Systematic evaluations of a new smartphone-based wearable telerehabilitation system for use by people with Parkinson’s disease

项目摘要 帕金森病（PD）是一种进行性神经退行性脑疾病，影响至少1000万人 国际吧主要的运动障碍是震颤、运动迟缓、肌肉僵硬和姿势不稳定。它 已经表明，PD患者的姿势不稳定通常对多巴胺能药物反应不足， 药物和手术治疗，这反过来又会导致失去平衡，跌倒的风险和不良反应 生活质量的影响。 PD通常在门诊神经病学或运动障碍诊所进行管理。大量研究 检查了身体和平衡康复方案对改善姿势稳定性的有益影响， PD的人。然而，许多挑战（例如，费用，有限的物理治疗师，有限的 使用临床设施、遵守规定的锻炼等）限制参与临床和 家庭设置。基于智能手机的远程康复技术可以提供一种替代方案， PD在家中进行平衡康复练习。在开发出第一款基于智能手机的 振动触觉生物反馈系统的静态站立练习，最近，PI开发和评估了一个 先进的原型，称为智能平衡系统（SBS），供PD患者进行身体检查时使用 在实验室里进行短时间（不到一小时）的治疗师推荐的动态平衡练习 设置和长时间（连续6周）在家里设置。SBS由智能手机和 可穿戴腰带，支持多模式（视觉和触觉）生物反馈作为辅助指导，并提供真实的- 物理治疗师推荐的动态重量转移平衡练习的时间误差幅度。 PI的研究结果强调了系统评估静态/动态持续改进的必要性 平衡性能，长期性能保持，以及PD患者的遗留效应， 通过SBS的远程康复方案或典型的基于纸张的方案进行家庭平衡训练。 因此，目标1将评估和比较SBS和纸质方案的结果，以用于长期治疗。 家庭康复平衡训练，目标2将定量和定性分析结转 SBS长期康复训练对静态/动态平衡能力、日常体力活动能力和运动能力的影响 活动，和信心，在减少跌倒的恐惧相比，一个典型的纸为基础的方案的对照组。 拟议的工作将提供深入了解如何在家庭平衡训练与SBS可以产生持久的 平衡性能的改进，转化为有益的效果（即，提高日常生活的信心 身体活动，减少跌倒的恐惧，降低跌倒的风险），并给出比典型的更好的结果。 纸质的治疗方案SBS的用户友好和可穿戴特性应减少对内部的需求， 家庭成员和照顾者的家庭援助。物理治疗应该改善作为物理治疗师 监测家庭平衡训练方案的依从性，跟踪运动进展，并提出建议 远程控制

PROJECT SUMMARY Parkinson’s disease (PD) is a progressive neurodegenerative brain disorder affecting at least 10 million people worldwide. The cardinal motor impairments are tremor, bradykinesia, muscle rigidity, and postural instability. It has been shown that postural instability in people with PD often responds insufficiently to dopaminergic medication and surgical treatment, which in turn results in loss of balance, risk of falling, and adverse effects on quality of life. PD is commonly managed in outpatient neurology or movement disorder clinics. Numerous studies have examined the beneficial effects of physical and balance rehabilitation regimens to improve postural stability in people with PD. Unfortunately, many challenges (e.g., cost, limited availability of physical therapists, limited access to clinical facilities, compliance with prescribed exercises, etc.) restrict participation in the clinical and home settings. Smartphone-based telerehabilitation technology can provide an alternative to assist people with PD in performing in-home balance rehabilitation exercises. Having developed the first smartphone-based vibrotactile biofeedback system for static standing exercises, recently, the PI developed and assessed an advanced prototype, called Smarter Balance System (SBS), for use by people with PD performing physical therapists’ recommended dynamic balance exercises over short periods (less than an hour) in a laboratory setting and long periods (6 consecutive weeks) in a home setting. The SBS, consisting of a smartphone and a wearable belt, supports multimodal (visual and touch) biofeedback as assistive guidance and provides real- time error magnitudes for the dynamic weight-shifting balance exercisesrecommended by physical therapists. The PI’s findings underscore the need to systematically evaluate persistent improvements in static/dynamic balance performance, long-term performance retention, and carry-over effects in people with PD performing in- home balance training with either the telerehabilitation regimen via the SBS or a typical paper-based regimen. Therefore, Aim 1 will assess and compare the results of the SBS and a paper-based regimen for long-term in- home rehabilitative balance training, and Aim 2 will quantitatively and qualitatively analyze the carry-over effects of long-term rehabilitative training with the SBS on static/dynamic balance performance, daily physical activities, and confidence in less fear of falling compared to a control group with a typical paper-based regimen. The proposed work will provide insights into how in-home balance training with the SBS can produce persistent improvements in balance performance, translate into beneficial effects (i.e., improved confidence in daily physical activities, reduced fear of falling, and decreased risk of falling), and give better results than typical paper-based regimens. The SBS’s user-friendly and wearable characteristics should reduce the need for in- home assistance by family members and caregivers. Physical therapy should improve as physical therapists monitor compliance with in-home balance training regimens, track exercise progress, and give suggestions remotely.