Motor Learning of Fall Resistant Skills Through Slip and Trip Exposure in Multiple Sclerosis

Обзор

The primary purpose of this interventional study is to examine the overall motor learning capacity from exposure to repeated perturbations among ambulatory people with multiple sclerosis (MS). This project will advance our understanding of learning new motor skills from exposure to external perturbations. If it is proven that people with MS can learn motor skills from perturbation training, the findings from this study will pave a theoretical foundation for applying perturbation training as a promising fall prevention intervention for people with MS.

Подробное описание

Falls present a significant health risk for people with multiple sclerosis (PwMS). Perturbation training has emerged as a promising strategy to prevent falls. This type of training, which is based on sensorimotor adaptation and motor learning, capitalizes on the central nervous system's (CNS) ability to develop new motor skills. With repeated exposure to large-scale slip or trip perturbations, participants can quickly learn how to better respond to falls. The primary benefits of this training include improved dynamic stability control, both proactively and reactively, by adjusting the body's center of mass (COM) relative to its base of support (BOS).

Sixty-four individuals with relapsing-remitting multiple sclerosis (MS) will be randomly assigned to one of two groups: Group A (training) and Group B (control). Both groups will first participate in an acquisition session. Group A will undergo a training procedure blending slips, trips, and unperturbed walking on a treadmill. In contrast, Group B will walk on the treadmill for the same duration without any perturbations. Immediately following the acquisition session, both groups will experience an unexpected slip and trip while walking over ground (with the order of the slip and trip randomized). Three and six months later, both groups will complete two retention sessions. Each retention session will involve experiencing a treadmill slip and trip (treadmill reslip and retrip) and an overground slip and trip (overground reslip and retrip), with the order randomized. Responses to these perturbations will be measured using the outcomes of fall or non-fall, dynamic stability, leg muscle reaction times, and recovery step length. Additionally, real-life prospective falls and near falls will be monitored for both groups over the six months following the acquisition session.

This project will advance our understanding of learning new motor skills from exposure to external perturbations. If it is proven that people with MS can learn motor skills from perturbation training, the findings from this study will pave a theoretical foundation for applying perturbation training as a promising fall prevention intervention for people with MS.

Вмешательства

• Поведенческое Perturbation Training
  Unexpected slips blended with trips and unperturbed walking trials on a treadmill. A safety harness will be worn at all times.
• Поведенческое Treadmill Walking
  Treadmill walking for the same amount of time as the training group without perturbation. A safety harness will be worn at all times.

Первичные конечные точки

• Perturbation Outcome (Fall or Non-Fall) on the Treadmill or Overground [Срок оценки: Baseline (acquisition session), 3-month retention session, 6-month retention session.]

Вторичные конечные точки (4)

• Dynamic Gait Stability as defined by the Feasible Stability Region (FSR) Theory [Срок оценки: Baseline (acquisition session), 3-month retention session, 6-month retention session.]
• Leg Muscle Reaction Time [Срок оценки: Baseline (acquisition session), 3-month retention session, 6-month retention session.]
• Recovery Step Length [Срок оценки: Baseline (acquisition session), 3-month retention session, 6-month retention session.]
• Prospective Real-Life Falls and Near Falls [Срок оценки: 6 month period after the acquisition session]

Критерии участия

Критерии включения

• Clinically confirmed multiple sclerosis
• At least 45 years old
• Able to walk independently at least 25 feet
• Able to stand independently for at least 30 seconds
• Patient Determined Disability Steps score between 0 and 4
• Free from pregnancy
• Montreal Cognitive Assessment score of 23 or higher

Критерии исключения

• Previous experience with perturbation training
• T-score from the dual x-ray absorptiometry (DXA) scan of less than -2.5
• Coexisting psychiatric disorders or other neurological conditions, severe medical illness, or cardiovascular diseases
• Participants have had a relapse in the past 8 weeks

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Двойное слепое

Основная цель

Профилактика

Центры проведения

США · 1 центр

• Georgia State University Biomechanics Lab — Atlanta

Публикации

• Yang F, Pai YC. Automatic recognition of falls in gait-slip training: Harness load cell based criteria. J Biomech. 2011 Aug 11;44(12):2243-9. doi: 10.1016/j.jbiomech.2011.05.039. Epub 2011 Jun 21. PMID 21696744
• Yang F, Bhatt T, Pai YC. Generalization of treadmill-slip training to prevent a fall following a sudden (novel) slip in over-ground walking. J Biomech. 2013 Jan 4;46(1):63-9. doi: 10.1016/j.jbiomech.2012.10.002. Epub 2012 Nov 8. PMID 23141636
• Yang F, Su X, Wen PS, Lazarus J. Adaptation to repeated gait-slip perturbations among individuals with multiple sclerosis. Mult Scler Relat Disord. 2019 Oct;35:135-141. doi: 10.1016/j.msard.2019.07.019. Epub 2019 Jul 23. PMID 31376685

Идентификаторы

NCT: NCT06919900 · H25443

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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