Posture Assisted Locomotion Training in Persons with Parkinson's Disease

描述（由申请人提供）：相关性本研究与公共卫生的相关性在于其重点在于理解和改善导致帕金森病患者步态发作衰弱性冻结的姿势和步态控制问题。项目摘要/摘要本研究的长期目标是探讨物理治疗干预对进展期帕金森病（PD）患者姿势和步态障碍的有效性的机制基础并提供证据支持。在这个探索性项目中，我们建议评估一种新的治疗方法的可行性，包括姿势辅助运动（PAL）训练，以提高PD患者的步启动和步态表现，并减少步态冻结（FOG）的发生率。具体目的是：1)比较一种新的PAL训练方法与其他更广泛使用的物理治疗方法（包括感觉线索和任务练习）对PD患者步启动和步态表现的影响。评估的结果指标包括：1)踏步前预期体位调整（APAs）的发生率、时间和幅度；2)步进起始时间与距离；3)步态速度、节奏和步幅。评估将在基线、培训六周后、培训后一个月和三个月进行；2)通过比较训练前、训练中点、训练后立即、训练后1个月和3个月的FOG频率，评估步进训练是否能降低FOG的发生率。3)探讨训练引起的步进起始表现的改变是否伴随着步进准备过程中中枢运动兴奋性的改变。运动准备将通过比较由声惊吓刺激引起的姿势调整-步序列的肌电图、动力学和运动学特征来评估。

DESCRIPTION (provided by applicant): Relevance The relevance of this research to public health lies in its focus on understanding and ameleorating problems of posture and gait control leading to debilitating freezing of gait episodes in persons with Parkinson's disease. Project Summary/Abstract The long-term objectives of this research are to investigate the mechanistic basis and provide evidence in support of the effectiveness of physical therapy interventions for posture and gait disorders in persons with advancing Parkinson's disease (PD). In this exploratory project, we propose to assess the feasibility of a novel therapeutic approach involving posture assisted locomotion (PAL) training to enhance step initiation and gait performance and reduce the incidence of freezing of gait (FOG) in PD. The specific aims are: 1) to compare the effects of a novel PAL training approach with other more widely used physical therapy approaches involving sensory cueing and task practice on step initiation and gait performance in individuals with PD. The outcome measures to be assessed include: 1) incidence, timing, and magnitude of anticipatory postural adjustments (APAs) that precede stepping; 2) step initiation timing and distance; 3) gait speed, cadence, and stride length. Assessments will occur at baseline, after six weeks of training, and at one month and three months post-training; 2) to assess whether step training can reduce the incidence of FOG by comparing FOG frequency before, at the mid-point and immediately after training, and at one month and three months post- training. 3) to explore whether training induced changes in step initiation performance are accompanied by alterations in central motor excitability during the preparation for stepping. Motor preparation will be assessed by comparing elctromyographic, kinetic, and kinematic profiles of the postural adjustment-stepping sequence evoked by an acoustic startle stimulus during the period of motor preparation for voluntary stepping.