我们感谢我们的参与者和专家，他们就此步行计划中开发的方法进行了咨询。

该协议已获得埃默里机构审查委员会和亚特兰大退伍军人管理局研究与发展委员会的批准。所有参与者在参与前都签署了知情同意书。
1. 参与者招募
<ol><li>通过传单、登记册、转诊、PD 通讯、教育会议、网络研讨会、支持小组、老年人生活社区和网站招募老年人和患有 PD 和前驱阿尔茨海默病 （pAD） 的人（参与者信息见 表 1 ）。</li>
	<li>确保患有 PD 的参与者被诊断出患有"特发性"帕金森氏症，并对多巴胺能治疗有积极反应7.确保 pAD 患者有轻度认知障碍和主观记忆丧失。</li>
	<li>确认患有 PD 或 pAD 的参与者没有其他神经系统损伤，并且可以在有和没有帮助的情况下走动 3 米或更长时间。</li>
</ol>2. 安全培训
<ol><li>通过面对面的体验式平衡管理课程培训员工、讲师、护理伙伴和志愿者，这是一种理解平衡的系统方法，通过提供有关平衡的三个系统的信息:前庭、视觉和躯体感觉。<ol><li>引入支撑基础、重心和稳定性极限等原则。进行练习，例如 （1） 站立时移动到脚的边缘并保持平衡，（2） 站立时闭上眼睛并将重心从脚转移到脚，（3） 观察伴侣转移他们的体重，直到伴侣必须迈出一步，并学习使用体重来支撑伴侣的重量。</li>
		<li>使用前面提到的平衡管理课程（步骤 2.1.1）中的平衡管理练习来提高团队在康复运动课程中检测和预防潜在跌倒的能力。</li>
		<li>向首席研究员 （PI） 和物理治疗师的工作人员提供关于保护具有特定步态和平衡障碍的参与者的持续教育。</li>
	</ol></li>
</ol>3. 技术考虑
<ol><li>识别并使用任何市售的健身应用程序（参见 材料表），这些应用程序可以跟踪时间、距离、步数、配速、海拔以及设定目标和显示进度所需的其他参数。</li>
	<li>确定一个具有视频和声音功能的团队会议平台（请参阅 材料表），用于虚拟热身。</li>
	<li>使用一键式移动电话或电话会议线路进行虚拟步行和冷静。</li>
	<li>利用心率监测器（参见 材料表）在整个步行过程中跟踪心率。</li>
	<li>创建使用健身应用程序、视频团队会议平台和电话会议线路的详细书面和图片说明。在步行日前 2 天通过电子邮件将说明发送给所有新参与者。在步行之前和整个过程中为所有参与者提供技术支持。</li>
</ol>4.地上步行环境
<ol><li>在当地社区、城镇或老年人中心附近亲自步行之前，根据方便、安全和适当性为有感觉和运动障碍的老年人规划和检查安全的户外步行路线。<ol><li>记下休息点、长凳和阴凉处，这些在步行时很有用，任何不平坦的表面和路缘石，这可能会带来安全问题，以及其他重要的环境资产或危险。考虑该地区的交通量以及人行道和/或人行道的整体质量。</li>
	</ol></li>
	<li>确保有一个适当的、老年人安全的步行环境，包括限制交通、畅通无阻的人行道、长椅或其他休息点、阴凉处和大部分平坦的地面。一些小的坡度和下降可能是可以忍受的，但要检查那些使用滚动助行器的参与者的坡道。</li>
</ol>5. 虚拟与面对面步行小组的参与者筛选
<ol><li>要求参与者在初次测试期间或第一次步行之前完成一份关于他们的年龄、教育、病史、跌倒史、手杖/助行器等辅助设备的使用以及当前药物的问卷调查。与所有参与者一起查看表格，以确保完整性/准确性。 注意:出于安全考虑，如果参与者的得分为 4 分或更高，或者如果他们对保持独立筛选器8 中的前三个关键问题中的任何一个回答"是"，如果参与者在新的步态冻结问卷 9 的第 3 项上得分为 2 或更高，则参与者被视为不适合虚拟步行课程， 如果经常使用辅助设备，或者如果参与者报告每月跌倒超过一次。</li>
	<li>使用其他体能指标来评估体能以保持安全和评估进展（例如，心率监测、VO2 次最大评估、6 分钟步行测试、Mini Best 测试以及使用市售设备的血管功能测量）10、11、12（参见材料表）。</li>
</ol>6. 安排参与者散步
<ol><li>同时主持虚拟和面对面的步行活动，以及填补领导、联合领导和背标职位所需的工作人员数量，以及安全/协助所需的任何其他工作人员。</li>
	<li>将步行安排在一天中适合小组的时间。</li>
	<li>每周安排两次步行，持续 12 周，确保总共至少 20 次步行。12 周后，邀请参与者每周步行一次。本研究中提出的步行时间为 90 分钟，包括热身、步行和放松。</li>
	<li>在步行前 2 天通过电子邮件将虚拟步行小组说明发送给参与者。说明如下:<ol><li>使用带有一键式手机或其他视频或电话会议线路链接的邀请。</li>
		<li>为新参与者提供有关如何使用技术和健身跟踪应用程序的说明，以及有关安全和适当着装的说明。</li>
	</ol></li>
</ol>7. 员工角色和职责
<ol><li>集团领导职责<ol><li>在步行前确定具有相似步行能力的参与者。为被认为有高跌倒风险的参与者分配背标/工作人员，以在热身、步行和降温期间保护他们。</li>
		<li>在会议开始时介绍自己和共同领导，以及其他工作人员。对参与者进行博格感知运动率 （RPE） 10 分制13 分制的教育，该量表用于确定参与者对其体力劳动的看法。简要讨论会议议程。</li>
		<li>使用安全、努力和时间/重复的提示进行全身热身。</li>
		<li>在热身期间监控远程参与者，以确保正确的姿势、对齐和安全。</li>
		<li>激励参与者。告诉他们，如果他们参与，他们做得很好。祝贺所有参与者的努力。</li>
		<li>注意热身、休息、散步和放松的时间。</li>
		<li>在步行过程中，在一键式移动/电话会议中持续评估参与者的安全性、强度和形式。</li>
		<li>在每次 RPE 更新后，如果长时间没有听到参与者说话，请提供姿势和步态机制的口头提示（表 2）（以确保我们不会与参与者失去联系）。</li>
		<li>鼓励休息和补水休息。</li>
		<li>询问参与者他们的步行环境（例如，人行道、山丘等）和他们的步行姿势（姿势）。经常与参与者联系，了解安全问题以及他们如何监测和保持良好的步态生物力学。</li>
		<li>步行后，在一键式移动或电话会议线路上引导冷却。</li>
		<li>回答有关技术、步行形式、强度、目标等的任何问题。</li>
		<li>如果共同领导者因任何原因断开连接，则接管责任。</li>
	</ol></li>
	<li>共同牵头职责<ol><li>在步行前 2 天通过电子邮件将参与者信息和健身跟踪应用程序的说明以及团队会议链接发送给所有参与者。</li>
		<li>在会议开始时出席。如果参与者未出席，请致电参与者进行检查。</li>
		<li>在实践团队会议视频通话期间协助参与者使用技术。</li>
		<li>在 5 分钟的休息时间内，在视频通话和一键式移动通话之间的过渡期间协助参与者。</li>
		<li>协助参与者设置、使用和启动/停止健身跟踪应用程序。</li>
		<li>询问并记录参与者在热身前、热身后以及步行的 15 分钟、30 分钟和 45 分钟时间点的 RPE 和心率。</li>
		<li>手动记录参与者在步行 45 分钟时间点的 RPE、心率、步数、步行距离、海拔和平均配速。</li>
		<li>收集数据后立即或尽快将数据输入任何市售的数据库调查软件。</li>
		<li>如果组长因任何原因与通话断开连接，则接管组长职责。</li>
	</ol></li>
	<li>背标/其他员工职责<ol><li>确保所有参与者的安全，特别是对于步行速度较慢、使用辅助设备或跌倒风险增加、姿势不稳或步态冻结的参与者。工作人员可以与被认为有高跌倒风险的参与者进行一对一甚至二对一的配对。</li>
		<li>确保参与者沿着同一条路线行走，并且没有参与者在路线上迷路。仔细观察交通，并提醒小组注意迎面而来的交通。</li>
		<li>根据组长或共同组长的要求，协助履行任何其他职责。</li>
		<li>在步行过程中与参与者交往。</li>
</ol></li>	
</ol>8. 虚拟和面对面步行:准备步骤
<ol><li>虚拟步行程序<ol><li>在上课时间前 15-20 分钟，登录视频团队会议。对新参与者进行 RPE 量表教育。进行 25 分钟的热身。在热身前和热身后进行 RPE（共同领导者）。</li>
		<li>热身由组长进行，全身大振幅运动，包括姿势、重心转移、旋转和踏步。以坐姿和站姿进行热身，并提示安全、努力、幅度和形式。口头确保参与者的安全。</li>
		<li>休息 5 分钟，让参与者为步行做好准备。协助参与者登录经批准的健身追踪应用程序和一键式移动或其他电话会议线路。</li>
		<li>在每次 RPE 签到和步行后指导参与者正确的姿势和步态机制。有关提示的完整列表，请参阅 表 2 。要求参与者注意他们的环境并描述他们的周围环境。</li>
		<li>将步行小组限制在四到六名参与者。强烈鼓励参与者带上看护人或步行伙伴散步。在第一次步行之前，与参与者讨论步行的位置和地形，以确保安全和熟悉所选区域。</li>
		<li>在 15 分钟、30 分钟和 45 分钟时记录并记录参与者的 RPE。</li>
		<li>要求参与者在 45 分钟后停止他们的健身跟踪应用程序，并参加教练通过音频功能提供的 5-10 分钟的引导式放松。</li>
	</ol></li>
	<li>面对面的步行程序<ol><li>戴着口罩到达既定的步行地点。对参与者进行 COVID-19 筛查，并协助使用可穿戴 HR 和健身跟踪技术。对新参与者进行 RPE 规模和议程的教育。</li>
		<li>通过全身大振幅运动进行热身，包括姿势、重心转移、旋转和踏步。引导坐姿和站姿练习，并提示安全、努力、幅度和形式。让指定的工作人员保护有平衡障碍的参与者，以确保他们的安全。</li>
		<li>记录热身前后的 RPE 和 HR。</li>
		<li>休息 5 分钟，让参与者为步行做好准备。协助参与者启动步行应用程序技术。</li>
		<li>根据速度、能力和跌倒风险将步行组分成更小的组。为每个步行小组分配一名领队、一名背标员和/或其他研究人员，每组中留有一人进行音频通话。步行活动能力最强的小组组长领导虚拟步行组。</li>
		<li>记录 15 分钟、30 分钟和 45 分钟时间点的 RPE 和 HR。</li>
		<li>在步行开始时，在 15 分钟、30 分钟和 45 分钟时给出姿势和步态提示。安全是最重要的。被认为跌倒风险高的参与者将至少有一个人与他们同行，以确保安全和守卫。应密切监测这些人的疲劳情况。提示环境危害，鼓励休息和使用辅助设备。</li>
		<li>要求参与者在 45 分钟的时间点停止他们的步行应用程序，并参加 5-10 分钟的引导式放松。</li>
		<li>间歇性地（大约每 10 节课）进行满意度问卷调查，以确定参与者所经历的享受程度。</li>
	</ol></li>
</ol>9. 参与者后期评估
<ol><li>如步骤 5.2 所述，测量所选的健身指标，以确定参与者在步行计划过程中的健康状况变化。</li>
	<li>管理参与者满意度调查。</li>
</ol>

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<li>Mirelman, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Gait+impairments+in+Parkinson%27s+disease%5BTitle%5D)+AND+%22Lancet+Neurology%22%5BJournal%5D)">Gait impairments in Parkinson's disease.</a> Lancet Neurology. 18 (7), 697-708 (2019).</li>
<li>Lopez, J., Perez-Rojo, G., Noriega, C., Martinez-Huertas, J. A., Velasco, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Longitudinal+impact+of+the+COVID-19+pandemic+on+older+adults%27+wellbeing%5BTitle%5D)+AND+%22Frontiers+in+Psychiatry%22%5BJournal%5D)">Longitudinal impact of the COVID-19 pandemic on older adults' wellbeing.</a> Frontiers in Psychiatry. 13, 837533(2022).</li>
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<li>Target Heart Rate and Estimated Maximum Heart Rate. Centers for Disease Control and Prevention. , Available from: 
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</ol>

我们没有利益冲突要报告。

上面详述的方法描述了一种安全可行的方法，可以为患有神经退行性疾病的老年人实施低成本、突出的地面步行计划 1,2。虚拟课程被证明在因 COVID-19 而与社会隔离期间有效促进身心健康和生活质量3.一旦隔离措施解除并且 COVID-19 疫苗变得容易获得，这项研究的参与者更喜欢面对面步行而不是虚拟步行。少数要求虚拟步行组的参与者由...

患有神经退行性疾病（特别是帕金森病 （PD））的老年人行动不便、跌倒风险高、生活质量 （QOL） 下降和活动水平普遍下降。更具体地说，老年人和帕金森病患者的行走困难很常见，导致独立性下降，发病率和死亡率增加1。与年龄相关的步态变化包括步态生物力学改变、步态速度减慢和协调性下降。在帕金森病中，运动迟缓和运动功能减退，以及时间和协调问题，会导致步态改变2。
此外，老年人还受到 2020 年 3 月全球 COVID-19 大流行爆发的影响3.许多国家实施了"隔离和检疫"和"社交距离"，以限制病毒的传播。鉴于 COVID-19 导致老年人的高死亡率和发病率，严格的社交距离和隔离规则对老年人仍然有效约一年，直到疫苗问世。对老年人来说，保持社交距离和社交隔离的意外后果包括身体活动明显减少和每日步数减少。例如，许多老年人在一年或更长时间内无法参加日常功能性体育活动，例如跑腿和社交活动，也无法参加正式的日常锻炼计划。这一趋势令人不安，因为许多老年人在大流行前没有达到建议的每日身体活动量4。
老年人和帕金森病患者的体育活动参与已被广泛研究，并已被证明对老年人的身体、心理和认知有益5.提高力量、平衡和耐力可以降低跌倒的风险，增强独立性，提高生活质量。一种简单、突出且低成本的运动形式是步行。老年人身体活动指南建议每周进行 150 分钟的中等强度运动，例如快走，以获得健康益处。心率为最大心率的 64%-76% 或 10 点 Borg 感知运动率量表 4 至 6 之间的感知运动率 （RPE） 可用于定义中等步行强度6。
这项工作中提出的方法是一种混合的面对面/虚拟步行小组形式，适用于因神经退行性疾病而有和没有平衡障碍的老年人。基于在线技术的平台的使用增加以及老年人对技术的熟悉程度的提高促进了这种方法的使用。该技术是在大流行期间开发的，从 2020 年夏季到 2020 年秋季，历时数月，开发过程包括每周举行一次专家工作组会议，以就这些方法达成共识。这些工作组会议是在该方法试行之前召开的。混合方法的一个优点是能够让来自遥远地理位置的跌倒风险低（需要较少监督）的老年人参与进来，同时也能够监督跌倒或其他不良事件风险较高的老年人。在这项工作中，安全问题也得到了广泛的解决。
这种方法的目的是为康复专家和健身教练提供指南、建议和程序，以便为患有神经退行性疾病的老年人安全可行的虚拟和面对面步行课程，以改善老年人的身体机能和社会联系，从而提高生活质量。

<table><tbody><tr><td>Chest strap heart rate monitor</td><td>Polar</td><td>NA</td><td></td></tr><tr><td>Computer with video/sound</td><td></td><td>NA</td><td></td></tr><tr><td>Fitness tracking app</td><td>Any commercially available app</td><td>NA</td><td></td></tr><tr><td>iPAD</td><td>Apple IPAD</td><td>NA</td><td></td></tr><tr><td>Pressure management device</td><td>Atcor Medical, Australia</td><td>SphygmoCor</td><td></td></tr><tr><td>Smartphone</td><td>Apple or Android</td><td>NA</td><td></td></tr><tr><td>Standard chair</td><td></td><td>NA</td><td></td></tr><tr><td>Team meeting platform</td><td>Zoom&amp;nbsp;</td><td>NA</td><td></td></tr></tbody></table>

walk with me hybrid virtual/in-person walking for older adults with neurodegenerative disease

本研究为患有神经退行性疾病的老年人提供了虚拟和面对面步行小组的方案，并解决了大流行期间身体活动和社会联系的下降问题。身体活动，特别是中等强度的步行，已被证明对老年人有多种健康益处。这种方法是在 COVID-19 大流行期间创建的，有助于降低老年人的身体活动水平和社会孤立。面对面和虚拟课程都利用了健身追踪应用程序和视频平台等技术。数据来自两组患有神经退行性疾病的老年人:前驱阿尔茨海默病患者和帕金森病患者。虚拟课程的参与者在步行前接受了平衡障碍筛查，任何被认为有跌倒风险的人都没有资格参加虚拟课程。随着 COVID 疫苗的问世和限制的取消，面对面的步行团体变得可行。工作人员和护理人员接受了平衡管理、角色/职责和提供步行提示方面的培训。两次步行，无论是虚拟的还是面对面的，都包括热身、散步和放松，并在整个过程中给出了姿势、步态和安全提示。在热身前、热身后以及 15 分钟、30 分钟和 45 分钟时间点测量感知运动率 （RPE） 和心率 （HR）。参与者还使用手机上的步行应用程序（应用程序）来记录步行距离和步数。该研究显示，两组的HR和RPE之间存在正相关。虚拟小组的参与者对步行小组在社会隔离期间提高生活质量以及促进身体、心理和情感健康方面给予了好评。该方法展示了一种安全可行的方法，可以为患有神经系统疾病的老年人实施虚拟和面对面的步行小组。

试点虚拟步行小组 在 COVID-19 期间，一个由七人组成的专家工作组与八名试点参与者一起创建并实施了虚拟步行协议。该工作组由一名PI、一名物理治疗师、一名运动生理学家、一名实验室经理、两名研究协调员和一名研究生组成。工作组几乎每周举行一次会议，在方法试点之前就方法达成共识。为了试行这些方法，来自PD和老年人社区的参与者被要求加入。其中四名虚拟步行者被?...

Watch this Scientific Journal Video about Walk with Me Hybrid Virtual/In-Person Walking for Older Adults with Neurodegenerative Disease at JoVE.com

Walk with Me Hybrid Virtual/In-Person Walking for Older Adults with Neurodegenerative Disease

本方案旨在为康复专家和健身教练提供安全、可行和循证的方法，为患有神经退行性疾病的老年人提供虚拟和面对面的步行课程。

与我同行:为患有神经退行性疾病的老年人提供混合虚拟/面对面步行

This study presents a protocol for virtual and in-person walking groups for older adults with neurodegenerative diseases and addresses the decline in ...

walk-with-me-hybrid-virtualin-person-walking-for-older-adults-with

Research

JoVE Journal

Behavior

918 次观看.  Emory University School of Medicine. 本方案旨在为康复专家和健身教练提供安全、可行和循证的方法，为患有神经退行性疾病的老年人提供虚拟和面对面的步行课程。 

视频: Walk with Me Hybrid Virtual/In-Person Walking for Older Adults with Neurodegenerative Disease

Behavioral Phenotyping of Murine Disease Models with the Integrated Behavioral Station (INBEST)

Due to rapid advances in genetic engineering, small rodents have become the preferred subjects in many disciplines of biomedical research. In studies of chronic CNS disorders, there is an increasing demand for murine models with high validity at the behavioral level. However, multiple pathogenic mechanisms and complex functional deficits often impose challenges to reliably measure and interpret behavior of chronically sick mice. Therefore, the assessment of peripheral pathology and a behavioral profile at several time points using a battery of tests are required. Video-tracking, behavioral spectroscopy, and remote acquisition of physiological measures are emerging technologies that allow for comprehensive, accurate, and unbiased behavioral analysis in a home-base-like setting. This report describes a refined phenotyping protocol, which includes a custom-made monitoring apparatus (Integrated Behavioral Station, INBEST) that focuses on prolonged measurements of basic functional outputs, such as spontaneous activity, food/water intake and motivated behavior in a relatively stress-free environment. Technical and conceptual improvements in INBEST design may further promote reproducibility and standardization of behavioral studies.

Behavioral Phenotyping of Murine Disease Models with the Integrated Behavioral Station INBEST

Prolonged and comprehensive monitoring of mice in a home-cage environment provides a deeper understanding of aberrant behavior in murine models of brain diseases. This paper describes the Integrated Behavioral Station (INBEST) as the key component of contemporary behavioral analysis.

小鼠疾病模型的集成行为车站行为表型（INBEST）

Due to rapid advances in genetic engineering, small rodents have become the preferred subjects in many disciplines of biomedical research. In studies of ...

科研

行为学

Community-based Adapted Tango Dancing for Individuals with Parkinson's Disease and Older Adults

Adapted tango dancing improves mobility and balance in older adults and additional populations with balance impairments. It is composed of very simple step elements. Adapted tango involves movement initiation and cessation, multi-directional perturbations, varied speeds and rhythms. Focus on foot placement, whole body coordination, and attention to partner, path of movement, and aesthetics likely underlie adapted tango&#8217;s demonstrated efficacy for improving mobility and balance. In this paper, we describe the methodology to disseminate the adapted tango teaching methods to dance instructor trainees and to implement the adapted tango by the trainees in the community for older adults and individuals with Parkinson&#8217;s Disease (PD). Efficacy in improving mobility (measured with the Timed Up and Go, Tandem stance, Berg Balance Scale, Gait Speed and 30 sec chair stand), safety and fidelity of the program is maximized through targeted instructor and volunteer training and a structured detailed syllabus outlining class practices and progression.

Adapted tango has demonstrated efficacy for improving mobility and balance. We describe the dissemination of adapted tango teaching methods to dance instructor trainees and the implementation of adapted tango by the trainees in the community for improving mobility and balance in older adults and individuals with Parkinson&#8217;s disease.

以社区为基础改编的探戈舞的个人与帕金森氏病和老年人

Adapted tango dancing improves mobility and balance in older adults and additional populations with balance impairments. It is composed of very simple ...

Substantiating Appropriate Motion Capture Techniques for the Assessment of Nordic Walking Gait and Posture in Older Adults

Nordic walking (NW) has become a safe and simple form of exercise in recent years, and in studying this gait pattern, various data collection techniques have been employed, each with positives and negatives. The aim was to determine the effect of NW on older adult gait and posture and to determine optimal use of different data collection systems in both short and long duration analysis. Gait and posture during NW and normal walking were assessed in 17 healthy older adults (age: 69 &#177; 7.3). Participants performed two trials of 6 Minute Walk Tests (6MWT) (1 with poles (WP) and 1 without poles (NP)) and 6 trials of a 5m walk (3 WP and 3 NP). Motion was recorded using two systems, a 6-sensor accelerometry system and an 8-camera 3-dimensional motion capture system, in order to quantify spatial-temporal, kinematic, and kinetic parameters.
With both systems, participants demonstrated increased stride length and double support and decreased gait speed and cadence WP compared to NP (p &#60;0.05). Also, with motion capture, larger single support time was found WP (p &#60;0.05). With 3-D capture, smaller hip power generation and moments of force were found at heel contact and pre-swing as well as smaller knee power absorption at heel contact, pre-swing, and terminal swing WP compared to NP, when assessed over one cycle (p &#60;0.05). Also, WP yielded smaller moments of force at heel contact and terminal swing along with larger moments at mid-stance of a gait cycle (p &#60;0.05). No changes were found for posture.
NW seems appropriate for promoting a normal gait pattern in older adults. Three-dimensional motion capture should primarily be used during short duration gait analysis (i.e. single gait cycle), while accelerometry systems should be primarily employed in instances requiring longer duration analysis such as during the 6MWT.

The aim was to substantiate optimal use of data collection techniques for Nordic walking gait and posture analysis. Three-dimensional motion capture should be used during short duration analysis (i.e. single gait cycle), while accelerometry should be employed for longer duration analysis (i.e. repeated cycles) like a 6 Minute Walk Test.

充实适当的运动捕捉技术的越野行走步态中老年人的评估和姿势

Nordic walking (NW) has become a safe and simple form of exercise in recent years, and in studying this gait pattern, various data collection techniques ...

Using a Real-Time Locating System to Measure Walking Activity Associated with Wandering Behaviors Among Institutionalized Older Adults

A real-time locating system (RTLS) can be used to track the walking activity of institutionalized older adults in long-term care who are at risk for wandering behaviors. The benefits of a RTLS are objective and continuous measurements of activity. Self-report methods of activity, especially wandering, by health care staff are vulnerable to floor effects and recall bias, and continuous clinical or research observation over the long-term can be time-consuming and expensive. Health care staff also fail to recognize the onset and/or duration of wandering behaviors, which are associated with a variety of adverse health outcomes in this population but amenable to intervention. RTLS technologies can measure the walking activity of institutionalized residents with cognitive impairment over time with a high degree of accuracy. This is particularly useful for the study of wandering, defined as walking for at least 60 seconds with few (if any) breaks in activity. Wandering is associated with disease progression, hospitalizations, falls and death. Previous work suggests older adults with poor balance ability and high sustained walking activity may be particularly susceptible to poor health outcomes. RTLS&#39;s are used to assess cognitive impairment and factors associated with gait and balance; however, supplemental paper and pencil gait/balance tools may be used to further refine risk profiles. This project discusses the use of a RTLS to measure walking activity and also gait quality and balance ability measures on this population.

This paper discusses the use of a continuous and objective real-time locating system to measure walking activity associated with wandering behaviors, focusing on older adults with cognitive impairment. Walking activity is measured by walking distance, sustained walking distance, and sustained gait speed. Also assessed are gait quality and balance ability.

利用实时定位系统测量被培养的老年人的游走行为相关的步行活动

A real-time locating system (RTLS) can be used to track the walking activity of institutionalized older adults in long-term care who are at risk for ...

Using a Virtual Reality Walking Simulator to Investigate Pedestrian Behavior

To cross a road successfully, individuals must coordinate their movements with moving vehicles. This paper describes use of a walking simulator in which people walk on a treadmill to intercept gaps between two moving vehicles in an immersive virtual environment. Virtual reality allows for a safe and ecologically varied investigation of gap crossing behavior. Manipulating the initial starting distance can further the understanding of a participant&#8217;s speed regulation while approaching a gap. The speed profile may be assessed for various gap crossing variables, such as initial distance, vehicle size, and gap size. Each walking simulation results in a position/time series that can inform how velocity is adjusted differently depending on the gap characteristics. This methodology can be used by researchers investigating pedestrian behavior and behavioral dynamics while employing human participants in a safe and realistic setting.

This protocol describes use of a walking simulator that serves as a safe and ecologically valid method to study pedestrian behavior in the presence of moving traffic.

使用虚拟现实步行模拟器调查行人行为

To cross a road successfully, individuals must coordinate their movements with moving vehicles. This paper describes use of a walking simulator in which ...

Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and neurological patients1-4, but also in healthy older adults5,6. The quantitative gait analysis described in this protocol is performed with a recently-introduced photoelectric system (see&#160;Materials table) which has the potential to be used in the clinic because it is portable, easy to set up (no subject preparation is required before a test), and does not require maintenance and sensor calibration. The photoelectric system consists of series of high-density floor-based photoelectric cells with light-emitting and light-receiving diodes that are placed parallel to each other to create a corridor, and are oriented perpendicular to the line of progression7. The system simply detects interruptions in light signal, for instance due to the presence of feet within the recording area. Temporal gait parameters and 1D spatial coordinates of consecutive steps are subsequently calculated to provide common gait parameters such as step length, single limb support and walking velocity8, whose validity against a criterion instrument has recently been demonstrated7,9. The measurement procedures are very straightforward; a single patient can be tested in less than 5 min&#160;and a comprehensive report can be generated in less than 1&#160;min.

This protocol is used to evaluate spatial and temporal gait variables of neurological/orthopedic patients and older persons by means of a recently-introduced floor-based photocell system.

时空步态参数的患者和老年人的临床评估

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and ...

医学

The Immersive Cleveland Clinic Virtual Reality Shopping Platform for the Assessment of Instrumental Activities of Daily Living

A decline in the performance of instrumental activities of daily living (IADLs) has been proposed as a prodromal marker of neurological disease. Existing clinical and performance-based IADL assessments are not feasible for integration into clinical medicine. Virtual reality (VR) is a powerful yet underutilized tool that could advance the diagnosis and treatment of neurological disease. An impediment to the adoption and scaling of VR in clinical neurology is VR-related sickness resulting from sensory inconsistencies between the visual and vestibular systems (i.e., locomotion problem).
The Cleveland Clinic Virtual Reality Shopping (CC-VRS) platform attempts to solve the locomotion problem by coupling an omnidirectional treadmill with high-resolution VR content, enabling the user to physically navigate a virtual grocery store to simulate shopping. The CC-VRS consists of Basic and Complex shopping experiences; both require walking 150 m and retrieving five items. The Complex experience has additional scenarios that increase the cognitive and motor demands of the task to better represent the continuum of activities associated with real-world shopping. The CC-VRS platform provides objective and quantitative biomechanical and cognitive outcomes related to the user&#39;s IADL performance. Initial data indicate that the CC-VRS results in minimal VR-sickness and is feasible and tolerable for older adults and patients with Parkinson&#39;s disease (PD). The considerations underlying the development, design, and hardware and software technology are reviewed, and initial models of integration into primary care and neurology are provided.

Virtual reality (VR) is a powerful yet underutilized approach to advance the diagnosis and treatment of neurological disease. The Cleveland Clinic Virtual Reality Shopping platform combines state-of-the-art VR content with an omnidirectional treadmill to quantify instrumental activities of daily living-a proposed prodromal marker of neurological disease.

沉浸式克利夫兰诊所虚拟现实购物平台，用于评估日常生活中的工具性活动

A decline in the performance of instrumental activities of daily living (IADLs) has been proposed as a prodromal marker of neurological disease. Existing ...

工程学

A Human-machine-interface Integrating Low-cost Sensors with a Neuromuscular Electrical Stimulation System for Post-stroke Balance Rehabilitation

A stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow to brain thereby preventing delivery of oxygen and nutrients. About half of the stroke survivors are left with some degree of disability. Innovative methodologies for restorative neurorehabilitation are urgently required to reduce long-term disability. The ability of the nervous system to reorganize its structure, function and connections as a response to intrinsic or extrinsic stimuli is called neuroplasticity. Neuroplasticity is involved in post-stroke functional disturbances, but also in rehabilitation. Beneficial neuroplastic changes may be facilitated with non-invasive electrotherapy, such as neuromuscular electrical stimulation (NMES) and sensory electrical stimulation (SES). NMES involves coordinated electrical stimulation of motor nerves and muscles to activate them with continuous short pulses of electrical current while SES involves stimulation of sensory nerves with electrical current resulting in sensations that vary from barely perceivable to highly unpleasant. Here, active cortical participation in rehabilitation procedures may be facilitated by driving the non-invasive electrotherapy with biosignals (electromyogram (EMG), electroencephalogram (EEG), electrooculogram (EOG)) that represent simultaneous active perception and volitional effort. To achieve this in a resource-poor setting, e.g., in low- and middle-income countries, we present a low-cost human-machine-interface (HMI) by leveraging recent advances in off-the-shelf video game sensor technology. In this paper, we discuss the open-source software interface that integrates low-cost off-the-shelf sensors for visual-auditory biofeedback with non-invasive electrotherapy to assist postural control during balance rehabilitation. We demonstrate the proof-of-concept on healthy volunteers.

A novel low-cost human-machine interface for interactive post-stroke balance rehabilitation system is presented in this article. The system integrates off-the-shelf low-cost sensors towards volitionally driven electrotherapy paradigm. The proof-of-concept software interface is demonstrated on healthy volunteers.

人机界面集成的低成本传感器，具有神经肌肉电刺激系统中风后康复平衡

A stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow to brain thereby preventing ...

神经科学

Exergaming in Older People Living with HIV Improves Balance, Mobility and Ameliorates Some Aspects of Frailty

Approximately 1.2 million people in the United States live with HIV infection. Medical advancements have increased the life expectancy and this cohort is aging. HIV-positive individuals have a high incidence of frailty (~20%) characterized by depression and sedentary behavior. Exercise would be healthy, but due to the frail status of many HIV-positive individuals, conventional exercise is too taxing. The aim of this study was to evaluate the effectiveness and acceptability of a novel game-based training program (exergame) in ameliorating some aspects of frailty in HIV-infected individuals. Ten older people living with HIV were enrolled in an exergame intervention. Patients performed balance exercises such as weight shifting, ankle reaching, and obstacle crossing. Real-time visual/audio lower-extremity joint motion feedback was provided using wearable sensors to assist feedback and encourage subjects to accurately execute each exercise task. Patients trained twice a week for 45 min for 6 weeks. Changes in balance, gait, psychosocial parameters and quality of life parameters were assessed at the beginning, midterm and at conclusion of the training program. Ten patients completed the study and their results analyzed. The mean age was 57.2 &#177; 9.2 years. The participants showed a significant reduction in center of mass sway (78.2%, p = .045) during the semi-tandem balance stance with eyes closed and showed a significant increase in gait speed during a dual task motor-cognitive assessment (9.3%, p = .048) with an increase in stride velocity of over 0.1 m/sec. A significant reduction in reported pain occurred (43.5%, p = .041). Preliminary results of this exergame intervention show promise in improving balance and mobility while requiring older people living with HIV to be more active. The exergame can be continued at home and may have long term as well as short-term benefits for ameliorating frailty associated with HIV infection.

Persons infected with HIV are often frail, depressed and live a sedentary lifestyle for which conventional exercise is too taxing. Here, we present an exercise protocol that ameliorates aspects of frailty in HIV-infected persons. An exergame integrating cognitive control was developed using biosensors that measured balance, weight-shifting and obstacle crossing.

老年人艾滋病感染者健身游戏平衡改善，流动性和可改善虚弱的几个问题

Approximately 1.2 million people in the United States live with HIV infection. Medical advancements have increased the life expectancy and this cohort is ...

A Rehabilitation Program of Exoskeleton-assisted Body Weight-Supported Treadmill Training with Non-immersive Virtual Reality for Stroke Patients

Stroke is a cerebrovascular event that significantly affects patients' mobility and independence. Restoring gait patterns is a critical goal of stroke rehabilitation, and technology-based therapies have shown promising results. Lower limb exoskeleton therapy, body weight-supported treadmill training (BWSTT), and game-based virtual reality (VR) training are innovative approaches that have improved muscle strength, balance, and walking capability in stroke patients. Integrating these therapies into a comprehensive rehabilitation program may enhance motor recovery and functional outcomes for stroke survivors. This study investigates the potential advantages of combining exoskeleton-assisted BWSTT with game-based VR in enhancing dual-task capability during stroke recovery. Berg Balance Scale (BBS) demonstrated significant improvement after training (p = 0.03), but no statistical differences were observed in the Timed Up-and-Go Test (TUG, p = 0.15) and Functional Independence Measure (FIM, p = 0.38). In summary, this treatment has led to improvements in patient balance. The use of advanced technological devices in this rehabilitation protocol during the acute phase following a stroke is promising and warrants further investigation through a randomized controlled trial.

The efficacy of combining exoskeleton-assisted, body weight-supported treadmill training with game-based virtual reality on dual-task capability in stroke survivors has yet to be studied. Therefore, this rehabilitation program aims to investigate the potential functions and advantages of this combination in enhancing walking capability during stroke recovery.

中风患者外骨骼辅助体重支持跑步机训练和非沉浸式虚拟现实康复计划

Stroke is a cerebrovascular event that significantly affects patients' mobility and independence. Restoring gait patterns is a critical goal of stroke ...