Backward Walking as a Novel Fall Prediction Tool for Multiple Sclerosis

项目总结 跌倒是多发性硬化症(MS)患者常见的公共卫生问题，而且可以 大大降低了生活质量。目前MS中的跌倒检测方法依赖于前向行走 速度和平衡性；然而，这些测量对跌倒的预测准确性有限。向后 步行速度(BW)是一种有前景的临床测量方法，已知与老年人跌倒病史有关 考虑到高患病率，患有多发性硬化症的人容易出现不准确的情况。 多发性硬化症患者的认知功能障碍；然而，体重对未来跌倒风险的预测准确性仍然存在 未知。有许多因素可能会导致跌倒的风险，但之前的研究未能检验 可能推动BW关系下降风险的机制。一种跌倒风险的临床标志物的鉴定 这与关键运动白质的潜在神经病理(即髓鞘降解)有关 区域和认知功能是迫切需要的。如果没有这样的措施，MS和目标客户的费率将下降 预防跌倒的康复不太可能实现。这项建议的具体目标是1) 建立BW作为结果工具的可靠性和最小可检测变化，并确定 体重指标对6个月内跌倒风险的预测能力；2)检查以下指标的独特贡献 认知领域对BW表现的影响；以及3)决定关键的髓鞘降解的贡献。 提升了BW的性能。我们的中心假设是BW速度是一个可靠和有效的预测因子 未来的跌倒与潜在的髓鞘降解和认知功能障碍有关。建议数 该项目将使用创新的技术来测量髓鞘含量，使用髓鞘水成像，高级 用于量化步行和临床评估的技术和方法 使用可穿戴传感器和调查测量进行认知和预期跌倒监测。识别 由潜在的病理和认知功能障碍支持的跌倒风险的临床标志 这是先前研究的一个重大差距，有可能改进秋季的针对性康复治疗 MS患者的预防、临床结果和生活质量

PROJECT SUMMARY Falls are a common public health concern among persons with Multiple Sclerosis (MS), and can substantially decrease quality of life. Current fall detection measures in MS rely upon forward walking speed and balance; however, these measures exhibit limited predictive accuracy for falls. Backward walking (BW) velocity is a promising clinical measure with known relationships to fall history in the elderly and persons with MS. Retrospective reporting of fall is subject to inaccuracy, given the high prevalence of cognitive dysfunction in MS; yet, the predictive accuracy of BW for prospective fall risk remains unknown. There are many factors that may contribute to fall risk, but prior studies have failed to examine mechanisms that may drive the relationship of BW to fall risk. Identification of a clinical marker of fall risk that is related to both underlying neuropathology (i.e., myelin degradation) of key motor white matter tracts and cognitive function is critically needed. Without such a measure, fall rates for MS and targeted rehabilitation for fall prevention is not likely to be realized. The specific aims of this proposal are to 1) Establish the reliability and minimal detectible change for BW as an outcome tool and determine the predictive capacity of BW measures for fall risk over 6 months; 2) Examine the unique contributions of cognitive domains to BW performance; and 3) Determine the contribution of myelin degradation in key tracts to BW performance. Our central hypothesis is that BW velocity is a reliable and valid predictor of future falls that is related to underlying myelin degradation and cognitive dysfunction. The proposed project will use innovative techniques to measure myelin content using myelin water imaging, advanced technologies and approaches for quantifying both laboratory and clinical assessments of walking and cognition and prospective fall monitoring using wearable sensors and survey measurement. Identifying a clinical marker of fall risk that is supported by underlying pathology and cognitive dysfunction addresses a major gap of prior research and has the potential of improving targeted rehabilitation therapies for fall prevention, clinical outcomes and quality of life for persons with MS.