An Engineering-Based Balance Assessment and Training Platform

到目前为止，跌倒是老年人意外受伤和死亡的主要原因。退伍军人人数是 受跌倒影响更严重，因为它比总人口年龄大得多(65岁以上45% 年龄比13%)，并有更高的残疾发生率。因此，退伍军人将受益更多 从准确的诊断和治疗平衡功能。尽管它很重要，但仍有许多未知之处 关于平衡因年龄和疾病而受损的方式。为人们提供治疗性干预 那些有跌倒风险的人已经被证明用处有限。工程方法非常适合于研究和 评估平衡性；但到目前为止还应用于过于简化的场景，这些场景缺乏以下复杂性 探索平衡和跌倒的肌肉骨骼和神经生理学基础。 这项研究的长期目标，始于退伍军人康复研究和开发 (RR&D)职业发展奖(CDA-2)，是为诊断制定改进的指令和方案 以及与平衡相关的姿势和运动协调问题的治疗。这项提议意义重大 先进的工程学和心理物理方法，以解决诊断和治疗中存在的差距 通过开发平衡评估和培训平台(BATP)来平衡障碍。这个 BATP的目标是定量评估和提高高危个体在以下情况下保持平衡的能力 受身体及其部位的意志性运动的干扰--一类重要的平衡障碍 这是许多日常生活活动中不可或缺的一部分，可能会导致跌倒。BATP的评估模块快速 建立受试者的平衡极限(LOB)，然后在达到某项任务时测量其表现 吊球。这些更好地暴露了平衡赤字，以便于识别和评估。BATP的培训模块 目标是通过不断挑战受试者在他们的工作中完成达到的任务来增加受试者的LOB 当前的LOB，当他们表现出熟练程度时，扩展到达的任务以增加他们的LOB。这个 与大多数这样的测试和培训不同，BATP关注的是在平衡极限下和刚刚超过极限时的表现 不以这种方式挑战受试者的协议。BATP最直接和最显著的指标是LOB 为了站稳脚跟；我们假设，正如BATP设计的那样，扩大这一LOB将会改善 平衡功能，使个人更能抵抗跌倒(在预期平衡的情况下 骚乱)。 这一假设的证实可以为现有训练方案的适度提供一个新的视角 成功率和设计新协议的方向，有可能显著改善这些 费率。我们相信，BATP产生的性能指标和分析结果可以形成 为更可靠、更准确地量化和解释平衡的新诊断措施奠定了基础 性能问题；以及具有跟踪这些问题随时间变化的敏感度。这样的诊断 治疗方案将特别有利于退伍军人保健系统，因为它将导致 改善：患者吞吐量、护理质量和治疗成本。尽管这项提议针对的是 BATP是一种通用的工具，可以帮助诊断和治疗老年卒中患者 由中风以外的疾病引起的平衡障碍。这些疾病包括肥胖、糖尿病(通常 导致腿部肌肉变性和周围神经病变)、骨质疏松症、前庭功能障碍、 以及其他神经系统疾病，如帕金森氏症。平衡受到损害的退伍军人 创伤性脑损伤(脑外伤--无论是否与战斗有关)也可能从这些工具中受益。

Falls are by far the leading cause of accidental injury and death in older adults. The Veteran population is more severely affected by falls since it is significantly older than the overall population (45% over 65 years of age vs. 13%), and has a higher prevalence of disability. Thus, Veterans would benefit substantially more from an accurate diagnosis and treatment of balance function. Despite its importance, much is still unknown about the manner in which balance is compromised by age and disease. Therapeutic interventions for people who are at risk of falling have proven to be of limited utility. Engineering methods are well suited to study and evaluate balance; but have to date been applied to overly simplified scenarios that lack the complexity to probe the musculoskeletal and neurophysiological bases for balance and falls. The long term objective of this research, which began with a VA Rehabilitation Research & Development (RR&D) Career Development Award (CDA-2), is to develop improved directives and protocols for the diagnosis and treatment of balance-related posture and movement coordination problems. This proposal significantly advances engineering and psychophysical methods to address existing gaps in the diagnosis and treatment of balance impairments through the development of a Balance Assessment and Training Platform (BATP). The goal of the BATP is to quantitatively assess and improve at-risk individuals’ ability to maintain balance when disturbed by volitional movements of the body and its parts—an important class of balance disturbances integral to many activities of daily living that can precipitate falls. The BATP’s Assessment Module quickly establishes the subject’s Limit of Balance (LoB), and then measures performance in a reaching task while at the LoB. These better expose balance deficits for identification and evaluation. The BATP’s Training Module’s goal is to increase subjects’ LoB by continuously challenging them to perform the reaching task at their current LoB, and when they demonstrate proficiency expanding the reaching task to increase their LoB. The BATP focuses on performance at and just beyond the limits of balance, unlike most such tests and training protocols that do not challenge subjects in this way. The BATP’s most immediate and salient metric is the LoB for standing reach; and we hypothesize that expanding this LoB, as the BATP is designed to do, will improve balance function and make individuals more resistant to falls (in the context of expected balance disturbances). Confirmation of this hypothesis could provide a new perspective on existing training protocols’ modest success rates, and direction for the design of new protocols with the potential to significantly improve these rates. We believe that the performance metrics and analytical results produced by the BATP can form the basis for new diagnostic measures that more reliably and precisely quantify and explain balance performance problems; as well as have the sensitivity to track changes in them over time. Such diagnostic and treatment protocols would be particularly beneficial to the VA Health Care System, as it would lead to improvements in: patient throughput, quality of care, and treatment costs. Though this proposal targets the aging Veteran stroke population, the BATP is a general tool that can aid in the diagnosis and treatment of balance disorders arising from conditions other than stroke. These include obesity, diabetes (which often leads to lower extremity muscle degeneration and peripheral neuropathy), sarcopenia, vestibular disorders, and otherneurological disorders such as Parkinson’sdisease. Veterans whose balance has been compromised by TraumaticBrainInjury(TBI—whether combat-related or not) may also benefit from these tools.