Cortical correlates of gait in Parkinson's disease: impact of medication and cueing

项目摘要/摘要 行走自律性，神经系统以最少的使用量成功协调运动的能力 对于日常生活中的独立行动来说，是一项关键的职能技能，并可以通过 药物治疗和/或适当的基于康复的干预。即使在早期，这种能力也受到了损害 帕金森氏病(PD)分期。帕金森病是主要的行动障碍和认知功能障碍的罪魁祸首 以及比大多数其他慢性神经疾病更差的生活质量，并给 医疗保健系统。目的探讨认知功能与行走自律性的关系。 在帕金森病患者和年龄匹配的健康对照组中，通过测量大脑不同部位的脑活动 行走和转身时大脑皮层。左旋多巴，帕金森病最常见的药物治疗方法， 改善步态的某些方面，但它可能会恶化或不会改变其他方面，如平衡。其影响 左旋多巴对步态自律性的影响还不是很清楚。AIM II将描述大脑皮质活动的变化 在步行过程中，由于帕金森病患者通常摄入左旋多巴。 暗示在康复中经常被使用。最近，由于日益人性化的无线网络 技术、个性化、闭环式提示设备现在正在开发，作为对固定的改进 提示方法(比如我们按照节拍器的节奏走，或者跨过放在地板上的线)。 最近，我们发现步态同步的触觉反馈改善了帕金森病患者的步态自动化；然而，它是 不知道哪些大脑机制与这种触觉反馈技术的学习有关，也不知道 福利在日常生活中转移到流动性上。我们的目标是调查步进同步的效果， 在实验室中测量的步态自动性的触觉提示；这是Aim III，一项临床试验。此外，AIM III 将探索在家中使用提示系统一周的可行性。 该项目将表征步态自律性的皮质相关性，步态自律性的变化 帕金森病患者的多巴胺替代和暗示，以及这些变化如何转化为步态的改善 然后转身。在……里面 使用 幸存者。 最终 此外，基于提示的个性化康复对许多其他人群也是有效的 步态障碍，如周围神经病、多发性硬化症、创伤性脑损伤和癌症 与这项技术相关的L风险最低，其好处可能在 在不同的人群中改善步行和减少跌倒。此外，通过了解更多 关于与行走自律性和通过暗示学习运动有关的大脑机制，我们将 能够为创新的、更有针对性的康复干预开辟一条新的路线。

Project Summary/Abstract Walking automaticity, the ability of the nervous system to successfully coordinate movement with minimal use of executive resources, is a critical functional skill for independent mobility in daily life, and may be improved by medication and/or appropriate rehabilitation-based intervention. This ability is compromised, even in early stages of Parkinson's disease (PD). PD is responsible for major mobility disabilities and cognitive dysfunction and a worse quality of life than most other chronic neurological diseases, and it imposes a heavy burden on the health care system. Aim I will investigate the relation between cognitive function and walking automaticity in subjects with PD and age-matched healthy control subjects by measuring brain activity in different parts of the cerebral cortex while walking and turning. Levodopa, the most common pharmacological treatment in PD, improves certain aspects of gait, but it may worsen or not change other aspects, such as balance. The effects of levodopa on gait automaticity are not well understood. Aim II will characterize the changes in cortical activity during walking due to usual levodopa intake in people with PD. Cueing is often being used in rehabilitation. More recently, due to the increasingly user-friendly wireless technology, personalized, closed-loop cueing devices are now being developed as an improvement over fixed cueing methods (such us walking to the pace of a metronome or stepping over lines placed on the floor). Recently, we showed that step-synchronized tactile feedback improved gait automaticity in PD; however, it is not known which brain mechanisms are associated with learning of this tactile-feedback technique, nor if benefits transfer to mobility during daily-living. Our objective is to investigate the effects of step-synchronized, tactile cueing on gait automaticity measured in the laboratory; this is Aim III, a clinical trial. In addition, Aim III will explore the feasibility of using the cueing system at home for one week. This project will characterize the cortical correlates of gait automaticity, the changes in gait automaticity with dopamine replacement and cueing in people with PD, and how these changes translate to improvement in gait and turning. In with survivors. ultimately addition, personalized cueing-based rehabilitation could be effective for many other populations gait disturbances, such as peripheral neuropathy, multiple sclerosis, traumatic brain injury, and cancer There are minima l risks associated with this technology and the benefits could be significant in improving walking and reducing falls in various populations.Furthermore, by understanding more about the brain mechanisms associated with walking automaticity and motor learning through cueing, we will be able to open a new route for innovative, more tailored, rehabilitation interventions.