Training the brain with a robotic device for balance recovery in near-frail older adults

 描述（由申请人提供）：该项目的长期目标是通过提高老年人在滑倒或绊倒时恢复平衡的能力来减少老年人的福尔斯跌倒。拟议的策略是使用艾姆斯，这是一种FDA批准的非侵入性干预措施，已被证明可以增强健全成年人的运动表现，并减少CNS损伤患者上肢和下肢的感觉运动障碍。基于先前研究的结果，我们现在假设艾姆斯干预可以通过增加腿部力量、减少反应时间以及改善腿部和轴向运动协调来减少近乎虚弱的老年人（年龄65-95岁）的福尔斯跌倒。本项目具有以下具体目标：（1）修改艾姆斯设备的硬件和软件，以提供本研究中提出的测试和培训，以及（2）测试概念验证，即每条腿上9小时的艾姆斯培训足以减少接受艾姆斯的研究参与者的福尔斯。在拟议的概念验证研究中，艾姆斯设备将用于训练阿肯色州费耶特维尔退伍军人之家（测试组）10名近乎虚弱的老年居民的双腿。另一组10名受试者也将入组，但不接受艾姆斯培训（对照组）。在基线时，所有20名参与者将能够独立行走，有或没有辅助设备。所有参与者都将接受感觉运动障碍评估（即，踝关节力量、踝关节运动范围和关节位置控制，以及踝关节本体感觉）和运动功能（即，平衡和步态），在此期间，试验组将接受艾姆斯训练，对照组将不接受。在这3个月期间以及随后的3个月内（即，总共6个月），将跟踪所有参与者中的福尔斯发生率。试验组的参与者预期腿部力量增加、腿部反应时间缩短、腿部本体感觉改善，同时腿部损伤减少和腿部功能改善。在6个月的跟踪期内，与对照组在同一时间段内的福尔斯次数相比，试验组的参与者预计也会经历更少的福尔斯。

 DESCRIPTION (provided by applicant): The long-term goal of this project is to reduce falls in older adults by improving their ability to recover equilibrium during a slip or trip. The proposed strategy is to use AMES, an FDA-cleared, non-invasive intervention that has been shown to enhance motor performance in able-bodied adults and to reduce sensorimotor impairment in both the upper and lower limbs of people with CNS injuries. Based on results from previous studies, we now hypothesize that the AMES intervention can reduce falls in near-frail older adults (ages 65-95 years) by increasing leg strength, reducing reaction time, and improving leg and axial motor coordination. This project has the following specific aims: (1) to modify the hardware and software of the AMES device to deliver the testing and training proposed in this study, and (2) to test the proof-of-concept, that 9 hours of AMES training on each leg is sufficient to reduce falls in the study participants receiving AMES. In the proposed proof-of-concept study, an AMES device will be used to train both legs of 10 near-frail older residents in the Arkansas Veterans' Home of Fayetteville (Test Group). Another comparable group of 10 participants will also be enrolled, but will not receive AMES training (Control Group). At baseline, all 20 participants will be able to ambulate independently, with or without assistive devices. All participants will be evaluated for sensorimotor impairments (i.e., ankle strength, ankle range of motion and joint position control, and ankle proprioception) and motor function (i.e., balance and gait) at the beginning and end of a 3-month period during which the Test Group will receive AMES training and the Control group will not. During this 3- month period and also in the 3 months that follow (i.e., for a total of 6 months), the incidence of falls in all participants will be tracked. Participants in the Test Group are expected to experience an increase in leg strength, a decrease in leg reaction time, and an improvement in leg proprioception and, in parallel, a reduction in leg impairment and improvement in leg function. Participants in the Test Group are also expected to experience fewer falls over the 6-month tracking period, compared to the number of falls in the Control Group over this same time period.