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

项目总结 帕金森病(PD)是一种进行性运动障碍，其特征是大量行走。 相关的残疾。基底节多巴胺能神经元的丢失会导致步态自律性降低， 帕金森病患者似乎会通过重新分配异常大量的注意力来进行补偿 走路。注意力的重新分配会降低步速，增加步幅，从而导致行走障碍 注意资源对真实世界行走的时间变异性和阻碍分配，例如导航 环境。改善行走已被确定为帕金森氏症患者的最优先事项。 节律性听觉刺激(RAS)是一种康复干预，与药理学不同 治疗，已经显示出改善帕金森病患者行走的前景。RAS是一种外部提示介质，利用 重复的听觉搏动通过听觉之间的直接联系到达运动皮质中的初级神经元 和运动脑区域。RAS假想通过听觉运动过程增强步态的自动性 夹带，即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上进行的 设置，并使用节拍器或音乐提供固定节奏的听觉提示，一个人必须缠绕在一起。 这种开环方法不能解释PD步态损害的巨大异质性，减少了 帕金森病患者的携带能力，以及需要自适应行走行为的现实世界环境。 此外，RAS对步态自律性的影响还知之甚少。要克服这些限制并 为了推动这一领域的发展，我们的团队试图研究一种基于音乐的闭环式数字疗法，旨在 自动化但个性化的进步的RAS步态训练计划，用于现实世界的环境。 在这个项目中，我将描述听觉-运动夹带、步幅-时间之间的关系 参与社区RAS步态训练的帕金森病患者的可变性(步态自动性)和步态速度 使用我们基于音乐的数字治疗。更具体地说，24名帕金森病患者将完成为期4周的步态 社区培训计划(5天/周，30分钟，共20节课)。我将描述一下 在社区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 夹带精确度与(A)步态自动性(步幅时间变异性)和(B)步态的关系 有提示和无提示行走时的速度(目标2)。我假设这个基于音乐的闭环系统数字 治疗将促进缠绕，需要更少的注意力资源，恢复步态的自动性和速度。 这项研究项目是对我发展计划的补充，也是我实现以下目标的催化剂 成为一名独立调查员，领导研究实验室调查 创新的、生态上有效的康复干预措施及其基本机制，目标是 改善患有神经疾病的人的真实行走结果。

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.