Combined Cognitive and Gait Training

描述（由申请人提供）： 结合认知和步态训练问题：最近对慢性中风幸存者步态训练的研究表明，步态协调可以通过以下干预措施得到最好的恢复：运动，地面步态训练和体重支持跑步机训练（BWSTT）。这些结果很重要，因为据我们所知，还没有其他关于持续步态缺陷（中风后> 6个月）的人恢复步态协调的报告。然而，一个遗留的问题是，在实验室中测量的恢复协调的步态运动并没有推广到许多受试者的日常环境。已知的几个因素的汇合可能导致缺乏概括性。首先，它是已知的双任务性能（步行和认知注意力任务）可以降低步态速度和注意力能力，即使在健康的成年人。其次，中风会损害注意力。第三，在日常环境中行走时，为了安全地处理正常发生的刺激，需要注意力。因此，鉴于新的步态训练方案在实验室环境中的成功，重要的是要解决剩余的问题，以便将恢复的功能步态（步态速度）和步态协调推广到日常环境中。目的：目的1是测试一种创新的运动和认知训练的组合，旨在恢复日常环境中的功能步态（步态速度）和步态协调。 假设一：在双重任务测试条件下，与单独的运动训练相比，结合认知和运动训练将产生更大的步态速度增益。主要措施：步态速度，在行走和处理步态路径中的视觉干扰（障碍物）的双重任务条件下测量。次要指标包括：步态协调、在日常环境中行走的时间和生活角色参与（生活质量）。目的2和3是研究两个研究组中的每一个对各自治疗的响应的组内、单独的运动和认知变化。研究方法：对于目标1，Hyp I，将招募38名受试者（卒中后>6个月），并随机分配至1）步态训练+认知训练组;或2）单独步态训练组。两组受试者将接受治疗5次/周，3小时/疗程，持续12周。步态训练方案将包括：运动;体重支持跑步机训练（BWSTT）;和地面步态训练。对于第1组，认知训练将分阶段进入日常训练，首先只强调认知训练， 随后进行双重训练（认知和运动）。目标2和3测量将包括在有和没有认知任务的情况下获得的步态测量，以及在有和没有步态任务的情况下获得的认知测量。将在两个治疗组中进行治疗前/治疗后比较。临床意义：所提出的干预措施有可能在日常环境中恢复安全，协调，功能性行走。 公共卫生相关性： 随着OIF，OEF，朝鲜冲突和越南退伍军人人口的老龄化，中风和持续的步态缺陷成为退伍军人事务部日益重要的问题。超过300万美国人患有中风的残余残疾，每年发生超过750，000例急性中风。30%至60%的康复中风患者有残留的功能障碍，干扰了独立的行动能力和自我护理，这反过来可能需要护理人员或机构，费用超过100，000美元/年/患者。社会因医疗保健和工作日损失的成本超过300亿美元/年。重要的是退伍军人事务部卫生保健系统开发和利用最先进治疗方法来提高退伍军人的生活质量。这项拟议的研究有可能为许多中风的退伍军人在日常环境中提供安全，协调的步态恢复。

DESCRIPTION (provided by applicant): Combined Cognitive and Gait Training Problem: Recent research in gait training for chronic stroke survivors showed that gait coordination can be best restored using the following interventions together: exercise, over ground gait training, and body weight supported treadmill training (BWSTT). These results are important because, to our knowledge, there have been no other reports of the restoration of gait coordination for those with persistent gait deficits (> 6 months after stroke). However, a remaining problem was that the restored coordinated gait movements measured in the laboratory did not generalize for many subjects to the everyday environment. The known confluence of several factors can cause lack of generalization. First, it is known that dual task performance (walking and cognitive attention task) can degrade both gait speed and attention ability, even in healthy adults. Second, stroke can impair attention. Third, during walking in the everyday environment, attention is required in order to safely process normally occurring stimuli. Therefore, given the success of the new gait training protocol in the lab setting, it is important to address the problems remaining, for the generalization of recovered functional gait (gait speed) and gait coordination to the everyday environment. Purpose: Aim 1 is to test an innovative combination of motor and cognitive training that is designed to restore functional gait (gait speed) and gait coordination to the everyday environment. Hypothesis I: Combined cognitive and motor training will produce greater gains in gait speed in the dual task test condition, versus motor training alone. Primary measure: gait speed, measured under the dual task conditions of walking and dealing with a visual distraction (obstacles) in the gait pathway. Secondary measures include: gait coordination, time spent walking in everyday environment, and life role participation (quality of life). Aims 2 and 3 are t investigate the within-group, separate motor and cognitive changes in response to the respective treatments for each of the two study groups. Methods: For Aim 1, Hyp I, thirty-eight subjects (>6 months post stroke) will be enrolled and randomized to either 1) Gait Training + Cognitive Training; or 2) Gait Training alone. Subjects in both groups will receive treatment 5 times/wk, 3hrs/session, for 12wks. The Gait Training Protocol will include: exercise; body weight supported treadmill training (BWSTT); and over ground gait training. For Group 1, the cognitive training will be phased into the daily sessions, by first emphasizing cognitive training alone, and subsequently dual training (cognitive and motor). Aims 2 and 3 measures will include gait measures acquired both with and without a cognitive task, as well as cognitive measures acquired both with and without the gait task. Pre-/post-treatment comparisons will be made within each of the two treatment groups. Clinical Significance: The proposed intervention has the potential to restore safe, coordinated, functional walking in the every day environment. PUBLIC HEALTH RELEVANCE: As the OIF, OEF, Korean Conflict, and Viet Nam veteran populations age, stroke and persistent gait deficits become an increasingly important problem for the Department of Veterans Affairs. More than 3 million Americans live with residual disabilities of stroke and over 750,000 acute strokes occur each year. Thirty to 60% of rehabilitated stroke patients have residual functional disability that interferes with independent mobility and self care, which in turn may require an attendant or institutionalization, costing in excess of $100,000/year/patient. The cost to society for medical care and days lost from work is more than $30 billion/year. It is important that the V.A. health care system develop and utilize state-of-the-art treatment to improve quality of life for its veterans. The proposed study has the potential to provide recovery of safe, coordinated gait in the everyday environment for many veterans who have had a stroke.