Merging attentional focus and balance training to reduce fall risk in older adults

在美国，每年大约有1500万老年人跌倒，而预防跌倒的项目只有 在遏制下降率方面取得了一定的成功。该提案使用了源自 注意力集中文献，以确定是否训练某人在平衡过程中将注意力集中在哪里 任务增强平衡控制，降低跌倒风险。老年人（N=90）被归类为跌倒者（1或 在过去12个月内有更多的福尔斯）将被招募。一系列平衡控制、跌倒风险的临床指标， 将在12周干预之前、期间和之后评估患者报告的结局，以检查变化 在性能和跌倒风险。为期12周的干预将强调引导参与者的注意力， 在一系列平衡任务期间，内部或外部。经验证据和我们的初步数据使我们 假设外部注意力集中训练会对平衡控制产生积极影响。这将是 第一项研究将检查12周的平衡干预使用注意力集中的平衡控制的变化 范例，我们将把平衡控制变化与临床指标联系起来，这些指标表明跌倒风险和患者- 报告结果。此外，我们的建议包括一个新的熵模型在姿势摇摆，一个度量， 被认为与平衡能力有关，以帮助解释假设的平衡增强。因此， 一项提案将把运动学习原则与12周的平衡干预结合起来，以确定跌倒风险是否 在老年人中减少。具体目标1在整个试验期间比较每个试验/会话内的平衡性能。 12周的平衡训练，以评估注意力焦点小组（外部与内部）是否在他们的 运动学习轨迹相对于平衡任务。具体目标2比较运动能力结果 与组间跌倒风险相关的措施（外部焦点、内部焦点或控制）， 在12周的平衡干预后。具体目标3比较了以下患者报告的结局指标： 害怕跌倒，功能健康和福祉，以及害怕在组间运动时受伤（外部） 焦点，内部焦点或控制）之前，期间和之后的12周的平衡干预。

Approximately 15 million older adults fall every year in the United States and fall prevention programs have only been moderately successful in arresting fall rates. This proposal uses motor learning principles derived from the attentional focus literature to determine whether training someone where to focus their attention during a balance task enhances balance control and reduces fall risk. Older adults (N=90) who are classified as fallers (one or more falls in the past 12 months) will be recruited. A series of balance control, clinical metrics of fall risk, and patient-reported outcomes will be assessed prior, during, and after a 12-week intervention to examine changes in performance and fall risk. The 12-week intervention will emphasize directing the participants’ attention either internally or externally during a series of balance tasks. Empirical evidence and our preliminary data leads us to hypothesize that an external focus of attention training will positively influence balance control. This will be the first study to will examine balance control changes over 12-week balance intervention using an attentional focus paradigm and we will relate the balance control changes to clinical metrics that indicate fall risk and patient- reported outcomes. Further, our proposal includes a novel model of entropy in postural sway, a metric that has been proposed to relate to balance ability, to help explain the hypothesized enhancement in balance. Thus, this proposal will merge motor learning principles with a 12-week balance intervention to determine if fall risk is reduced in older adults. Specific Aim 1 compares balance performance within each trial/session throughout the 12 weeks of balance training to evaluate whether the attentional focus groups (external vs. internal) differ in their motor learning trajectory with respect to the balance task. Specific Aim 2 compares the motor ability outcome measures that relate to fall-risk between the groups (external focus, internal focus, or control) before, during, and after the 12-week balance intervention. Specific Aim 3 compares the patient-reported outcome measures of fear of falling, functional health and well-being, and fear of injury from movement between the groups (external focus, internal focus, or control) before, during, and after the 12-week balance intervention.