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

描述（由申请人提供）：帕金森病（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，社会隔离和死亡率。大多数涉及使用视觉或听觉感官线索来改善姿势和步态的干预措施不会从诊所延续到日常生活中，并且表现会恢复到干预前的水平。pi的长期目标是克服便携式、移动交互式辅助设备干预保留的缺点，提供触觉提示以改善平衡和活动，特别是在帕金森病患者的步态启动和步态冻结领域。来自触觉的触觉线索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，触觉线索通过姿势反射来稳定姿势，并且不需要学习。然而，PD患者在姿势和步态方面使用触觉线索的情况尚不清楚。因此，本研究的直接目的是研究触觉线索对姿势和步态的临床价值，以及研究使用触觉线索控制运动的机制。具体目的是验证触觉线索可以改善PD和年龄匹配对照受试者的(1)姿势和(2)步态控制方面的假设，并表征这些线索参与的两组受试者的感觉-运动机制的时间协调。pi建议(1)比较尽可能静止站立时，有无非支持性手动接触（<1 N）与固定表面的姿势摆动的幅度和时间，以及(2)比较无辅助行走与使用独特的“移动扶手”时步行的步态参数、步态参数的跨步方差和肌电活动的时间，该“移动扶手”触摸改良的腰高传送带的移动表面。初步结果表明，触觉提示有助于PD患者的姿势和步态控制。PD患者在没有练习的情况下使用触觉提示进行药物测试，显示出与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，触摸移动扶手行走增加了PD患者的步幅长度和节奏，并减少了步幅长度的可变性。提出的实验代表了使用触觉（隐含的，速度）线索控制运动的一系列调查的开始，其结果可以转化为辅助设备的开发，以提供触觉线索来控制PD患者的姿势和步态。

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.