Cues from touch to aid posture and gait in individuals with Parkinson's disease

描述(申请人提供)：帕金森氏病(PD)影响姿势和步态的控制，并导致跌倒，导致活动减少，生活质量下降，抑郁，社交孤立和死亡。大多数使用视觉或听觉感觉线索来改善姿势和步态的干预措施不会从临床带入日常生活，性能恢复到干预前的水平。PIS的长期目标是克服使用便携、移动的交互式辅助设备进行干预的缺点，提供触觉提示以改善平衡和灵活性，特别是在帕金森氏症患者的步态启动和步态冻结领域。来自触摸的触觉暗示在这一领域具有巨大的潜力，因为对健康受试者的研究表明，触觉暗示利用姿势反射来稳定姿势，不需要学习。然而，在姿势和步态的背景下，帕金森病患者对触觉线索的使用并不被理解。因此，这项拟议的研究的直接目标是检查触觉提示对姿势和步态的临床价值，以及检查使用触觉提示控制运动的机制。本研究的具体目的是检验触觉线索可以改善帕金森病和年龄匹配对照受试者的(1)姿势和(2)步态控制方面的假说，并表征由这些线索参与的两组受试者感觉-运动机制的时间协调性。PI建议(1)比较站立时姿势摆动的幅度和时间，以及(2)比较步态参数、步态参数的步态变化以及在使用独特的“移动扶手”的情况下步行与使用独特的“移动扶手”时的肌电活动的时间。初步结果表明，触觉提示对帕金森病患者的姿势和步态控制是有益的。帕金森病患者在未经练习的情况下使用触觉提示停止服药，显示出与之前报道的健康受试者相同的姿势控制和姿势反应时间的改善。与无辅助行走相比，接受药物治疗的帕金森病患者在触摸移动扶手的同时行走增加了步长和节奏，并降低了步长变异性。拟议的实验代表了一系列关于使用触觉(隐含的，速度)线索控制运动的探索的开始，其结果可以转化为开发辅助工具，为帕金森氏症患者提供控制姿势和步态的触觉线索。 公共卫生相关性：这项拟议的研究将测试以下假设：帕金森氏症患者在手动触摸静止物体时有更好的姿势控制，而当手动触摸以期望的行走速度移动的物体时，他们的步态控制得到改善。这项研究的结果可以为设计便携式、移动、交互式行走和平衡辅助装置奠定基础，为提高行动能力和生活质量提供线索，并防止帕金森氏症患者和健康老年人跌倒。

DESCRIPTION (provided by applicant): Parkinson's disease (PD) affects the control of posture and gait, and leads to falling which contributes to reduced activity, reduced quality of life, depression, social isolation and mortality. Most interventions involving use of visual or auditory sensory cues to improve posture and gait do not carry over from the clinic to everyday living, and performance returns to pre-intervention levels. The PIs' long-term objective is to overcome the shortcomings of retention of interventions with portable, mobile interactive assistive devices, delivering haptic cues to improve balance and mobility, particularly in the realm of gait initiation and freezing of gait in individuals with Parkinson's disease. Haptic cues from touch hold great potential in this arena because studies in healthy subjects show haptic cues engage postural reflexes to stabilize posture and require no learning. However, the use of haptic cues by individuals with PD is not understood in the context of posture and gait. Thus, the immediate objectives of the proposed research is to examine the clinical value of haptic cues on posture and gait, as well as examine mechanisms governing motor control using haptic cues. The specific aims are to test the hypotheses that haptic cues can ameliorate aspects of (1) posture and (2) gait control associated with PD and age-matched control subjects, and to characterize the temporal coordination of sensory-motor mechanisms in both subject groups that are engaged by these cues. The PIs propose (1) to compare amplitudes and timing of postural sway while standing as still as possible with vs. without non-supportive manual contact (<1 N) with a stationary surface, and (2) to compare gait parameters, stride-to-stride variance of gait parameters, and timing of EMG activity of unassisted walking vs. walking while using a unique "moving hand rail," that is touching the moving surface of a modified waist-high conveyor belt. Preliminary results suggest haptic cues are beneficial to posture and gait control of individuals with PD. Individuals with PD tested off medication using haptic cues without practice showed the same improvements in postural control and timing of postural responses as previously reported in healthy subjects. Walking while touching the moving hand rail increased stride length and cadence, and reduced stride length variability of individuals with PD on medication, compared to walking unassisted. The proposed experiments represent a beginning of a line of inquiry about the control of movement using haptic (implicitly, speed) cues, the results of which can be translated to the development of assistive aids to deliver haptic cues to control posture and gait for individuals with PD. Public Health Relevance: The proposed research will test the hypotheses that individuals with Parkinson's disease have better postural control when manually touching something stationary, and that their gait control is improved when walking while manually touching something moving at the desired walking speed. Outcomes of this research can establish a basis for designing a portable, mobile, interactive walking and balance assistive device to provide cues to enhance mobility and quality of life, and prevent falling in individuals with Parkinson's disease, as well as healthy older individuals.