Posture Assisted Locomotion Training in Persons with Parkinson's Disease

描述(申请人提供)：相关性这项研究与公共健康的相关性在于它的重点是了解和改善姿势和步态控制的问题，这些问题导致帕金森氏症患者步态发作的虚弱冻结。项目概述/摘要本研究的长期目标是探讨帕金森病进展期患者姿势和步态障碍的物理治疗干预的机制基础，并提供证据支持其有效性。在这个探索性项目中，我们建议评估一种新的治疗方法的可行性，包括姿势辅助运动(PAL)训练，以提高步态起始和步态表现，并减少帕金森病患者步态冻结(FOG)的发生率。具体目的是：1)比较一种新的PAL训练方法和其他更广泛使用的物理治疗方法，包括感觉线索和任务练习，对帕金森病患者的步态启动和步态表现的影响。要评估的结果指标包括：1)步态前预期姿势调整(APA)的发生率、时机和幅度；2)步态启动时机和距离；3)步速、步频和步长。评估将在基线、培训六周后、培训后一个月和三个月进行；2)通过比较培训前、培训中点和培训后立即以及培训后一个月和三个月的雾化频率，评估阶梯式培训是否可以减少雾化的发生。3)探讨在踏步准备过程中，训练引起的踏步起始表现的改变是否伴随着中枢运动兴奋性的改变。运动准备将通过比较运动准备期间的姿势调整-步进序列的肌电、运动学和运动学曲线来评估，该序列由声学惊吓刺激引起。

DESCRIPTION (provided by applicant): Relevance The relevance of this research to public health lies in its focus on understanding and ameleorating problems of posture and gait control leading to debilitating freezing of gait episodes in persons with Parkinson's disease. Project Summary/Abstract The long-term objectives of this research are to investigate the mechanistic basis and provide evidence in support of the effectiveness of physical therapy interventions for posture and gait disorders in persons with advancing Parkinson's disease (PD). In this exploratory project, we propose to assess the feasibility of a novel therapeutic approach involving posture assisted locomotion (PAL) training to enhance step initiation and gait performance and reduce the incidence of freezing of gait (FOG) in PD. The specific aims are: 1) to compare the effects of a novel PAL training approach with other more widely used physical therapy approaches involving sensory cueing and task practice on step initiation and gait performance in individuals with PD. The outcome measures to be assessed include: 1) incidence, timing, and magnitude of anticipatory postural adjustments (APAs) that precede stepping; 2) step initiation timing and distance; 3) gait speed, cadence, and stride length. Assessments will occur at baseline, after six weeks of training, and at one month and three months post-training; 2) to assess whether step training can reduce the incidence of FOG by comparing FOG frequency before, at the mid-point and immediately after training, and at one month and three months post- training. 3) to explore whether training induced changes in step initiation performance are accompanied by alterations in central motor excitability during the preparation for stepping. Motor preparation will be assessed by comparing elctromyographic, kinetic, and kinematic profiles of the postural adjustment-stepping sequence evoked by an acoustic startle stimulus during the period of motor preparation for voluntary stepping.