REDUCING FALLS USING TASK-SPECIFIC TRAINING

描述（改编自申请人的摘要）：老年人的跌倒相关伤害和死亡是一个相当大的社会问题，这是目前提出的研究的重点，该研究建立在本实验室以前的经验基础上。该研究使用了一个简单的受试者内部和受试者之间的实验设计来确定特定任务训练在减少与旅行相关的跌倒发生率方面的有效性。在老年人中，绊倒分别占跌倒相关髋部骨折和上肢骨折的50%以上。避免跌倒的一个关键因素是控制躯干的运动。简单的、特定任务的训练包括一个大的、向前定向的姿势干扰，需要步进反应以避免摔倒。这些干扰已被证明可以模拟由实际脱扣事件引起的干扰，并使用创新的脱扣协议从实际脱扣事件中恢复需求。全球的假设是，与对照组相比，参加特定任务训练的受试者摔倒的发生率会更小。为了验证这一假设，将在三年内招募215名老年妇女，以解决两个具体目标和三个主要假设。在具体目标1中，运动技能学习发生的程度将在四周的时间内进行表征，并且在训练后保留运动技能的程度将被保留。假设技术水平的提高与跑步机干扰后躯干屈曲角度和躯干屈曲加速度的显著减小有关。同时，假设在停止训练的四周后，技能水平不会显著下降。在具体目标2中，将量化学习到的运动技能在多大程度上减少诱发正向绊倒后跌倒的发生率。据推测，与未经训练的对照组相比，参加特定技能训练方案的受试者摔倒的发生率显着降低。对这些假设的支持将提供证据，证明特定任务的锻炼可以有效地促进预防跌倒项目。这些证据将为进一步研究分级特定任务运动作为预防跌倒项目的组成部分提供一个跳板，该项目针对的是有记录的害怕跌倒、身体损伤和残疾的老年人。

DESCRIPTION (adapted from applicant's abstract): Fall-related injuries to, and deaths of older adults are a considerable societal problem that is the focus of the presently proposed research that builds upon the previous experience in this laboratory. The research uses a simple within- and between-subject experimental design to determine the effectiveness of task-specific training to decrease the incidence of trip-related falls. Trips account for up to, and greater than 50% of fall-related hip and upper extremity fractures, respectively, in older adults. A key element of avoiding a fall after a trip is controlling the motion of the trunk. The simple and task-specific training involves delivery of a large, forward directed postural disturbance that requires stepping responses to avoid falling. These disturbances have been shown to mimic the disturbances induced by, and the recovery requirements from an actual tripping event using an innovative tripping protocol. The global hypothesis is that fall incidence will be smaller in subjects who have participated in task-specific training compared to controls. To test the hypothesis, 215 older women will be recruited over a three-year period to address two specific aims and three primary hypotheses. In Specific Aim 1 the extent to which motor skill learning occurs will be characterized over a four-week period and the extent to which the motor skill is retained after training is withheld. The hypothesis is that increased skill level will be associated with significantly smaller trunk flexion angle and trunk flexion acceleration after the treadmill disturbance. Also, the hypothesis is that skill level will not degrade significantly after four weeks during which training is withheld. In Specific Aim 2 the extent to which the learned motor skill reduces the incidence of falls after inducing forward-directed trip will be quantified. It is hypothesized that subjects who participated in the skill specific training protocol will have a significantly lower incidence of falls compared to the untrained control group. Support of the hypotheses will provide evidence that task-specific exercise can contribute meaningfully and efficiently to fall prevention programs. Such evidence will provide a springboard for further study of graded task-specific exercise as a component of fall prevention programs targeting older adults with documented fear of falling, physical impairments, and disabilities.