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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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于跌倒的高风险和/或跌倒史而不符合资格。在最初的八名试点参与者中，只有一人在撰写本文时继续以虚拟方式行走。其他七名参与者由于各种原因无法继续虚拟行走，例如重返工作岗位、家庭义务、手术和步行时间。
总体而言，针对患有神经退行性疾病的老年人的混合虚拟/面对面步行组的方案和方法是可行的、安全的和有效的。通过利用简单的技术进行沟通和身体活动跟踪，本研究中的老年人在保持社交距离和隔离期间增加了他们的身体活动和社交联系。该协议中的关键步骤包括根据跌倒风险评分和跌倒史确定哪些参与者适合面对面步行与虚拟步行。没有已知跌倒风险或病史的健康老年人更适合虚拟步行组，而患有神经退行性疾病的人可能更适合面对面的监督步行组。在这项研究中，在护理人员和工作人员的额外帮助下，以及在步行前发送的电子邮件信息包中的分步说明，对虚拟和面对面步行参与者进行技术使用是可行的。大多数参与者在学习该技术之前需要一到两次技术演示。一些参与者需要健身跟踪应用程序的持续帮助，这大约需要两分钟才能完成设置。一些参与者开始使用健身应用程序来跟踪步行组以外的活动。规划安全的步行路线和与伙伴一起散步对于确保虚拟步行计划的成功也很重要。最后，在本协议中，对工作人员和护理人员/步行伙伴进行平衡管理和预防跌倒原则的培训至关重要，以确保面对面步行参与者的安全。
具有不同能力水平的群体的快速增长带来了一些挑战，导致在开始步行小组之前需要解决的考虑因素。首先要考虑的是，除了虚拟小组和几个小组或一对一配对之外，还有足够的工作人员来领导一个节奏更快的面对面步行小组。该计划的工作人员在一所大型大学的研究团队中。该团队由研究协调员、物理治疗师、私人教练、运动生理学家、研究生和本科生志愿者共同工作。对于较小的项目，可以对社区志愿者、学生和护理人员进行平衡管理和步行协议方面的培训，以满足安全需求。对于较小的程序来说，实现该协议的更可行的方法是按能力水平划分参与者。低跌倒风险的参与者和虚拟团体将需要更少的工作人员和志愿者。为了安全起见，高跌倒风险组通常需要较小，以确保工作人员与参与者的比例为一:1。另一个考虑因素与通过胸带和 iPad 上的应用程序监测 心率所 选择的方法有关。参与者必须在 iPad 的一定范围内才能进行准确监控。为参与者使用具有心率监测功能的智能手表而不是胸带是一种可行的解决方案，可以确保正确监测所有参与者的心率。
优势和局限性 这项研究有几个优点。经过几个月的试点和与具有不同步行能力的参与者的合作，为患有神经退行性疾病的老年人提供混合虚拟和面对面步行小组的方法现在具有强大的质量。事实上，该计划是与几位老年人和帕金森病患者共同设计的。试点持续了几个月。首先，我们与研究人员和研究生一起解决问题，然后邀请与实验室有联系的先前研究的参与者加入我们的散步，以便我们可以测试这些新方法。来自其他城市和州的一些老年人也参加了会议。这些方法将很好地适用于一般老年人群，以及PD和pAD以外的其他疾病，并鼓励身体活动，增加社会联系，从而提高社区锻炼环境中的生活质量。对于一些老年人来说，这样的计划可能会对孤独感和情绪产生非常积极的影响。
有几个因素可能影响了研究结果，因此这些是研究的局限性。首先，RPE数据显示参与者报告的RPE较低。虽然参与者的目标是在 RPE 的 4-6 范围内工作，但参与者平均有时报告为 3 或更低。这些低数字可能是由于参与者缺乏对 RPE 量表的理解，无法在 45 分钟内准确回忆量表，或者基于其他参与者给出的第一个数字的社会建议。此外，患有 PD 的参与者可能存在感觉运动知觉不匹配;在这种情况下，对努力的感知与速度或工作输出不匹配。为了解决这个问题，在每次步行之前都会审查 RPE 量表，向参与者提供单独的提示以提高他们的速度和努力度，并且可以更改步行路线以纳入更困难的地形，例如山丘。参与者在地面上自行选择的步态速度可能会导致 RPE 和 HR 降低。患有帕金森病和严重步态障碍的人可能无法将心率提高到中等强度，从而影响他们的 RPE14。虽然这种方法对参与者的步行速度和强度几乎没有控制，但有组织的步行计划对身体活动水平和生活质量的好处是积极的。此外，与使用跑步机或其他此类固定设备相比，有环境要求的地上步行的好处更大，因为地上行走可能更适合速度和强度控制、显着性和现实生活中的适用性。
总之，这里描述的混合远程和面对面步行计划可能在全国范围内对有和没有运动障碍的老年人有用。此外，可以使用该程序解决社交网络和孤独感的减少。

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 border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<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&#160;</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诊断为帕金森病，其中四名步行者是老年人，没有已知的神经退行性疾病诊断。在 4 个月的时间范围内，虚拟飞行员步行每周进行两次。参与者被邀请参加一周内的任何步行活动。当时没有记录参与者每次步行的出勤率，但在试行虚拟步行的 4 个月内，我们的流失率为零，没有已知的不良事件。在此期间未测量心率和 RPE。该试点计划的目标是了解该方法在大流行隔离期间使用技术来增加身体活动和社会联系是否可行且有效。在4个月结束时进行了参与者满意度调查（表3）。
混合虚拟/面对面小组 随着隔离措施的结束和 COVID-19 疫苗的普及，专门为跌倒风险较高和/或喜欢面对面指导的人成立了面对面的步行小组。试点参与者被邀请继续每周加入虚拟小组。一般来说，虚拟和面对面小组的注册是滚动的，并且持续开放，步行小组每周提供五天，每个参与者每周步行两次，目标是在三个月的时间范围内步行 20 次。面对面和虚拟组包括患有帕金森病的老年人和患有 pAD 的老年人。面对面的步行小组包括所有行动水平的人，从独立的步行者到因平衡和步态障碍而需要帮助的人。虚拟组仅包括根据跌倒风险筛查过程被认为符合条件的参与者。
在撰写本文时，面对面步行组有 6 名 PD 患者和 4 名 pAD 患者，随着更多参与者被随机分配到研究的步行干预中，预计会有所增长。在最初的八名虚拟飞行员参与者中，有七人因疾病、工作义务和其他个人原因不再参加。对于面对面组，六名患有 PD 的参与者中有三名需要训练有素的工作人员进行一对一的监督。两名患有帕金森病的受试者对虚拟小组感兴趣;然而，由于跌倒的风险很高，这些参与者都没有资格参加虚拟步行组。六名帕金森病参与者中的其余三名和所有四名患有 pAD 的参与者都符合低跌倒风险，因此可以在工作人员较少的监督下行走。这七名低风险参与者出于未知原因选择了面对面的步行组而不是虚拟组。除了组长和副组长外，还有一到两名工作人员被分配到低跌倒风险组，以监测安全并在需要时协助组长。通常，组长带领虚拟参与者和低跌倒风险组。在步行期间，所有协助步行的工作人员都通过一键式移动电话或电话会议热线与小组负责人和共同负责人联系。总共有 11 名工作人员可以支持这些步行活动，并根据每周报名的参与者人数分配步行活动。工作人员包括研究协调员、物理治疗师、私人教练、运动生理学家和研究生。随着时间的流逝，随着步行组参与者规模的增加，增加了更多的工作人员。如上文协议部分所述，PI 和工作人员物理治疗师以及正式的平衡管理培训课程对新员工进行了非正式的一对一指导和培训。下面提供的数据是从 10 名患有 PD 或 pAD 的参与者中收集的，这些参与者在撰写本文时亲自参加了 4 到 15 节课的步行小组。人口统计学和临床特征表（表1）显示，参与者年龄约为70岁，受教育程度相对较高（16-17年）。与pAD参与者相比，PD参与者在过去六个月中跌倒的频率更高。与pAD参与者相比，更多的PD参与者使用辅助设备，并且更害怕跌倒。在撰写本文时，没有不良事件报告。
心率、RPE 和距离结果 如方法所述，在整个课程的五个不同时间点的面对面步行期间收集了每个参与者的心率/RPE 数据:基线、热身后、15 分钟、30 分钟和 45 分钟。在步行结束时，还收集了步行过程中行驶的距离。
参与者的心率和RPE在步行过程中增加，PD患者的RPE变化比pAD患者更多（图1 和 图2）。此外，RPE与心率之间存在很强的正相关关系（图3）。当参与者以最大心率的 50%-75% 的低至中等强度行走时，发现低 RPE 分数与心率之间存在相关性。在这些步行过程中，PD患者平均步行1,800 m，pAD患者平均步行3,000 m（图4）。
在试点虚拟参与者中分发了满意度调查。这些参与者是患有帕金森病的人，没有其他已知的神经系统疾病。在4个月的时间里，共有8名参与者从8名持续步行者中选出了5名参与者。总体而言，该计划广受好评（表3）。该小组的所有成员都强烈同意，步行可以提高他们的生活质量，激励他们锻炼身体，有助于心理健康，并且他们会向朋友或家人推荐该计划。大多数参与者发现该小组在身体上具有挑战性。然而，一些人持中立或不同意态度，这可能是由于虚拟步行的性质。尽管参与者根据 RPE 口头提示强度范围，但最终，速度和路线由参与者自行选择。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/62869/62869fig01.jpg"> 图 1:PD 和 pAD 参与者在面对面步行时的平均心率。 从参加 2 到 20 节课的个别参与者的多个面对面会议中收集的数据。在整个课程的五个不同时间点收集心率:基线、热身后、15 分钟、30 分钟和 45 分钟。图中描绘了平均心率 （± SD），在每个时间点按组分为 PD 个体（蓝色;n = 6）和 pAD 个体（橙色;n = 4），每组每个时间点 n = 45-57 HR。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/62869/62869fig01large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/62869/62869fig02.jpg"> 图 2:参与者在面对面步行期间的平均感知用力率 （RPE）。 从参加 2 到 20 节课的个别参与者的多个面对面会议中收集的数据。在整个课程的五个不同时间点收集 RPE:基线、预热后、15 分钟、30 分钟和 45 分钟。图中描绘了平均 RPE （± SD），在每个时间点按组分为 PD 个体（蓝色;n = 6）和 pAD 个体（橙色;n = 4），每组每个时间点 n = 50-59。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/62869/62869fig02large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/62869/62869fig03.jpg"> 图 3:面对面步行中不同时间点的平均 RPE 和心率之间的相关性。 计算了整个面对面步行课程和每组（PD 和 pAD）的五个不同时间点的平均心率和平均 RPE。然后将这些值关联起来，并计算出 R 平方值。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/62869/62869fig03large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/62869/62869fig04.jpg"> 图 4:PD 患者和 pAD 患者在面对面步行中的平均步行距离。 图中描绘了参与者在按临床组划分的班级 45 分钟步行部分期间步行的平均距离（PD:n = 58;pAD:n = 53）。这个平均值包括参加 2 到 20 节课的个别参与者的多次会议。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/62869/62869fig04large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
表 1:虚拟步行组与面对面步行组的 PD 和 pAD 参与者的人口统计表。<a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/62869/62869_Table%201.xlsx" target="_blank">请按此下载此表格。</a>
表 2:姿势和步态提示示例。 介绍了在基线、15 分钟和 30 分钟的虚拟和面对面步行时给出的几种可能的姿势和步态提示。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/62869/62869_Table%202.xlsx" target="_blank">请按此下载此表格。</a>
表3:满意度调查。 来自最初八名虚拟步行参与者的代表性满意度调查回复。例如，五分之五的受访者强烈同意虚拟步行组改善了他们的生活质量。八分之五的参与者对调查做出了回应。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/62869/62869_Table%203.xlsx" target="_blank">请按此下载此表格。</a>

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

Nanyang Technological University

Research

JoVE Journal

Behavior

798 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

Performing Behavioral Tasks in Subjects with Intracranial Electrodes

Patients having stereo-electroencephalography (SEEG) electrode, subdural grid or depth electrode implants have a multitude of electrodes implanted in different areas of their brain for the localization of their seizure focus and eloquent areas. After implantation, the patient must remain in the hospital until the pathological area of brain is found and possibly resected. During this time, these patients offer a unique opportunity to the research community because any number of behavioral paradigms can be performed to uncover the neural correlates that guide behavior. Here we present a method for recording brain activity from intracranial implants as subjects perform a behavioral task designed to assess decision-making and reward encoding. All electrophysiological data from the intracranial electrodes are recorded during the behavioral task, allowing for the examination of the many brain areas involved in a single function at time scales relevant to behavior. Moreover, and unlike animal studies, human patients can learn a wide variety of behavioral tasks quickly, allowing for the ability to perform more than one task in the same subject or for performing controls. Despite the many advantages of this technique for understanding human brain function, there are also methodological limitations that we discuss, including environmental factors, analgesic effects, time constraints and recordings from diseased tissue. This method may be easily implemented by any institution that performs intracranial assessments; providing the opportunity to directly examine human brain function during behavior.

Patients implanted with intracranial electrodes provide a unique opportunity to record neurological data from multiple areas of the brain while the patient performs behavioral tasks. Here, we present a method of recording from implanted patients that can be reproducible at other institutions with access to this patient population.

执行任务的行为与颅内电极主题

Patients having stereo-electroencephalography (SEEG) electrode, subdural grid or depth electrode implants have a multitude of electrodes implanted in ...

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 ...

Measuring Attentional Biases for Threat in Children and Adults

Investigators have long been interested in the human propensity for the rapid detection of threatening stimuli. However, until recently, research in this domain has focused almost exclusively on adult participants, completely ignoring the topic of threat detection over the course of development. One of the biggest reasons for the lack of developmental work in this area is likely the absence of a reliable paradigm that can measure perceptual biases for threat in children. To address this issue, we recently designed a modified visual search paradigm similar to the standard adult paradigm that is appropriate for studying threat detection in preschool-aged participants. Here we describe this new procedure. In the general paradigm, we present participants with matrices of color photographs, and ask them to find and touch a target on the screen. Latency to touch the target is recorded. Using a touch-screen monitor makes the procedure simple and easy, allowing us to collect data in participants ranging from 3 years of age to adults. Thus far, the paradigm has consistently shown that both adults and children detect threatening stimuli (e.g., snakes, spiders, angry/fearful faces) more quickly than neutral stimuli (e.g., flowers, mushrooms, happy/neutral faces). Altogether, this procedure provides an important new tool for researchers interested in studying the development of attentional biases for threat.

Here we describe a touch-screen visual search paradigm that can be used to study threat detection across the lifespan. The paradigm has already been used in various studies demonstrating that both children and adults detect threatening stimuli like snakes, spiders, and angry faces faster than non-threatening stimuli.

测量注意偏向对威胁儿童和成人

Investigators have long been interested in the human propensity for the rapid detection of threatening stimuli. However, until recently, research in this ...

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 ...

The 4 Mountains Test: A Short Test of Spatial Memory with High Sensitivity for the Diagnosis of Pre-dementia Alzheimer's Disease

This protocol describes the administration of the 4 Mountains Test (4MT), a short test of spatial memory, in which memory for the topographical layout of four mountains within a computer-generated landscape is tested using a delayed match-to-sample paradigm. Allocentric spatial memory is assessed by altering the viewpoint, colors and textures between the initially presented and target images.
Allocentric spatial memory is a key function of the hippocampus, one of the earliest brain regions to be affected in Alzheimer&#39;s disease (AD) and impairment of hippocampal function predates the onset of dementia. It was hypothesized that performance on the 4MT would aid the diagnosis of predementia AD, which manifests clinically as Mild Cognitive Impairment (MCI).
The 4MT was applied to patients with MCI, stratified further based on cerebrospinal fluid (CSF) AD biomarker status (10 MCI biomarker positive, 9 MCI biomarker negative), and with mild AD dementia, as well as healthy controls. Comparator tests included tests of episodic memory and attention widely accepted as sensitive measures of early AD. Behavioral data were correlated with quantitative MRI measures of the hippocampus, precuneus and posterior cingulate gyrus.
4MT scores were significantly different between the two MCI groups (p = 0.001), with a test score of &#8804;8/15 associated with 100% sensitivity and 78% specificity for the classification of MCI with positive AD biomarkers, i.e., predementia AD. 4MT test scores correlated with hippocampal volume (r = 0.42) and cortical thickness of the precuneus (r = 0.55).
In conclusion, the 4MT is effective in identifying the early stages of AD. The short duration, easy application and scoring, and favorable psychometric properties of the 4MT fulfil the need for a simple but accurate diagnostic test for predementia AD.

This article describes the 4 Mountains Test (4MT), a hippocampus-dependent test of working allocentric spatial memory. The hippocampus is affected early in Alzheimer's disease (AD) and this article outlines the 4MT methodology and results of patient testing, which demonstrates the value of the 4MT in the diagnosis of pre-dementia AD.

四山测试:空间记忆的一个简短的测试与高灵敏度的预痴呆诊断阿尔茨海默氏病

This protocol describes the administration of the 4 Mountains Test (4MT), a short test of spatial memory, in which memory for the topographical layout of ...

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 ...

A Behavioral Test Battery for the Repeated Assessment of Motor Skills, Mood, and Cognition in Mice

Pharmacological and toxicological studies in neurodegeneration require comprehensive behavioral analysis in mice because motor dysfunctions and dysfunctions in mood and cognition are common and often shared symptoms in neurodegenerative diseases. Shown here is a behavioral test battery for motor, mood, and cognition, which can be repeatedly tested in a longitudinal study. This battery assesses the overall behavioral phenotype in mice by examining each domain of behavior with at least two independent well-accepted tests (i.e., open-field test and rotarod test for motor function, social interaction test, elevated plus maze test, and forced swim test for emotional function, and Morris water maze test and novel object recognition test for cognitive function). Therefore, this sensitive and comprehensive test battery is a powerful tool for the study of behavioral alternation in neurodegeneration.

A comprehensive behavioral test battery of motor skills, mood&#8212;including social interaction, depression, and anxiety&#8212;and cognition is designed for the repeated assessment of neurodegeneration-related behavioral changes in mice.

一种用于小鼠运动技能、情绪和认知重复评估的行为测试电池

Pharmacological and toxicological studies in neurodegeneration require comprehensive behavioral analysis in mice because motor dysfunctions and ...

Lexical Decision Task for Studying Written Word Recognition in Adults with and without Dementia or Mild Cognitive Impairment

Older adults are slower at recognizing visual objects than younger adults. The same is true for recognizing that a letter string is a real word. People with Alzheimer&#39;s disease (AD) or Mild Cognitive Impairment (MCI) demonstrate even longer responses in written word recognition than elderly controls. Despite the general tendency towards slower recognition in aging and neurocognitive disorders, certain characteristics of words influence word recognition speed regardless of age or neuropathology (e.g., a word&#8217;s frequency of use). We present here a protocol for examining the influence of lexical characteristics on word recognition response times in a simple lexical decision experiment administered to younger and older adults and people with MCI or AD. In this experiment, participants are asked to decide as quickly and accurately as possible whether a given letter string is an actual word or not. We also describe mixed-effects models and principal components analysis that can be used to detect the influence of different types of lexical variables or individual characteristics of participants on word recognition speed.

This article describes how to implement a simple lexical decision experiment to assess written word recognition in neurologically healthy participants and in individuals with dementia and cognitive decline. We also provide a detailed description of reaction time analysis using principal components analysis (PCA) and mixed-effects modeling.

研究成人有无痴呆症或轻度认知障碍的文字识别的词汇决策任务

Older adults are slower at recognizing visual objects than younger adults. The same is true for recognizing that a letter string is a real word. People ...

Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease

As a systemic disease, chronic obstructive pulmonary disease (COPD) affects the respiratory system, inducing restless and exercise dyspnea. It also impacts exercise capacity and forms a vicious circle in which it further aggravates the condition of patients and accelerates disease progression. As a functional holistic exercise, traditional Chinese exercises (TCE) play an important role in the rehabilitation of COPD on the basis of adjusting the breath and performing coordinated movements. This study investigates the effects of prescribed pulmonary exercises (which are modified from TCE) on exercise capacity of upper and lower limbs, endurance exercise capacity, and quality of life in stable COPD patients. The goal is to determine the accessibility of these prescribed exercises in COPD rehabilitation. Participants are randomly divided into a non-exercise control group (CG) or prescribed pulmonary exercise group (PG) at a ratio of 1: 1. The PG receives intervention for 60 min twice per day, 7 days a week, for a total of 3 months. The intensity is measured using the Borg category-ratio 10 scale and with a heart-rate monitor. Then, an exercise capacity test and quality of life questionnaire are scheduled at 1 week before and after the formal intervention. After 3 months of intervention, the 30 s arm curl test, 30 s sit-to-stand test, 6 min walking test, and quality of life show significant improvement in COPD patients (p &#60; 0.05). These findings indicate that prescribed pulmonary exercises can be applied as alternative, convenient, and effective home- and community-based exercises for stable COPD patients.

Presented here is a protocol to investigate the effects of home-based prescribed pulmonary exercise in stable chronic obstructive pulmonary disease (COPD) patients, which is modified based on traditional Chinese exercises according to dyspnea and limited exercise capacity observed in COPD patients.

稳定慢性阻塞性肺病患者家庭处方肺运动

As a systemic disease, chronic obstructive pulmonary disease (COPD) affects the respiratory system, inducing restless and exercise dyspnea. It also ...