An Engineering-Based Balance Assessment and Training Platform

到目前为止，福尔斯是老年人意外伤害和死亡的主要原因。退伍军人是 更严重地受到福尔斯的影响，因为它比总人口年龄大得多（65岁以上的45%）。 年龄与13%），残疾率较高。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， 平衡是如何被年龄和疾病破坏的。对人的治疗干预 有跌倒危险的人的帮助已经被证明是有限的。工程方法非常适合研究和 评估平衡性;但迄今为止已应用于过于简化的场景，这些场景缺乏复杂性， 探索平衡和福尔斯的肌肉骨骼和神经生理学基础。 这项研究的长期目标是从VA康复研究与开发开始， (RR&D）职业发展奖（CDA-2），是制定改进的指令和协议的诊断 以及治疗与平衡相关的姿势和运动协调问题。这一建议意义重大 先进的工程和心理物理方法，以解决现有的差距，在诊断和治疗 通过开发平衡评估和培训平台（BATP），帮助改善平衡障碍。的 BATP的目标是定量评估和提高处于危险中的个人在以下情况下保持平衡的能力： 被身体及其部分的意志运动所扰乱-一种重要的平衡紊乱 日常生活中的许多活动都有可能导致福尔斯摔倒。BATP的评估模块 建立受试者的平衡极限（LoB），然后在达到目标时测量其在达成任务中的表现。 LoB。这些更好地暴露了平衡赤字，以供识别和评估。BATP的培训模块 我们的目标是通过不断挑战受试者在他们的活动范围内完成伸手可及的任务来增加他们的LoB。 当前的LoB，当他们表现出熟练程度时，扩展延伸任务以增加他们的LoB。的 与大多数此类测试和训练不同，BATP侧重于平衡极限和刚刚超出平衡极限的表现 不以这种方式挑战受试者的协议。BATP最直接和最突出的指标是LoB 我们假设，按照BATP的设计，扩大这一LoB， 平衡功能，并使个人更能抵抗福尔斯（在预期平衡的情况下 干扰）。 证实这一假设可以提供一个新的角度对现有的训练协议的适度 成功率，以及设计新协议的方向，有可能显着改善这些 rates.我们相信，BATP产生的性能指标和分析结果可以形成 新的诊断措施的基础，更可靠，更精确地量化和解释平衡 性能问题;以及随着时间的推移跟踪它们的变化的敏感性。这样的诊断 和治疗方案将是特别有益的VA医疗保健系统，因为它会导致 改善：患者吞吐量、护理质量和治疗成本。虽然这项提案针对的是 老年退伍军人中风人群，BATP是一种通用工具，可以帮助诊断和治疗 由中风以外的情况引起的平衡障碍。这些包括肥胖、糖尿病（通常 导致下肢肌肉变性和周围神经病），肌肉减少症，前庭障碍， 和其他神经系统疾病如帕金森病。平衡受到损害的退伍军人 创伤性脑损伤（TBI-无论是否与战斗有关）也可能受益于这些工具。

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.