Telerehabilitation balance training for community dwelling older adults

主要研究者：Sienko提案：1159635平衡障碍和福尔斯通常由急性或慢性不稳定性发作引起，这会造成大量的身体、情感和金钱损失。考虑到老年人中有很大比例的人会遇到平衡问题，以及这些人作为一个整体过独立生活的愿望，降低跌倒风险至关重要。平衡训练加强了感觉运动策略的发展，以改善姿势控制和功能移动性，这对老年人预防跌倒至关重要。感觉增强是一种通过例如身体位置的振动触觉提示来增强或替换受损感觉信息的技术。PI和其他研究人员已经证明，感觉增强在实验室环境中的实时操作期间减少了躯干摇摆，初步结果表明，在少量训练课程后的几分钟到几小时内，平衡性能存在持续改善。虽然单个案例研究的结果表明，持续长达八周的改善，但没有进行系统的研究来确定感觉增强训练对大量平衡训练课程后长期保持的影响。提出的工作的三个主要目标如下：1）开发和表征的远程康复手机为基础的平衡训练工具，旨在用于在社区居住的老年人的家中的功效; 2）测试在标准的家庭平衡训练练习期间接受振动触觉感觉增强的老年人的平衡改善的持续性（干预组）与那些没有感觉增强的人进行这些练习的持续改善相比，（三个对照组）; 3）评估远程医疗的效果-辅助平衡训练对锻炼计划的依从性。智力优势尽管在过去的十年中，感觉增强技术取得了成功，多年来，在实验室环境中改善具有平衡缺陷的人的站立平衡方面，重要的科学问题仍然没有答案;具体地说，使用感觉增强技术的训练的遗留效应是否超过单独训练的遗留效应。此外，现有的感觉增强技术是为了在短时间的监督会话中持续使用而开发的，而不是在许多无监督会话中定期康复使用;具体地说，以用户为中心的、易于使用的、基于家庭的技术尚未开发，从而阻碍了潜在的广泛采用。这项工作将开发一种基于手机平台的感官增强设备，适合老年人在家中重复使用。适当性，由易用性、清晰准确的运动指导、适当的稳定性阈值（即，何时给出纠正反馈），以及对进展的正确评估（即，何时进入下一个练习），将由工程师、预期的老年最终用户和那些在整个设计过程中进行康复的人（物理治疗师）对设备进行的共同创造性设计来支持。此外，我们将利用该设备的远程医疗固有功能，向研究小组传达有关家庭锻炼依从性的详细信息，以评估手机平台作为在家庭康复计划中提高依从性的手段。更广泛的影响如果在一系列延长的感觉增强会话后，平衡改善被证明可以保持数周至数月的时间段，对平衡受损个体的生活质量的显著影响可以通过降低跌倒风险、增加执行日常任务的信心以及在独立生活设施中保持更长时间的能力来实现。 此外，通过开发这里提出的蜂窝电话平衡训练器，可以以简单的、基于家庭的和低成本的方式实现这些平衡改善的定期维护。对于家庭成员和其他照顾者来说，这项技术预计将减少所需的平衡相关帮助。从临床的角度来看，这项技术的远程康复功能将为物理治疗师提供一种机制，以监测家庭平衡治疗计划的依从性，并跟踪患者在一系列疗程中的进展。通过促进和记录可能在长时间段内发生的大量康复训练课程的平衡度量，该设备将提供一种收集数据的手段，该数据目前尚不清楚关于具有感觉增强的训练课程的数量与积极结果的持续性之间的关系。这种理解对于实现令人满意的康复至关重要。

PI: SienkoProposal: 1159635There are substantial physical, emotional, and monetary costs associated with balance impairments and the falls that typically ensue from acute or chronic bouts of instability. Given the large percentage of older individuals that experience balance problems, and the desire of these individuals as a whole to live independent lives, decreasing fall risks is of paramount importance. Balance training reinforces the development of sensorimotor strategies to improve postural control and functional mobility which is crucial for fall prevention in the older adult population. Sensory augmentation is a technique of augmenting or replacing compromised sensory information through, for example, vibrotactile cues of body position. The PI and other investigators have demonstrated that sensory augmentation decreases trunk sway during real-time operation in a laboratory setting, and preliminary results suggest that persistent improvements in balance performance exist over time periods of minutes to hours following a small number of training sessions. While the results of a single case study have shown improvements that lasted up to eight weeks, no systematic studies have been performed to determine the influence of sensory augmentation training on long-term retention following a large number of balance training sessions. The three primary goals of the proposed work are as follows: 1) Develop and characterize the efficacy of a telerehabilitation cell phone based balance training tool intended for use in the homes of community dwelling older adults; 2) Test for the persistence of balance improvements for older adults who receive vibrotactile sensory augmentation during standard at-home balance training exercises (intervention group) compared with the persistence of improvements for those who perform these exercises without sensory augmentation (three control groups); and 3) Assess the effect of telemedicine-assisted balance training on exercise program compliance.Intellectual MeritDespite the success of sensory augmentation technologies over the past ten years in improving standing balance for persons with balance deficits in laboratory settings, significant scientific questions remain unanswered; specifically, whether or not the carry-over effects of training with a sensory augmentation technology exceed the carry-over effects of training alone. Furthermore, existing sensory augmentation technologies were developed for continual use over a short number of supervised sessions rather than periodic rehabilitative use over many unsupervised session; specifically, user-centric, easy-to-use, homebased technologies have yet to be developed, thereby impeding potential widespread adoption. This work will develop a sensory augmentation device that is appropriate for repeated at-home use by older adults, based on a cell phone platform. Appropriateness, defined by ease of use, clear and accurate exercise instruction, proper stability thresholds (i.e., when to give corrective feedback), and correct assessment of progress (i.e., when to move on to the next exercise), will be supported by co-creative design of the device by engineers, prospective older adult end users, and those administering rehabilitation (physical therapists) throughout the design process. Furthermore, we will utilize the device's intrinsic functionality for telemedicine to communicate detailed information regarding at-home exercise compliance to the study team for evaluation of the cell phone platform as a means to increase compliance during at-home rehabilitative programs.Broader ImpactsIf balance improvements following an extended series of sensory augmentation sessions are demonstrated to be retained for time periods of weeks to months, significant impact on quality of life for balance-impaired individuals may be achieved through decreased fall risk, increased confidence in performing daily tasks, and ability to remain in an independent living facility for a longer period of time. Furthermore, periodic maintenance of these balance improvements may be enabled in a straightforward, home-based, and low-cost manner through the development of the cell phone balance trainer proposed here. For family members and other caregivers, this technology is expected to reduce the amount of required balance-related assistance. From a clinical standpoint, the telerehabilitation functionality of this technology will provide physical therapists with a mechanism to monitor compliance with prescribed at home balance therapy programs and track patient progress over a large series of sessions. By facilitating and recording balance metrics for a large number of rehabilitative training sessions that can take place over a long period of time, the device will provide a means to gather data that currently is unknown regarding the relationship between number of training sessions with sensory augmentation and persistence of positive outcomes. This understanding is critical to achieve satisfactory rehabilitation.