Restoring Central Motor Control to Improve Community Mobility of Older Adults

项目总结/摘要 在美国，多达3000万老年人有行走限制，这可能会影响社区的流动性。 社区流动性的限制导致残疾、机构收容和生活质量低下。相比 在临床环境中行走，社区移动需要快速协商复杂的，多感官的， 经常变化和不可预测的环境。成功的社区移动需要快速整合 个人的外部信息（例如表面质量、距离）和内部信息（例如疲劳、疼痛）。 这些输入的整合主要发生在中枢神经系统的水平。在正常情况下， 这种整合有利于自动运动控制，对注意力相关网络的要求很少，主要是 位于前额叶皮层（PFC）。随着老年人自动运动控制的减少， 步行任务中的PFC增加。身体系统中与肥胖相关的损伤（例如肌肉骨骼， 心肺）增加行走的需求，而大脑中的并发损伤可以减少 电机控制能力。当步行发生在 复杂社区环境的背景（例如不平坦的表面，注意力需求）;因此， 自动运动控制可能是社区移动性的关键组成部分。运动技能训练（MST）是一种 开发综合干预方法以改善行走。MST的目标是恢复自动 运动控制和行走时的行为灵活性，这是解决环境问题所必需的。 社区流动性的挑战。MST方法可以恢复自动电机控制，并提供 有能力应对环境挑战和保持社区流动性的老年人。我们 建议测试MST对社区流动性和运动控制的影响。社区流动性将是 通过全球定位系统（GPS）跟踪，包括活动， 空间（个人在日常活动中旅行的区域）和离家的时间。中枢运动控制 将在双任务期间通过PFC的无线功能近红外光谱（fNIRS）进行评估 走路此外，我们将评估个人的认知功能和邻里环境的影响 通过社区社会经济状况和步行能力审计来评估社区流动性的变化。我们将 利用正在进行的标准治疗与标准加MST相比的随机、12周疗效试验 (R01 AG 045252; PI：Jennifer Brach），该研究招募了年龄在65岁及以上的个体，步态速度为0.6- 1.2 m/s（n=248）。母试验的主要结果是步态速度;我们的建议将延长结果 从基于诊所的测量到基线和12、24和36周随访时的真实的世界社区流动性 探访研究结果将为改善老年人社区流动性的干预措施提供证据。

Project Summary/Abstract As many as 30 million older adults in the US have walking limitations which could impact community mobility. Restriction in community mobility contribute to disability, institutionalization, and poor quality of life. Compared to walking in clinical settings, community mobility requires rapid negotiation of complex, multi-sensorial, and often variable and unpredictable environments. Successful community mobility requires rapid integration of information both external (e.g. surface quality, distances) and internal (e.g. fatigue, pain) to the individual. Integration of these inputs primarily occurs at the level of the central nervous system. Under normal conditions, this integration favors automatic motor control with few demands on attention-related networks, primarily located in the prefrontal cortex (PFC). As automatic motor control diminishes in older adults, activation of the PFC during walking tasks increases. Age-related impairments in body systems (e.g. musculoskeletal, cardiopulmonary) increase the demands of walking while concurrent impairments in the brain can reduce capacity for motor control. The mismatch in demands and capacity can be magnified when walking occurs in the context of complex community environments (e.g. uneven surfaces, attentional demands); therefore, automatic motor control is likely a critical component of community mobility. Motor skill training (MST) is an integrated intervention approach developed to improve walking. The goal of MST is restoration of automatic motor control and behavioral flexibility during walking, which are needed for addressing environmental challenges during community mobility. The MST approach may restore automatic motor control and provide older individuals with the capacity to address environmental challenges and maintain community mobility. We propose to test the effects of MST on community mobility and motor control. Community mobility will be quantified by state of the art, objective measures from global position system (GPS) tracking, including activity space (the area travelled by an individual in daily activities) and time away from home. Central motor control will be assessed by wireless functional near-infrared spectroscopy (fNIRS) at the PFC during dual-task walking. Further, we will assess the influence of individuals’ cognitive function and neighborhood environments by neighborhood socioeconomic status and walkability audits on changes in community mobility. We will leverage an ongoing randomized, 12-week efficacy trial of standard therapy compared to standard plus MST (R01 AG045252; PI: Jennifer Brach) that is enrolling individuals aged 65 years and older with gait speeds 0.6- 1.2 m/s (n=248). The primary outcome of the parent trial is gait speed; our proposal will extend the outcome from clinic-based measures to real world community mobility at baseline and 12, 24, and 36 week follow-up visits. Results will provide evidence for intervention approaches to improve community mobility of older adults.