Tai Chi and Dual Task Interference on Postural Control in Parkinson's Disease

描述（由申请人提供）：姿势不稳定和动态平衡控制受损通常是帕金森病（PD）的无效治疗症状，导致跌倒风险增加。患者经常求助于使用注意力策略来维持步态和姿势任务的稳定性。当患者需要同时或双重执行任务时，这些注意力导向策略似乎不成功。因此，康复策略的发展不仅旨在改善姿势稳定性，而且在这一人群中改善双重任务表现是至关重要的。这一试点建议直接关系到国家残疾人权利审查委员会提高残疾人健康、生产力、独立性和生活质量的使命。大量证据表明，太极拳（TC）有助于预防社区居住的老年人跌倒。pi表明，TC减少跌倒的一种方法是通过减少对姿势稳定性的双重任务干扰。评估这一潜在机制的关键第一步是在双重任务条件下姿势稳定性明显受到挑战的人群中对这一假设提出严峻挑战。一般的假设是，TC改善了轻至中度特发性PD患者在双重任务条件下的静态和动态姿势控制。这一假设将通过3个具体目标进行测试：(1)确定TC训练是否改善了双任务条件下安静站立时的姿势控制，(2)确定太极训练是否改善了双任务条件下正向运动时的动态姿势控制，(3)确定太极训练是否改善了双任务条件下扰动运动时的动态姿势控制。24例患者将随机接受高强度TC训练（N=16； 75分钟/ 3周，持续16周）或非运动对照组（N=8），单盲方法。主要结果测量，姿势摇摆，步态表现（步态速度，步幅，步态变异性）和动态稳定性（压力中心和质量中心的耦合），将使用混合模型方差分析和方差分析比较训练前和训练后/控制。这项初步研究将证明在认知或上肢运动任务同时进行的难度增加的平衡和步态任务中，TC是否能改善姿势控制。长期目标是确定与TC学习相关的姿势机制，并改善成人行动障碍的康复计划。

DESCRIPTION (provided by applicant): Postural instability and impaired dynamic balance control are often ineffectually treated symptoms of Parkinson's Disease (PD) leading to an increased risk of falls. Patients often resort to the use of attentional strategies to maintain stability during the performance of gait and postural tasks. These attention-directed strategies appear unsuccessful when patients are required to perform concurrent or dual tasks. Thus, the development of rehabilitation strategies aimed at improving not only postural stability but also dual task performance in this population is paramount. This pilot proposal is directly related to the mission of NCMRR to enhance the health, productivity, independence, and quality of life of persons with disabilities. Substantial evidence suggests that Tai Chi (TC) is instrumental in preventing falls among community-dwelling older adults. The PIs suggest that one means by which TC leads to a reduction in falls is through reducing dual task interference on postural stability. A critical first step in evaluating this potential mechanism is critically challenging this hypothesis in populations where postural stability is markedly challenged under dual task conditions. The general hypothesis is that TC improves both static and dynamic postural control during dual task conditions in patients with mild to moderate idiopathic PD. This hypothesis will be tested with 3 specific aims to (1) determine if TC training improves postural control during quiet stance under dual task conditions, (2) determine if Tai Chi training improves dynamic postural control during forward directed locomotion under dual task conditions, and (3) determine if Tai Chi training improves dynamic postural control during perturbed locomotion under dual task conditions. Twenty four patients will be randomized to receive either intense TC training (N=16; 75 minutes/ 3xweek for 16wks) or non exercise control (N=8) in a single blind manner. The primary outcome measures, postural sway, gait performance (gait velocity, stride length, gait variability), and dynamic stability (coupling of the center of pressure and center of mass), will be compared pre- and post-training/control using mixed model MANOVA and ANOVAs. This pilot investigation will demonstrate whether TC improves postural control during balance and gait tasks of increasing difficulty that are performed concomitantly with either a cognitive or upper extremity motor task. The long term goal is to identify postural mechanisms associated with a learning of TC and improve rehabilitation programs for adults with mobility impairments. One of most pressing contemporary research and public health priorities (specifically for the National Institute of Child Health and Human Development) focuses on the need to enhance the health, productivity, independence, and quality of life of persons with disabilities. The current proposal describes a 16-week randomized, single-blind control of Tai Chi Exercise that has the potential for significant utility in reducing Parkinsonian disability as well reducing the known dual task performance interference on locomotor and postural control in individuals with Parkinson's disease.