Motor Imagery: A Pilot Intervention for Improving Gait and Cognition in the Elderly

 描述(由申请人提供)：超过三分之一的社区居民患有临床可诊断的步态异常，步态障碍与发病率、住院、死亡率、认知能力下降和痴呆症的风险增加有关。对帕金森氏症和中风后的新研究令人信服地表明，运动想象--想象没有实际执行的运动动作--是一种有效的康复工具，但运动想象对相对健康的老年人改善步态的效果目前尚不清楚。这项拟议的研究旨在确定一种想象的步态方案对改善健康老年人的两种步态的有效性。这种想象的步态方案包括想象的单一(想象行走；iW)和双重任务(想象说话时行走；iWWT)情况下的步态，需要执行功能(EF)，并已通过实际步态方案的验证，该方案涉及生态有效的双重任务情况(说话时行走；WWT)，可以预测老年人的跌倒、虚弱、残疾和死亡。对48名认知健康的老年人进行了一项试验性的随机临床试验，在想象步态的前后测量步态、EF和功能磁共振成像。总体的工作假设是，想象的步态可以作为一种康复工具来改善老年人的步态，因为它参与并加强了与实际步态相似的神经系统。这项试验的第一个目的是建立我们想象的步态方案的有效性，以改善老年人的步态和EF。我们预测，我们想象中的步态干预将得到改善：1) 在实际W和WWT条件下的步态速度比主动控制(AC；视觉意象)下的步态速度更大；2)实际T和WWT条件下的认知表现比AC条件下的改善更大。这位飞行员的第二个目标是确定神经可塑性的变化，以响应我们想象的步态干预。我们预测：1)我们想象的步态方案涉及与实际步态和EF相关的神经系统，而AC条件涉及与视觉处理和一般图像有关的神经系统，2)在我们想象的步态干预之后，我们想象的步态方案涉及的神经系统得到加强。这项试验性随机对照试验有可能为未来全面开展随机对照试验奠定基础，以测试老年人想象步态的治疗潜力。

 DESCRIPTION (provided by applicant): Over a third of community-residing elders have clinically diagnosable gait abnormalities, and gait impairment has been linked to an increased risk for morbidity, hospitalization, mortality, cognitive decline, and dementia. Convincing new studies in Parkinson's disease and post stroke suggest that motor imagery - envisioning motor actions without actual execution - is an effective rehabilitative tool, but the efficacy of motor imagery for improving gait in relatively healthy elderly is currently unknown. The proposed research aims to establish the efficacy of an imagined gait protocol for improving both gait in healthy elderly. This imagined gait protocol involves imagined gait in single (imagined walking; iW) and dual-task (imagined walking while talking; iWWT) situations, demands executive functions (EF), and has been validated against an actual gait protocol that involves an ecologically- valid dual-task situation (walking while talking; WWT) that predicts falls, frailty, disability and mortality in the elderly. A pilot Randomized Clinical Trial of 48 cognitively-health elderly with pre-post measures of gait, EF, and fMRI during imagined gait is proposed. The overall working hypothesis is that imagined gait can be used as a rehabilitative tool for improving gait in the elderly because it engages and strengthens similar neural systems as actual gait. The first aim of this pilot is to establish the efficacy of our imagined gait protocolto improve gait and EF in the elderly. We predict that our imagined gait intervention will improve: 1) gait velocity during actual W and WWT conditions to a greater extent than the Active Control (AC; Visual imagery), and 2) improve cognitive performance during actual T and WWT conditions to a greater extent than the AC condition. The second aim of this pilot is to determine neuroplasticity changes in response to our imagined gait intervention. We predict that: 1) our imagined gait protocol engages neural systems linked to actual gait and EF, while the AC condition engages neural systems linked to visual processing and imagery in general, and 2) the neural systems engaged during our imagined gait protocol are strengthened following our imagined gait intervention. This pilot RCT has the potential to build the foundation for a future full-scale RCT to test the therapeutic potential of imagined gait in the elderly.