Posture Assisted Locomotion Training in Persons with Parkinson's Disease

描述（由申请人提供）：相关性本研究与公共卫生的相关性在于其重点是了解和改善帕金森病患者的姿势和步态控制问题，导致步态发作的衰弱冻结。项目摘要/摘要本研究的长期目标是调查的机制基础，并提供证据支持的有效性的姿势和步态障碍的人与进步帕金森氏病（PD）的物理治疗干预。在这个探索性的项目中，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，以提高步启动和步态表现，并减少步态冻结（FOG）在PD的发生率。具体目标是：1）比较新型PAL训练方法与其他更广泛使用的物理治疗方法（包括感觉提示和任务练习）对PD患者起步和步态表现的影响。待评估的结局指标包括：1）踏步前预期姿势调整（APA）的发生率、时间和幅度; 2）踏步起始时间和距离; 3）步态速度、节奏和步长。评估将在基线、训练六周后以及训练后一个月和三个月进行; 2）通过比较训练前、训练中点和训练后即刻以及训练后一个月和三个月的FOG频率来评估台阶训练是否可以降低FOG的发生率。3)探讨训练诱导的跨步起始能力的变化是否伴随着跨步准备过程中中枢运动兴奋性的改变。将通过比较在自主踏步运动准备期间由声惊吓刺激诱发的姿势调整-踏步序列的肌电图、动力学和运动学特征来评估运动准备。

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.