Optimizing motor training in Parkinson disease through neural mechanisms

描述 患有帕金森氏病(PD)的退伍军人行动不便，这对他们的生活质量产生了不利影响。候选人已经证明了改编后的探戈舞的有效性，在这种舞蹈中，参与者既领导(内部指导：IG)又跟随(外部指导：例如)动作(Hackney&Earhart，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运动有不同的神经模式。帕金森氏症患者在IG运动方面有困难，但这个问题可以通过在“领导”时采用的策略来解决。在“跟随”过程中，帕金森病患者可以利用多个外部线索，这有助于帕金森病患者的运动，因为EG任务绕过了基底节(Freedland等人，2002年)。在患有帕金森病的老年退伍军人中，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，并结合活动能力的改善。长期目标是通过了解帕金森病患者的下肢运动神经回路以及训练有效的回路中的神经变化来优化患有帕金森病的退伍军人的运动训练。本研究的目的如下：1.探索退伍军人帕金森病患者在IG和EG状态下的肢体运动神经活动，然后采用随机对照试验设计，通过改编探戈来评估IG和EG训练后神经回路的变化。2.获得对患有和不患有帕金森病的老兵复杂神经运动系统进行成像的专业知识，并将这些专业知识应用于评估训练后神经回路的变化。3.进一步获利 具有康复研究方法学的经验。4.在研究帕金森病运动障碍及其潜在机制和定向训练反应的同时，提高假设生成、推理能力和解决问题的能力。指导：指导团队结合了在功能磁共振成像、康复临床试验和帕金森病患者护理方面的专业知识。导师包括Krish Sathian，医学博士，博士(初级，神经学，成像)，Steven L.Wolf，博士。PT(运动康复、临床试验)、Daniel Corcos(PD、成像、运动康复)和Bruce Crosson(PD、成像、神经认知评估)、医学博士玛丽安·埃瓦特和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、统计学和康复方法论方面的课程和研讨会。候选人的导师将提供关于运动系统、帕金森病的病理生理学、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调查开始。我们将在40-70岁患有和不患有帕金森病的退伍军人的IG和EG条件下，检查临床使用的足部敲击任务的神经相关性。然后，我们将在适应的探戈课上评估IG和EG训练的相对有效性，与改善活动能力和敲脚的行为控制相比，患有帕金森病的参与者将接受疾病严重性评估，并将在停药期间、训练前1周、训练后1周和1个月后接受结果测量测试。参与者必须在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。在功能核磁共振扫描仪中，我们将评估参与者在训练后改善脚部敲击的情况，并调查特定神经回路中激活的变化，以及训练对活动的影响。候选人预计，拟议的职业和研究计划将为她申请功绩审查资金做好准备，以确立作为调查人员的独立性。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的治疗指南。

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.