Musical rhythm synchronization as a mechanism to optimize gait in the real-world in persons with Parkinson disease

项目摘要 帕金森病（PD）是一种进行性运动障碍，其特征是大量行走- 残疾相关。基底神经节多巴胺能神经元的缺失导致步态自律性降低， PD患者似乎通过将异常大量的注意力重新分配给 走路注意力的重新分配通过降低步态速度，增加步幅， 时间变异性和阻碍注意力资源分配到现实世界的步行，如导航 环境改善行走已被确定为PD患者的最优先事项。 节律性听觉刺激（RAS）是一种康复干预，与药物不同， 治疗，已显示出改善PD行走的希望。RAS是一种外部提示媒介， 重复的听觉节拍通过听觉和听觉之间的直接联系来启动运动皮层中的神经元 和运动脑区域。RAS假设通过运动-运动过程增强步态自主性 在这种情况下，运动信号频率锁定到听觉刺激的频率。虽然RAS 已被证明可以改善选定的步态参数，大多数研究都是在相对静态的临床中进行的 设置和使用节拍器或音乐提供固定节奏的听觉线索，一个人必须夹带。 这种开环方法无法解释PD步态障碍的巨大异质性， PD患者的夹带能力，以及需要自适应步行行为的现实世界环境。 此外，RAS对步态自律性的影响知之甚少。为了克服这些局限性， 为了推进这一领域，我们的团队试图研究一种闭环的、基于音乐的数字治疗方法， 自动化但个性化的渐进式RAS步态训练计划，用于现实世界的环境中。 对于这个项目，我将描述的关系，电机夹带，步幅时间 在社区中参与RAS步态训练的PD患者的步态变异性（步态自律性）和步态速度 使用我们的音乐数字治疗仪更具体地说，24名PD患者将完成4周步态 社区培训计划（每周5天，30分钟;共20次）。我将描述 在社区中使用基于音乐的数字治疗的RAS期间的夹带能力（目标1），并确定 牵引精度与（a）步态自动性（步幅时间变异性）和（B）步态之间关系 提示和未提示行走期间的速度（目标2）。我假设这个基于音乐的闭环数字 治疗将促进牵拉，需要较少的注意力资源，恢复步态自动性和速度。 这个研究项目补充了我的发展计划，并作为我实现目标的催化剂， 成为一名独立的调查员，领导一个研究实验室，调查 创新的、生态上有效的恢复措施及其基本机制，目标是 改善患有神经系统疾病的人在现实世界中的行走结果。

PROJECT SUMMARY Parkinson disease (PD) is a progressive movement disorder characterized by substantial walking- related disability. Loss of dopaminergic neurons in the basal ganglia results in reduced gait automaticity, for which persons with PD appear to compensate by reallocating an abnormally large amount of attention to walking. The re-allocation of attention contributes to walking disability by reducing gait speed, increasing stride time variability and hindering distribution of attentional resources to real-world walking, such as navigating the environment. Improving walking has been identified as the greatest priority among persons with PD. Rhythmic Auditory Stimulation (RAS) is a rehabilitation intervention which, unlike pharmacologic treatment, has shown promise for improving walking in PD. RAS is an external cueing medium utilizing repetitive auditory beats to prime neurons in the motor cortex by way of direct connections between auditory and motor brain regions. RAS hypothetically enhances gait automaticity through a process of auditory-motor entrainment, in which the motor signal frequency locks to the frequency of the auditory stimulus. Although RAS has been shown to improve select gait parameters, most studies have been conducted in relatively static clinic settings and use a metronome or music to provide fixed-tempo auditory cues to which a person must entrain. This open loop approach fails to account for the vast heterogeneity in PD gait impairments, diminished entrainment ability of persons with PD, and real-world environments that demand adaptive walking behavior. Moreover, the impact of RAS on gait automaticity is poorly understood. To overcome these limitations and advance this field, our team has sought to examine a closed-loop, music-based digital therapeutic designed to automate yet individualize a progressive RAS gait training program for use in real-world environments. For this project, I will describe the relationships between auditory-motor entrainment, stride-time variability (gait automaticity), and gait speed in persons with PD engaged in RAS gait training in the community using our music-based digital therapeutic. More specifically, 24 persons with PD will complete a 4-week gait training program (5 days/week for 30 minutes; totaling 20 sessions) in the community. I will characterize entrainment ability during RAS with a music-based digital therapeutic in the community (Aim 1) and determine the relationship between entrainment precision and (a) gait automaticity (stride time variability) and (b) gait speed during cued and uncued walking (Aim 2). I hypothesize that this closed-loop music-based digital therapeutic will facilitate entrainment, require fewer attentional resources, restore gait automaticity and speed. This research project complements my development plan and serves as a catalyst towards my goal of becoming an independent investigator leading a research laboratory investigating the effectiveness of innovative, ecologically valid rehabilitation interventions and their underlying mechanisms with the goal of improving real-world walking outcomes in persons with neurological conditions.