2016 — 2017 |
Finley, James M. |
R21Activity Code Description: To encourage the development of new research activities in categorical program areas. (Support generally is restricted in level of support and in time.) |
Design and Development of a Mixed Reality System For Skilled Locomotor Training in Individuals With Parkinson's Disease @ University of Southern California
Project Summary/Abstract One of the most disabling limitations for individuals with Parkinson?s disease (PD) are impairments that reduce safe walking in the community. Specifically, people with PD demonstrate difficulty in managing the very elements required for independent access to the community such as completing turns, moving smoothly from one terrain to another such as gravel to grass and avoiding and/or managing obstacles. In fact, tripping over obstacles has been identified as the major cause of falls in community-dwelling people with PD. Commonly, rather than dealing with the challenges of walking in the community, individuals with PD may often be resigned to become home-bound and minimize their risk of adverse events in environment thus negatively impacting their quality of life. However, it is now understood that individuals with PD have the capacity for improved performance and learning of motor skills. Additionally, it has been shown that it is particularly important for individuals with PD that the practice environment matches the real-life environment for learning to transfer from the practice environment to the real world. Thus, it is critical to allow individuals with PD to practice advanced walking skills such as turning and obstacle avoidance in real-world scenarios to maximize functional walking ability. Therefore the primary objective of the proposed study is to develop and test a training system that will allow individuals with PD to practice the advanced walking skills necessary for independence in the community. A preliminary study conducted in support of the current proposal demonstrates the feasibility of using the system while walking on a treadmill. Individuals with PD tolerated walking in the immersive environment without any adverse effects. To accomplish the objectives of this proposal, a low-cost, portable, gait training system will be created to facilitate the practice of advanced locomotor skills (e.g. turning, obstacle avoidance, and dual-tasking) for individuals with PD. Importantly, the system will be capable of being used on multiple platforms (standard treadmills, over-ground in an open space, or in conjunction with newer, omni-directional treadmills). During development, a sample of individuals with PD will be recruited to experience and provide feedback on the value and meaningfulness of the training environments. The secondary objective is to determine the feasibility of individuals with PD completing a set of progressive training sessions in the developed environments. Feasibility will be assessed by participant drop-out rate, the prevalence of adverse effects, and the participant?s perceived value of the training environment. This study will result in a new, innovative training approach that will improve skilled locomotor ability in individuals with PD. Furthermore, this study will create a unique, low-cost, and enjoyable system that could be used in the clinic or at home for training and monitoring of movement-related dysfunction.
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2018 — 2020 |
Finley, James M. |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Toward a Mechanistic Understanding of Optimization Principles Underlying Hemiparetic Gait @ University of Southern California
This project seeks to identify how motor impairments in stroke survivors contribute to mobility deficits through the use of behavioral observations and computational models. Ultimately, this knowledge could be used to design more effective interventions to improve walking ability, increase functional independence, and reduce fall risk in individuals post-stroke. After a stroke, walking ability is affected by motor control deficits which are often characterized by hemiparesis, or weakness on one side of the body. During walking, hemiparesis is often associated with a visible limp that is due to differences in step lengths and stance times between the right and left sides of the body. Reducing these right-left asymmetries are a common objective of rehabilitation, and recently researchers have developed a number of approaches designed to reduce asymmetries such as acoustic pacing, unilateral step training, and split-belt treadmill training. Despite the recent clinical focus on reducing asymmetry, the potential functional benefits of improving symmetry have yet to be established. This research will address this gap by answering two fundamental questions: 1) Do improvements in symmetry lead to functional benefits such as a more efficient walking pattern or improvements in balance? 2) If stroke survivors retain the capacity to walk more symmetrically why do they choose to do otherwise? Although improvements in symmetry can no doubt reduce the potential stigma of walking with a limp, it is possible that a symmetric walking pattern could be less efficient or put patients at a higher risk of falls if it requires that they push the limits of their capacity. Alternatively, it is possible that, through repeated stepping practice, post- stroke individuals have reinforced a suboptimal pattern due to insufficient experience with a more optimal, symmetric pattern. Addressing these issues requires a thorough understanding of the processes by which stroke survivors optimize their walking pattern. Here, these issues are addressed using behavioral approaches to quantify tradeoffs between asymmetry and measures of walking ability such as stability and economy, and computational methods to identify the causal relationships linking these variables. Ultimately, the knowledge derived from this work will provide a mechanistic understanding of how the damaged brain optimizes movement, and may also inform the way in which clinicians develop personalized rehabilitation objectives for stroke survivors. Our findings may also inform cost/benefit analyses of walking in other patient populations known to have asymmetric walking patterns such as amputees or individuals with Parkinson's disease. Furthermore, providing a more mechanistic rationale for gait rehabilitation interventions could improve the efficiency of physical therapy, reduce health care costs, and ultimately help to better reintegrate individuals with neuromotor impairments into society by maximizing their mobility.
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