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Testing Effectiveness of a Stochastic Noise Stimulator to Immediately Improve Balance and Gait

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Mass Eye and Ear

Status

Not yet enrolling

Conditions

Aging
Vestibular Disorder

Treatments

Device: Sham Comparator
Device: Subperceptual Stimulus

Study type

Interventional

Funder types

Other
NIH

Identifiers

NCT06688578
2024P002722
7R01AG073161-03 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

The goal of this intervention study is to determine if a new electronic stimulation device, similar to a TENS can improve balance and make walking easier in older individuals with reduced balance function. The main question it aims to answer is:

Can using the device improve walking speed in older individuals?

Participants will be asked to perform a number of tasks while wearing the device:

Walk for 6 minutes

  • Stand in place while having their balance measured (eyes open and closed)
  • Stand on a foam block while having their balance measured (eyes open and closed)
  • Sit in a chair that will tilt +/- 20 degrees while wearing goggles that take videos of the participants eyes.

Full description

Neural degeneration with age and disease is a recognized and critical problem in health. Despite the significant problems associated with neural degenerative diseases and effects of aging, there remains a lack of effective treatments. An important neural system used daily is the vestibular system. The vestibular system provides continual information on our location in space and is integral to balance, locomotion, daily activities and quality of life. Our lab and others have demonstrated that with increasing age there is a loss of vestibular function that is associated with increased incidence of falls. In fact, falls are the leading cause of injury and death in older Americans (CDC). Older Americans experience 36 million falls per year resulting in 3 million emergency room visits, 700,000 hospitalizations and 32,000 deaths resulting in an estimated $50 billion in annual healthcare costs. Since falls in elderly individuals are associated with greatly increased mortality, reducing fall risk is an essential area to target for healthy aging. Since vestibular function is inherently involved in balance and gait, dealing with age related vestibular loss is an essential component of reducing fall risk. Similarly, patients with vestibular loss have reduced quality of life and increased risk of falls.

Our lab was the first to demonstrate that age related reductions in ocular torsion, a vestibular ocular reflex indicative of otolith function, are associated with increased postural sway in a large group of individuals (N=151) from 21-92 years. Our lab is also the first to demonstrate that subperceptual levels of random electrical stimulation, termed stochastic resonance, are able to improve ocular torsion, indicating improved otolith function, to compensate for age-related vestibular loss.6 Our lab as well as others have also demonstrated that the use of this stimulation can improve static balance and gait in a range of populations. Therefore, a neuromodulation device that could improve balance and gait and reduce fall risk would greatly improve quality of life in aging and reduce mortality. Currently, there are limited treatment options available that can compensate for vestibular loss. A novel neuromodulation treatment is clearly needed. However, current data in our lab and others have only examined the response in the lab over relatively short periods. A recent study found that 3 hours of stimulation improved static balance and this improvement lasted post stimulation for up to 4 hours. These data suggest that this stimulus could be used as a novel rehabilitation device. However there still remains several gaps in knowledge:

  1. Do the improvements seen in one system translate to other systems? (i.e., if the investigators see improvement in vestibular ocular reflex, will that translate into improvements in static balance and gait)
  2. Do these improvements in static balance translate into gait improvements?

The overall purpose of this study is to investigate whether low level (sub-perceptual) electrical stimulation produces improvements in vestibular function (balance system) that translate into improved balance and gait.

A. Objectives The goal of this study is to determine the cross-modality effectiveness of improving vestibular function on static balance and gait in a population of older individuals with verified reduced vestibular function.

B. Hypotheses / Research Question(s) Our overall hypothesis is that stimulation of the vestibular system with extremely low level (subperceptual) electrical signals via surface electrodes will produce immediate improvements in vestibular function that will also translate into improve static balance and gait in older individuals.

Enrollment

120 estimated patients

Sex

All

Ages

21+ years old

Volunteers

Accepts Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria Older (ages 60+) and younger (aged 21-59) participants with no significant health history will be recruited from the community.

Exclusion Criteria

Any person with a self-reported history of:

  • impaired proprioception
  • significant eye problems
  • neuromuscular disease
  • seizure
  • stroke
  • unmedicated diabetes
  • cardiovascular disease (except controlled hypertension)
  • renal disease or electrolyte imbalance
  • orthopedic disorders such as severe neck or back pain
  • uncontrolled high blood pressure (200/110 or greater)
  • implanted electronic devices (pacemakers, defibrillators, implanted pumps or stimulator devices, cochlear, etc.)
  • psychotic medications or current psychotic symptoms
  • Any other psychiatric condition requiring hospitalization since 1991
  • recent history of alcohol or drug abuse within the past 6 months
  • inability to stand unassisted for 30 seconds or walk unassisted for 6 minutes

Trial design

Primary purpose

Treatment

Allocation

Randomized

Interventional model

Crossover Assignment

Masking

Double Blind

120 participants in 2 patient groups

Sham
Sham Comparator group
Description:
During each testing session there will be a sham and stimulation trial of each test. The order of the sham/stim trials will be randomized.
Treatment:
Device: Sham Comparator
Stim
Experimental group
Description:
Three different methods will be used to determine the level of stimulation that produces the greatest improvement in gait. The basic concept is that to determine the optimal level of stimulus the investigators apply various levels of random subperceptual electrical stimulation while measuring either vestibular ocular reflex, static sway or gait. Then the investigators will compare the performance of the selected variable at each level of stimulation to determine which amount of stimulation produced the greatest improvement in the selected variable. Once that is determined
Treatment:
Device: Subperceptual Stimulus

Trial contacts and locations

2

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Central trial contact

Jorge M Serrador, PhD; Stephanie G Iring-Sanchez, PhD

Data sourced from clinicaltrials.gov

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