The Impact of Cognition on Rehabilitative Treatment for Slow Gait Speed

步态缓慢和认知障碍在老年退伍军人中很普遍，是独立的预测因素 用于随后的住院、残疾和死亡。最近的科学证据表明，走路和 认知是相互关联的，因此它们的下降可能具有共同的潜在神经生物学病理。 因此，治疗步行速度慢不仅可以改善行动能力，还可以改善认知能力。活得长，走得强 (LLWS)是一种新的创新型康复护理计划，面向步行速度较慢的退伍军人(≥50岁)。 LLWS治疗主要集中在行动不便问题上。然而，据估计，40%的LLW 参与者已经表现出认知缺陷；因此，目前的LLWS治疗是否 旨在为有认知问题的退伍军人的独特特征提供最佳服务。例如, 我们不知道有认知障碍的退伍军人是否会坚持康复计划。同样， 我们不确定不同认知状态的治疗反应是否相同。因此，这项研究 目的是了解老年退伍军人对治疗的依从性、依从性和反应 在参加LLWS临床试验时没有认知问题。这项研究将提供1)洞察 LLWS治疗是否需要修改以提高依从性和依从性，2)检查 LLWS治疗后基线认知状态与步速变化之间的关系，以及3)发现 LLWS治疗对认知功能的影响这一职业发展计划的长期目标 奖项(CDA-1)是为了推进研究和教育培训，以便让PI建立一个独立的 开发个性化康复治疗以保持安全活动和认知的研究路线 功能各异的老年退伍军人。PI之前是美国国立卫生研究院的研究协调员 支持R21运动治疗研究，后来进行了自己的可行性和准实验 学习。目前，她的导师是乔纳森·比恩，医学博士，公共卫生硕士，哈佛医学院PM&R教授 他是弗吉尼亚州波士顿医疗保健系统新英格兰GRECC学院的主任。这样做的短期目标是 CDA-1将在1)康复科学，2)活动能力评估和治疗，3)获得经验 神经心理评估和分析，4)个性化康复治疗(老年护理 原则)，以及5)研究方法和赠款写作技能，为退伍军人管理局研究奠定坚实的基础 职业生涯。PI将使用由丰富的学术研究提供的教学课程的组合 环境，实践研究培训，以及来自专家团队的指导，他们可以提供广泛的 并支持她的研究。拟议的研究具有重要意义和创新性，因为它提供了 关于如何量身定做创新的康复护理以更好地适应退伍军人的个人需求的信息。

Slow walking and cognitive impairment are prevalent among aging Veterans and are independent predictors for subsequent hospitalization, disability, and death. Recent scientific evidence suggests that walking and cognition are interrelated whereby their declines may share a common underlying neurobiological pathology. Thus, treating slow walking speed may not only improve mobility but also cognition. Live Long Walk Strong (LLWS) is a new innovative rehabilitative care program targeting Veterans (≥50yrs) with slow walking speed. LLWS treatment primarily focuses on mobility problems. However, it is estimated that 40% of LLWS participants have manifested cognitive deficits; thus, it is uncertain whether current LLWS treatment is designed to optimally serve the unique characteristics of Veterans who have cognitive problems. For example, we do not know whether Veterans with cognitive challenges will adhere to the rehabilitative program. Likewise, we are unsure whether the treatment response will be the same across cognitive status. Therefore, the study objective is to understand the treatment adherence, compliance, and response among older Veterans with and without cognitive problems participating in the LLWS clinical trial. The present study will 1) provide insight into whether LLWS treatment needs to be modified to increase compliance and adherence, 2) examine the association between baseline cognitive status and change in gait speed after LLWS treatment, and 3) discover the influence of LLWS treatment on cognition. The long-term goal of this proposed Career Development Award (CDA-1) is to advance research and educational training in order for the PI to establish an independent line of research developing personalized rehabilitative treatment to maintain safe mobility and cognition among aging Veterans with varying functional abilities. The PI previously was the study coordinator of a NIH supported R21 exercise treatment study and later conducted her own feasibility and quasi-experimental studies. Currently, she is mentored by Jonathan Bean, MD, MPH, a professor of PM&R at Harvard Medical School and Director of New England GRECC at VA Boston Healthcare System. The short-term goals of this CDA-1 are to acquire experience in 1) rehabilitation science, 2) mobility assessment and treatment, 3) neuropsychological assessment and analysis, 4) personalized rehabilitation treatment (geriatric care principles), and 5) research methods and grant writing skills to establish a strong foundation for a VA-research career. The PI will use the combination of didactic coursework provided from a rich academic research environment, hands-on research training, and mentorships from a team of experts who can offer extensive knowledge and support her research. The proposed research is significant and innovative as it provides information about how to tailor innovative rehabilitative care to better suit the individual needs of Veterans.