Hsu Chun Liang, Manor Brad, Iloputaife Ikechkwu, Oddsson Lars I E, Lipsitz Lewis
Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Roslindale, MA, United States.
Harvard Medical School, Boston, MA, United States.
Front Aging Neurosci. 2022 Nov 3;14:1027242. doi: 10.3389/fnagi.2022.1027242. eCollection 2022.
Foot sole somatosensory impairment associated with peripheral neuropathy (PN) is prevalent and a strong independent risk factor for gait disturbance and falls in older adults. Walkasins, a lower-limb sensory prosthesis, has been shown to improve gait and mobility in people with PN by providing afferent input related to foot sole pressure distributions lower-leg mechanical tactile stimulation. Given that gait and mobility are regulated by sensorimotor and cognitive brain networks, it is plausible improvements in gait and mobility from wearing the Walkasins may be associated with elicited neuroplastic changes in the brain. As such, this study aimed to examine changes in brain network connectivity after 26 weeks of daily use of the prosthesis among individuals with diagnosed PN and balance problems. In this exploratory investigation, assessments of participant characteristics, Functional Gait Assessment (FGA), and resting-state functional magnetic resonance imaging were completed at study baseline and 26 weeks follow-up. We found that among those who have completed the study ( = 8; mean age 73.7 years) we observed a five-point improvement in FGA performance as well as significant changes in network connectivity over the 26 weeks that were correlated with improved FGA performance. Specifically, greater improvement in FGA score over 26 weeks was associated with increased connectivity within the Default Mode Network (DMN; < 0.01), the Somatosensory Network (SMN; < 0.01), and the Frontoparietal Network (FPN; < 0.01). FGA improvement was also correlated with increased connectivity between the DMN and the FPN ( < 0.01), and decreased connectivity between the SMN and both the FPN ( < 0.01) and cerebellum ( < 0.01). These findings suggest that 26 weeks of daily use of the Walkasins device may provide beneficial neural modulatory changes in brain network connectivity the sensory replacement stimulation that are relevant to gait improvements among older adults with PN.
与周围神经病变（PN）相关的足底体感障碍很常见，并且是老年人步态障碍和跌倒的一个强有力的独立危险因素。Walkasins是一种下肢感觉假体，已被证明通过提供与足底压力分布和小腿机械触觉刺激相关的传入输入，可改善PN患者的步态和活动能力。鉴于步态和活动能力受感觉运动和认知脑网络调节，佩戴Walkasins导致的步态和活动能力改善可能与大脑中引发的神经可塑性变化有关，这似乎是合理的。因此，本研究旨在检查被诊断患有PN和平衡问题的个体在每天使用该假体26周后脑网络连接性的变化。在这项探索性研究中，在研究基线和26周随访时完成了参与者特征评估、功能性步态评估（FGA）和静息态功能磁共振成像。我们发现，在完成研究的人群中（n = 8；平均年龄73.7岁），我们观察到FGA表现有5分的改善，并且在26周内网络连接性有显著变化，这些变化与FGA表现的改善相关。具体而言，26周内FGA评分的更大改善与默认模式网络（DMN；p < 0.01）、体感网络（SMN；p < 0.01）和额顶网络（FPN；p < 0.01）内连接性增加有关。FGA改善还与DMN和FPN之间连接性增加（p < 0.01）以及SMN与FPN（p < 0.01）和小脑（p < 0.01）之间连接性降低相关。这些发现表明，每天使用Walkasins设备26周可能会在脑网络连接性方面产生有益的神经调节变化以及与感觉替代刺激相关的变化，这与患有PN的老年人步态改善有关。
