Combined Cognitive and Gait Training

描述(由申请人提供)： 认知和步态训练的结合问题：最近对慢性中风幸存者的步态训练的研究表明，结合以下干预措施可以最好地恢复步态协调：运动、地面步态训练和体重支持跑步机训练(BWSTT)。这些结果很重要，因为据我们所知，还没有其他关于那些持续步态缺陷的人恢复步态协调的报告(中风后6个月)。然而，仍然存在的一个问题是，在实验室测量的恢复的协调步态运动并不能对许多受试者适用于日常环境。已知的几个因素的汇合可能导致缺乏概括性。首先，已知双重任务表现(步行和认知注意任务)会降低步速和注意力能力，即使在健康的成年人中也是如此。其次，中风会损害注意力。第三，在日常环境中行走时，为了安全地处理正常发生的刺激，需要注意。因此，鉴于新的步态训练方案在实验室环境中取得了成功，重要的是解决剩余的问题，以便将恢复的功能性步态(步态速度)和步态协调推广到日常环境中。目的：目标1是测试一种运动和认知训练的创新组合，旨在恢复日常环境中的功能性步态(步态速度)和步态协调。假设一：在双重任务测试条件下，与单独进行运动训练相比，认知训练和运动训练相结合将在步态速度方面产生更大的收益。主要测量：步态速度，在步行和处理步态路径中视觉分心(障碍)的双重任务条件下测量。次要测量包括：步态协调性、在日常环境中行走的时间和生活角色参与(生活质量)。目标2和目标3不是调查两个研究组分别接受治疗后的组内、单独的运动和认知变化。方法：对于目标1，Hyp I，38名受试者(卒中后6个月)将被随机分为1)步态训练+认知训练；或2)单独步态训练。两组受试者均接受5次/周、3小时/次的治疗，疗程12周。步态训练议定书将包括：锻炼；体重支持跑步机训练(BWSTT)；以及地面步态训练。对于第一组，认知训练将分阶段进入日常课程，首先只强调认知训练，以及 随后进行双重训练(认知和运动)。目标2和3的测量将包括在有和没有认知任务的情况下获得的步态测量，以及在有和没有步态任务的情况下获得的认知测量。将在两个治疗组中进行治疗前/治疗后的比较。临床意义：所提出的干预措施有可能在日常环境中恢复安全、协调、功能性的步行。

DESCRIPTION (provided by applicant): Combined Cognitive and Gait Training Problem: Recent research in gait training for chronic stroke survivors showed that gait coordination can be best restored using the following interventions together: exercise, over ground gait training, and body weight supported treadmill training (BWSTT). These results are important because, to our knowledge, there have been no other reports of the restoration of gait coordination for those with persistent gait deficits (> 6 months after stroke). However, a remaining problem was that the restored coordinated gait movements measured in the laboratory did not generalize for many subjects to the everyday environment. The known confluence of several factors can cause lack of generalization. First, it is known that dual task performance (walking and cognitive attention task) can degrade both gait speed and attention ability, even in healthy adults. Second, stroke can impair attention. Third, during walking in the everyday environment, attention is required in order to safely process normally occurring stimuli. Therefore, given the success of the new gait training protocol in the lab setting, it is important to address the problems remaining, for the generalization of recovered functional gait (gait speed) and gait coordination to the everyday environment. Purpose: Aim 1 is to test an innovative combination of motor and cognitive training that is designed to restore functional gait (gait speed) and gait coordination to the everyday environment. Hypothesis I: Combined cognitive and motor training will produce greater gains in gait speed in the dual task test condition, versus motor training alone. Primary measure: gait speed, measured under the dual task conditions of walking and dealing with a visual distraction (obstacles) in the gait pathway. Secondary measures include: gait coordination, time spent walking in everyday environment, and life role participation (quality of life). Aims 2 and 3 are t investigate the within-group, separate motor and cognitive changes in response to the respective treatments for each of the two study groups. Methods: For Aim 1, Hyp I, thirty-eight subjects (>6 months post stroke) will be enrolled and randomized to either 1) Gait Training + Cognitive Training; or 2) Gait Training alone. Subjects in both groups will receive treatment 5 times/wk, 3hrs/session, for 12wks. The Gait Training Protocol will include: exercise; body weight supported treadmill training (BWSTT); and over ground gait training. For Group 1, the cognitive training will be phased into the daily sessions, by first emphasizing cognitive training alone, and subsequently dual training (cognitive and motor). Aims 2 and 3 measures will include gait measures acquired both with and without a cognitive task, as well as cognitive measures acquired both with and without the gait task. Pre-/post-treatment comparisons will be made within each of the two treatment groups. Clinical Significance: The proposed intervention has the potential to restore safe, coordinated, functional walking in the every day environment.