Lockhart Thurmon, Frames Chris, Olson Markey, Moon Seong H, Peterson Dan, Lieberman Abraham
Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States.
Muhammad Ali Movement Disorders Clinic, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States.
Front Neurol. 2023 Oct 24;14:1211441. doi: 10.3389/fneur.2023.1211441. eCollection 2023.
The aim of this study was to investigate to what extent PD affects the ability to walk, respond to balance perturbations in a single training session, and produce acute short-term effects to improve compensatory reactions and control of unperturbed walking stability. Understanding the mechanism of compensation and neuroplasticity to unexpected step perturbation training during walking and static stance can inform treatment of PD by helping to design effective training regimens that remediate fall risk. Current rehabilitation therapies are inadequate at reducing falls in people with Parkinson's disease (PD). While pharmacologic and surgical treatments have proved largely ineffective in treating postural instability and gait dysfunction in people with PD, studies have demonstrated that therapy specifically focusing on posture, gait, and balance may significantly improve these factors and reduce falls. The primary goal of this study was to assess the effectiveness of a novel and promising intervention therapy (protective step training - i.e., PST) to improve balance and reduce falls in people with PD. A secondary goal was to understand the effects of PST on proactive and reactive feedback responses during stance and gait tasks. Multiple-baseline, repeated measures analyses were performed on the multitude of proactive and reactive performance measures to assess the effects of PST on gait and postural stability parameters. In general, the results indicate that participants with PD were able to use experiences with perturbation training to integrate and adapt feedforward and feedback behaviors to reduce falls. The ability of the participants with PD to adapt to changes in task demands suggests that individuals with PD could benefit from the protective step training to facilitate balance control during rehabilitation.
本研究的目的是调查帕金森病（PD）在多大程度上影响行走能力、在单次训练中对平衡扰动的反应，以及产生急性短期效应以改善代偿反应和控制未受扰动的行走稳定性。了解行走和静态站立期间对意外步幅扰动训练的代偿和神经可塑性机制，有助于设计有效的训练方案以降低跌倒风险，从而为PD的治疗提供依据。目前的康复疗法在降低帕金森病患者的跌倒风险方面效果不佳。虽然药物和手术治疗在治疗PD患者的姿势不稳和步态功能障碍方面已被证明基本无效，但研究表明，专门针对姿势、步态和平衡的治疗可能会显著改善这些因素并减少跌倒。本研究的主要目标是评估一种新颖且有前景的干预疗法（保护性步幅训练，即PST）在改善PD患者平衡和减少跌倒方面的有效性。次要目标是了解PST对站立和步态任务期间主动和反应性反馈反应的影响。对大量主动和反应性表现指标进行了多基线重复测量分析，以评估PST对步态和姿势稳定性参数的影响。总体而言，结果表明，PD患者能够利用扰动训练的经验来整合和适应前馈和反馈行为，以减少跌倒。PD患者适应任务需求变化的能力表明，PD患者可从保护性步幅训练中受益，以促进康复期间的平衡控制。
