A Virtually Supervised Web-Based Home Exercise Technology for Older Adults

描述(由申请者提供)：力量和平衡训练已被证明可以预防老年人的身体衰退和摔倒。大多数预防跌倒的措施 研究的重点是利用合格的个人进行有监督的团体或基于家庭的锻炼干预。由于功能或认知能力下降、护理责任或交通困难，这些干预措施在全社区范围内的实施受到限制。个人高成本和缺乏集体锻炼设施也是问题所在。一种前景看好且经济实惠的力量裁剪方法 而在社区环境中为老年人提供平衡运动就是通过互联网提供培训。然而，基于网络的交互式家庭锻炼技术，包括虚拟监督培训，尚未开发出来。BioSensics LLC(马萨诸塞州剑桥)和亚利桑那大学(高级运动性能跨学科联盟(ICAMP)和亚利桑那州老龄中心)合作的Shift SBIR项目的目标是开发一种低成本、易于使用的交互式网络应用程序，用于基于家庭的力量和平衡训练，以改善老年人的行动能力和降低跌倒风险。拟议的系统将根据现有的基于网络的非互动原型培训方案开发，使用虚拟屏幕教官。这款新的交互式网络应用程序将包括一个屏幕上的“用户头像”，它可以模仿用户的动作。这将通过开发一种包含运动学传感器的仪表化套鞋来实现。基于传感器信号，将使用简化的人体生物力学模型实时估计身体部分的运动学(例如，脚位置、脚踝角度和臀部角度)。运动学数据将驱动屏幕上的用户化身，该化身将向用户提供关于他们的锻炼表现的实时反馈。将包括基于游戏的功能，用于奖励正确进行的练习，并激励用户根据他/她的初始运动表现实现个人设定的锻炼目标。为了确保用户友好，将根据老年人使用媒体的既定指南开发该应用程序。在两项临床研究中的第一项中，我们将评估新系统提供的运动过程中下肢运动学估计的准确性。在第二项临床研究(随机对照试验)中，我们将评估与无监督的家庭训练相比，拟议的技术在改善机动性、步态、平衡性、生活质量和摔倒风险方面的有效性。将使用几个经过验证的成果衡量标准来评估与培训有关的功能性能变化，以及用户对新技术的可接受性/可用性。这项研究的一个独特之处在于，将客观地评估运动的坚持性和运动的准确性。该项目的第二阶段计划进行一项更大的临床研究，以进一步评估拟议技术在改善老年人活动能力和减少跌倒方面的好处。此外，在第二阶段将进行额外的硬件和软件开发，以使该系统适合目标人群的商业化。这项拟议的技术可以降低老年人跌倒的风险，改善老年人的功能、生活质量和独立性，从而对美国医疗保健系统产生重要影响。这一方法解决了老龄化人口的关键问题，这些人口具有高跌倒风险和多种疾病过程。此外，这项研究中评估和改进的方法将用于未来的基于网络的应用程序，重点是在各种影响活动和平衡的疾病过程中进行运动训练，如中风、糖尿病和痴呆症。

DESCRIPTION (provided by applicant): Strength and balance training has been demonstrated to prevent physical decline and falls in older adults. The majority of fall prevention studies have focused on supervised group or home-based exercise interventions utilizing qualified personal. The implementation of these interventions on a community-wide level is limited due to home-bound status because of functional or cognitive decline, care-giving responsibilities, or transportation difficulties. High costs for personal, and lack of group exercie facilities are likewise problematic. A promising and cost-effective approach for tailoring strength and balance exercise to older adults in a community setting is to provide training via the internet. However, interactive web-based home exercise technologies, including virtually supervised training, have not yet been developed. The objective of this collaborative SHIFT SBIR project between BioSensics LLC (Cambridge, MA) and the University of Arizona (Interdisciplinary Consortium on Advance Motion Performance (iCAMP) and Arizona Center on Aging) is to develop a low cost, easy-to-use, interactive web application for home-based strength and balance training to improve mobility and reduce fall risk in older adults. The proposed system will be developed based on an existing non-interactive prototype web-based training program using a virtual on- screen trainer. The new interactive web application will include an on-screen 'user avatar' that mimics its users movements. This will be accomplished by developing an instrumented overshoe containing kinematic sensors. Based on the sensor signals, body segment kinematics (e.g., foot position, ankle angle, and hip angle) will be estimated in real-time using a simplified biomechanical model of the human body. The kinematic data will drive the on-screen user avatar, which will provide real-time feedback to the user regarding their exercise performance. Game-based features will be included for rewarding correctly performed exercises and motivating the user to achieve individually set exercise goals based on his/her initial motor performance. To ensure user-friendliness, the application will be developed based on established guidelines for media use in older adults. In the first of two clinical studies we will evaluate the accuracy of the estimates of lower extremity kinematics during exercise provided by the new system. In the second clinical study (a randomized controlled trial) we will evaluate the effectiveness of the proposed technology for improving mobility, gait, balance, quality of life, and risk of falling compared to unsupervised home trainin. Several validated outcome measures will be used to assess training-related changes in functional performance, as well as user perceived acceptability/usability of the new technology. A unique element of the present study is that both exercise adherence and exercise accuracy will be objectively assessed. A larger clinical study to further assess the benefits of the proposed technology for improving mobility and reducing falls in older adults is planned for Phase II of this project. In addition, in Phase II additional hardware and software development will be performed to make the system suitable for commercialization to the target population. The proposed technology could have an important effect on the US health care system by reducing the risk of falling and improving function, quality-of-life, and independence among older adults. This methodology addresses key issues for an aging population with high risk of falling and multiple disease processes. Moreover, the methods evaluated and refined in this study will be used in future web-based applications focused on exercise training in various disease processes that effect mobility and balance, such as stroke, diabetes, and dementia.