Backward Walking as a Novel Fall Prediction Tool for Multiple Sclerosis

项目摘要 福尔斯是多发性硬化症（MS）患者常见的公共卫生问题， 大大降低了生活质量。MS中的当前跌倒检测措施依赖于向前行走 速度和平衡;然而，这些测量显示出对于福尔斯的有限的预测准确性。落后 步行（BW）速度是一种有前途的临床测量方法，已知与老年人跌倒史有关 由于高患病率，跌倒的回顾性报告可能不准确。 然而，BW对预期跌倒风险的预测准确性仍然存在 未知有许多因素可能导致跌倒风险，但先前的研究未能检查 可能驱动BW与跌倒风险关系的机制。确定跌倒风险的临床标志物 这与潜在的神经病理学（即，髓鞘降解）的关键运动白色物质 神经束和认知功能是非常需要的。如果没有这样的措施，MS的下降率和目标 预防跌倒的康复不太可能实现。本提案的具体目标是：1） 确定BW作为结局工具的可靠性和最小可检测变化，并确定 BW指标对6个月内跌倒风险的预测能力; 2）检查以下因素的独特贡献： 认知领域对BW表现的影响;以及3）确定髓磷脂降解在关键神经元中的作用。 bw性能。我们的中心假设是，BW速度是一个可靠和有效的预测因子， 未来的福尔斯下降与潜在的髓鞘降解和认知功能障碍有关。拟议 该项目将使用创新的技术来测量髓鞘含量使用髓鞘水成像，先进的 用于量化步行的实验室和临床评估的技术和方法， 使用可穿戴传感器和调查测量的认知和预期跌倒监测。识别 跌倒风险的临床标志物得到了基础病理学和认知功能障碍的支持， 这是先前研究的一个主要空白，有可能改善跌倒的靶向康复治疗。 预防、临床结果和MS患者的生活质量。

PROJECT SUMMARY Falls are a common public health concern among persons with Multiple Sclerosis (MS), and can substantially decrease quality of life. Current fall detection measures in MS rely upon forward walking speed and balance; however, these measures exhibit limited predictive accuracy for falls. Backward walking (BW) velocity is a promising clinical measure with known relationships to fall history in the elderly and persons with MS. Retrospective reporting of fall is subject to inaccuracy, given the high prevalence of cognitive dysfunction in MS; yet, the predictive accuracy of BW for prospective fall risk remains unknown. There are many factors that may contribute to fall risk, but prior studies have failed to examine mechanisms that may drive the relationship of BW to fall risk. Identification of a clinical marker of fall risk that is related to both underlying neuropathology (i.e., myelin degradation) of key motor white matter tracts and cognitive function is critically needed. Without such a measure, fall rates for MS and targeted rehabilitation for fall prevention is not likely to be realized. The specific aims of this proposal are to 1) Establish the reliability and minimal detectible change for BW as an outcome tool and determine the predictive capacity of BW measures for fall risk over 6 months; 2) Examine the unique contributions of cognitive domains to BW performance; and 3) Determine the contribution of myelin degradation in key tracts to BW performance. Our central hypothesis is that BW velocity is a reliable and valid predictor of future falls that is related to underlying myelin degradation and cognitive dysfunction. The proposed project will use innovative techniques to measure myelin content using myelin water imaging, advanced technologies and approaches for quantifying both laboratory and clinical assessments of walking and cognition and prospective fall monitoring using wearable sensors and survey measurement. Identifying a clinical marker of fall risk that is supported by underlying pathology and cognitive dysfunction addresses a major gap of prior research and has the potential of improving targeted rehabilitation therapies for fall prevention, clinical outcomes and quality of life for persons with MS.