EG）运动（哈克尼&埃尔哈特2009，2010）。为了改善结果，必须研究运动障碍和改善的潜在神经机制。IG和EG运动具有不同的神经模式。PD患者在IG运动方面有困难，但这个问题可以通过“领导”时采用的策略来解决。在“跟随”期间，患有PD的参与者可以利用多种外部线索，这有助于PD中的运动，因为EG任务绕过基底神经节（Freedland等人，2002年）。在患有PD的老年退伍军人中，我们的目标是确定IG和EG下肢运动期间的神经激活模式，然后检查IG和EG训练对神经激活的影响以及移动性的改善。长期目标是通过了解PD中的下肢运动回路以及训练有效的回路中的神经变化来优化PD退伍军人的运动训练。研究目标如下：1.采用随机对照试验设计，探讨在IG和EG条件下PD退伍军人下肢运动的神经活动，然后通过适应性探戈评估IG和EG训练后回路的神经变化。为了获得专业知识，在成像的复杂神经运动系统的退伍军人和没有PD，然后将这种专业知识，以评估神经回路的变化，作为培训的结果。3.为了获得进一步 康复研究方法的经验。4.在研究PD运动障碍、其潜在机制和对针对性训练的反应时，提高假设生成、推理能力和解决问题的能力。指导：指导团队将教师与fMRI，康复临床试验和PD患者护理方面的专业知识相结合。导师包括Krish Sathian，MD，Ph.D.（初级，神经病学，影像学），Steven L.沃尔夫博士PT（运动康复，临床试验）、丹尼尔科科斯（PD，成像，运动康复）和布鲁斯克罗森（PD，成像，神经认知评价），博士Marian Evatt，医学博士和Kaundinya Gopinath，博士将分别担任临床和研究合作者。职业和研究计划：职业发展活动包括神经科学、成像、统计和康复方法学方面的课程和研讨会。候选人的导师将提供有关运动系统，PD病理生理学，运动康复和成像应用的结构化阅读和讨论。研究计划将从功能磁共振成像研究开始开始。我们将研究神经相关的临床使用的脚轻敲任务，在IG和EG条件下，在40-70岁的退伍军人与PD。然后，我们将评估在适应性探戈课期间IG与EG训练的相对有效性，与改善活动性和足部轻敲的行为控制相比，将评估PD参与者的疾病严重程度，并将在训练前1周以及训练后1周和1个月接受“关闭”药物的结果测量测试。参加者必须在12周内参加20节IG或EG改编的探戈课程，由经验丰富的教练授课。在功能磁共振成像扫描仪中，我们将评估参与者在训练后改善的足部敲击，并研究特定神经回路的激活变化以及对mobilit的训练效果。候选人希望拟议的职业和研究计划将准备她申请绩效审查资金，以建立作为一个独立的调查。该计划还将提供急需的证据，以支持帕金森病退伍军人运动障碍治疗指南。

DESCRIPTION Veterans with Parkinson's disease (PD) have impaired mobility, which adversely affects their quality of life. The candidate has demonstrated the effectiveness of adapted tango dance, in which participants both lead (internally guide: IG) and follow (externally guide: EG) movement (Hackney & Earhart 2009, 2010). To improve outcomes, the underlying neural mechanisms for both motor impairments and improvement must be investigated. IG and EG movements have distinct neural patterns. Individuals with PD have trouble with IG movement but this problem is helped by strategies employed while "leading". During "following", participants with PD can exploit multiple external cues, which facilitate movement in PD, because EG tasks bypass the basal ganglia (Freedland et al., 2002). In older veterans with PD, we aim to determine neural activation patterns during IG and EG lower limb movement and then examine effects of IG and EG training on neural activation in conjunction with mobility improvements. The long-term goal is to optimize motor training for veterans with PD by understanding lower limb motor circuitry in PD as well as neural changes in circuitry through which training is effective. The objectives are as follows: 1. To explore neural activity of lower limb movements in veterans with PD under IG and EG conditions, and then to evaluate neural changes in circuitry after IG and EG training through adapted tango, using a randomized controlled trial design 2. To gain expertise in imaging of complex neuromotor systems of veterans with and without PD, and then apply this expertise to the evaluation of neural circuitry changes as a result of training. 3. To gain further experience in rehabilitative study methodology. 4. To Improve hypothesis generation, reasoning ability and problem solving while investigating PD motor impairment, its underlying mechanisms and response to targeted training. Mentoring: The mentoring team combines faculty with expertise in fMRI, rehabilitative clinical trials, and the care of persons with PD. Mentors include Krish Sathian, MD, Ph.D. (Primary, neurology, imaging), Steven L. Wolf, PhD. PT (motor rehabilitation, clinical trials), Daniel Corcos (PD, imaging, motor rehabilitation) and Bruce Crosson (PD, imaging, neurocognitive evaluation), Ph.D. Marian Evatt, MD and Kaundinya Gopinath, Ph.D. will serve as clinical and research collaborators, respectively. Career and Research Plan: Career development activities include coursework and seminars in neuroscience, imaging, statistical and rehabilitative methodology. The candidate's mentors will provide structured readings and discussions on motor systems, the pathophysiology of PD, motor rehabilitation and imaging applications. The research plan will begin with an fMRI investigation. We will examine neural correlates of a clinically-used foot-tapping task, during IG and EG conditions in veterans aged 40-70 with and without PD. Then, we will assess the relative effectiveness of IG versus EG training during an adapted tango class, compared to a behavioral control for improved mobility and foot tapping, Participants with PD will be assessed for disease severity, and will receive tests of outcome measures while "OFF" medications, 1 week before training, and 1 week and 1 month after training. Participants must attend 20 lessons of IG or EG adapted tango in 12 weeks, taught by an experienced instructor. In an fMRI scanner, we will assess participants for improved foot tapping after training and investigate changes in activation in specific neural circuits in conjunction with training effects upon mobilit. The candidate expects the proposed career and research plan will prepare her to apply for Merit Review funding to establish independence as an investigator. This plan will also provide greatly needed evidence to support guidelines for the treatment of motor impairment in veterans with PD.