Perturbation training for enhancing stability and limb support control for fall-risk reduction among stroke survivors

本研究的长期目标是开发一种有效的训练模式，以提高中风幸存者对福尔斯的防御机制，并可能降低医疗费用。疾病控制和预防中心估计，每年与跌倒有关的伤害的直接医疗费用为340亿美元。每年有40%到70%的社区中风幸存者经历过有害的福尔斯，髋部骨折的风险往往比健康的同行高1.5到4倍;只有不到40%的人恢复了独立的行动能力。因此，福尔斯不仅影响日常生活活动，而且降低活动能力，增加二次中风和死亡率的风险。尽管福尔斯在这一人群中的潜在经济和功能影响，但卫生保健人员在开发和验证干预措施以降低跌倒风险方面的能力有限。进一步强调运动训练，重点是增强瘫痪肢体功能。该项目设计包括一项随机对照试验，以检查慢性卒中幸存者获得，推广和保持对滑倒干扰训练的适应能力，不仅可以降低跌倒风险，还可以改善行走功能。它还探讨了这种范式的翻译亚急性人群。该范例是新颖的，因为它通过双边训练范例来针对轻瘫与非轻瘫肢体对跌倒风险的贡献，该训练范例包括首先训练非轻瘫侧，然后轻瘫侧，以促进在轻瘫侧获得跌倒预防技能，否则可能需要更长的时间来获得训练效果。这种扰动训练的长期益处，针对两个肢体以减少福尔斯，不仅将在实验室中进行评估，而且还将通过可穿戴传感器在真实的生活中进行评估，沿着改善的社区步行功能。这项研究的假设，如果得到结果的支持，将提供一个证据支持的训练方案，以减少跌倒的风险，不仅在偏瘫中风的人，但也在其他获得性单侧皮质病变的幸存者。

The long-term objective of this research is to develop an efficacious training paradigm to enhance stroke survivors' defense mechanisms against falls and possibly reduce healthcare cost. The Centers for Disease Control and Prevention estimates the direct medical cost for fall related injuries to be $34 billion annually. Forty percent to 70% of community-dwelling stroke survivors experience detrimental falls each year and tend to have 1.5 to 4 times higher risk of hip fracture than their healthy counterparts; with only less than 40% of those individuals regaining independent mobility. Falls, thus not only affect activities of daily living but also reduce mobility, increase risk of second stroke and mortality. Despite potential financial and functional implications of falls in this population, health-care personnel are limited in their ability to develop and validate interventions to reduce fall-risk for them. Further emphasis is placed on locomotor training with focus on enhancing paretic limb function. The project design consists of a randomized controlled trial to examine the ability of chronic stroke survivors to acquire, generalize and retain adaptations to slip-perturbation training for not only mitigating fall risk but also improving walking function. It also explores translation of this paradigm to the sub-acute population. The paradigm is novel in that it targets contributions of the paretic vs. non-paretic limbs on fall-risk through a bilateral training paradigm that involves training the non-paretic side first and then paretic to facilitate acquisition of fall-prevention skills on the paretic side, which may otherwise take longer to acquire training effects. The longer-term benefits of such perturbation training, targeting both limbs for reducing falls will be assessed not only in the laboratory but also in real life via wearable sensors, along with improved community walking function. The hypothesis of this study if supported by the results will provide an evidence-supported training protocol to reduce the fall-risk not only in people living with hemiparetic stroke but also among survivors of other acquired unilateral cortical lesions.