Restoring Central Motor Control to Improve Community Mobility of Older Adults

恢复中央运动控制，改善老年人的社区流动性

ANDREA ROSSO Show email (2018-09-01 to 2022-05-31) $2,502,591

Project ID: R01AG057671 (NIA)

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Abstract

As many as 30 million older adults in the US have walking limitations which could impact community mobility. Restriction in community mobility contribute to disability, institutionalization, and poor quality of life. Compared to walking in clinical settings, community mobility requires rapid negotiation of complex, multi-sensorial, and often variable and unpredictable environments. Successful community mobility requires rapid integration of information both external (e.g. surface quality, distances) and internal (e.g. fatigue, pain) to the individual. Integration of these inputs primarily occurs at the level of the central nervous system. Under normal conditions, this integration favors automatic motor control with few demands on attention-related networks, primarily located in the prefrontal cortex (PFC). As automatic motor control diminishes in older adults, activation of the PFC during walking tasks increases. Age-related impairments in body systems (e.g. musculoskeletal, cardiopulmonary) increase the demands of walking while concurrent impairments in the brain can reduce capacity for motor control. The mismatch in demands and capacity can be magnified when walking occurs in the context of complex community environments (e.g. uneven surfaces, attentional demands); therefore, automatic motor control is likely a critical component of community mobility. Motor skill training (MST) is an integrated intervention approach developed to improve walking. The goal of MST is restoration of automatic motor control and behavioral flexibility during walking, which are needed for addressing environmental challenges during community mobility. The MST approach may restore automatic motor control and provide older individuals with the capacity to address environmental challenges and maintain community mobility. We propose to test the effects of MST on community mobility and motor control. Community mobility will be quantified by state of the art, objective measures from global position system (GPS) tracking, including activity space (the area travelled by an individual in daily activities) and time away from home. Central motor control will be assessed by wireless functional near-infrared spectroscopy (fNIRS) at the PFC during dual-task walking. Further, we will assess the influence of individuals? cognitive function and neighborhood environments by neighborhood socioeconomic status and walkability audits on changes in community mobility. We will leverage an ongoing randomized, 12-week efficacy trial of standard therapy compared to standard plus MST (R01 AG045252; PI: Jennifer Brach) that is enrolling individuals aged 65 years and older with gait speeds 0.6- 1.2 m/s (n=248). The primary outcome of the parent trial is gait speed; our proposal will extend the outcome from clinic-based measures to real world community mobility at baseline and 12, 24, and 36 week follow-up visits. Results will provide evidence for intervention approaches to improve community mobility of older adults.

美国有多达3000万老年人有行走限制，这可能会影响社区流动性。社区流动性的限制导致残疾，制度化和生活质量低下。与在临床环境中行走相比，社区移动性需要快速协商复杂的，多感官的，并且通常是变化的和不可预测的环境。成功的社区流动需要将外部信息（例如表面质量，距离）和内部信息（例如疲劳，疼痛）快速整合到个人身上。这些输入的整合主要发生在中枢神经系统的水平。在正常情况下，这种集成有利于自动电机控制，对注意力相关网络的要求很少，主要位于前额皮质（PFC）。随着老年人的自动电机控制减少，在步行任务期间PFC的激活增加。身体系统中与年龄相关的损伤（例如，肌肉骨骼，心肺）增加了行走的需求，同时大脑中的同时损伤会降低运动控制的能力。当在复杂的社区环境（例如，不平坦的表面，注意力需求）的环境中行走时，需求和容量的不匹配可以被放大;因此，自动电机控制可能是社区移动性的关键组成部分。运动技能训练（MST）是一种综合干预方法，旨在改善步行。 MST的目标是在步行期间恢复自动运动控制和行为灵活性，这是解决社区流动期间的环境挑战所必需的。 MST方法可以恢复自动运动控制，并为老年人提供应对环境挑战和维持社区流动性的能力。我们建议测试MST对社区活动性和运动控制的影响。社区流动性将通过现有技术量化，来自全球定位系统（GPS）跟踪的客观测量，包括活动空间（个人在日常活动中旅行的区域）和远离家乡的时间。在双任务行走期间，将通过PFC上的无线功能近红外光谱（fNIRS）评估中央电机控制。此外，我们将评估个人的影响力？社区经济状况和社区流动性变化的可步行性审计的认知功能和邻里环境。与标准加MST（R01 AG045252; PI：Jennifer Brach）相比，我们将利用正在进行的为期12周的标准疗法随机疗效试验，该试验正在招募65岁及以上的人，步态速度为0.6-1.2 m / s（n = 248）。父母试验的主要结果是步态速度;我们的建议将基于临床的措施的结果扩展到基线的现实世界社区流动性以及12周，24周和36周的随访。结果将为改善老年人社区流动性的干预方法提供证据。