Changes in standing stability with balance-based torso-weighting with cerebellar ataxia: A pilot study.

OBJECTIVES: People with cerebellar ataxia have few options to improve the standing stability they need for function. Strategic placement of light weights on the torso using the balance-based torso-weighting (BBTW) method has improved stability and reduced falls in people with multiple sclerosis, but has not been tested in cerebellar ataxia. We examined whether torso-weighting increased standing stability and/or functional movement in people with cerebellar ataxia. METHODS: Ten people with cerebellar ataxia and 10 matched controls participated in this single-session quasi-experimental pilot study. People with ataxia performed the Scale for the Assessment and Rating of Ataxia (SARA) prior to clinical testing. All participants donned inertial sensors that recorded postural sway; stopwatches recorded duration for standing and mobility tasks. All participants stood for up to 30 s on firm and foam surfaces with eyes open then eyes closed, and performed the Timed Up and Go (TUG) test. Light weights (0.57-1.25 kg) were strategically applied to a vest-like garment. Paired t tests compared within-group differences with and without BBTW weights. Independent t tests assessed differences from controls. All t tests were one-tailed with alpha set at .05. RESULTS: Duration of standing for people with ataxia was significantly longer with weighting (p = .004); all controls stood for the maximum time of 120 s with and without weights. More severe ataxia according to SARA was moderately correlated with greater improvement in standing duration with BBTW (Pearson r = .54). Tasks with more sensory challenges (eyes closed, standing on firm surface) showed less body sway with weighting. Duration for the TUG was unchanged by torso-weighting in people with ataxia. CONCLUSION: Strategic weighting improved standing stability but not movement speed in people with ataxia. BBTW has potential for improving stability and response to challenging sensory conditions in this population. Future studies should further examine gait stability measures along with movement speed.

Four Months of Wearing a Balance Orthotic Improves Measures of Balance and Mobility Among a Cohort of Community-Living Older Adults.

BACKGROUND AND PURPOSE: The Centers for Disease Control and Prevention estimated that there were 29 million falls and 7 million injuries in 2014 in the United States. Falls, decreased balance, and mobility disability are common in older adults and often result in loss of independence. Finding interventions to address these issues is important, as this age group is growing exponentially. Prior studies indicate balance and mobility can be improved by the balance-based torso-weighting (BBTW) assessment implemented through wear of a balance orthotic (BO). This study sought to determine the impact of wearing a BO on balance, mobility, and fall risk over time. METHODS: This quasiexperimental, 1-group pre-/posttest study investigated the effect of 4 months of daily wear (4 hours per day) of a BO on mobility, balance, and falls efficacy in 30 older adults living in a retirement community with limited mobility defined by a Short Physical Performance Battery (SPPB) score range between 4 and 9 out of a maximum of 12 points. Pre- and posttreatment tests included the Timed Up and Go (TUG), Functional Gait Assessment (FGA), Falls Efficacy Scale (FES), and SPPB. Participants received the BBTW assessment, consisting of individualized assessment of 3-dimensional balance loss, and treatment with a strategically weighted and fitted BO to control balance loss. The BO was worn twice a day for 2 hours (4 hours per day) for 4 months. Participants continued regular activity and no other interventions were provided. All posttests were conducted after 4 months and at least 8 hours after removal of the BO. Subitems from the SPPB (gait speed [GS], 5-time sit-to-stand [FTSST], and tandem stance time [TST]) were analyzed as separate outcome measures. Data were analyzed with paired t tests with a Bonferroni correction (SPPB, GS, FGA, and FES) when statistical assumptions were met. Data that did not meet the statistical assumptions of the paired t test (FTSST, TST, and TUG) were analyzed with Wilcoxon signed rank tests with a Bonferroni correction. RESULTS AND DISCUSSION: Twenty-four participants, average age 87 (5.7) years, completed the study. Paired t tests indicated that mean group scores on the SPPB, GS, and FGA significantly improved from pre- to posttests. The SPPB improved by 1.3 points (P = .001). GS improved by 0.09 m/s (P = .004) and both mean values improved beyond fall risk cutoffs. The FGA also improved by 2.6 points (P = .001). There were no significant changes in FES scores (P = .110). Wilcoxon signed rank tests indicated median group scores of the FTSST significantly improved from pre- to posttests by 7.4 seconds (P = .002) and median TUG times improved by 3.5 seconds (P = .004). There were no changes in TST (P = .117). CONCLUSIONS: This study suggests that wearing a BO for 4 hours per day for 4 months results in improvements in functional assessments related to fall risk (SPPB, GS, FGA, TUG, and FTSST) in a group of older adult participants with limited mobility.

Effects of Torso-Weighting on Standing Balance and Falls During the Sensory Organization Test in People with Multiple Sclerosis.

BACKGROUND: In people with multiple sclerosis (MS), common gait and balance impairments can lead to falls, fear of falling, activity restriction, and social isolation. Sensory augmentation in the form of torso-weighting has resulted in improvement in gait and balance, but research on its effect on falls in MS is lacking. METHODS: 60 people with MS and 10 bin-matched controls completed the Sensory Organization Test (SOT) while nonweighted and again while weighted using the Balance-Based Torso-Weighting assessment method. This was a quasi-experimental pre-post intervention study. The SOT composite scores, equilibrium scores, and number of falls occurring across six SOT conditions were compared between and within groups using 2-way analysis of variance, α = .05 with planned t test analyses of weighting effects. RESULTS: A significant increase in composite score of 9.14 points nonweighted to weighted occurred in the MS group (P < .001) but not in controls (P = .626). Equilibrium scores were significantly higher with weights in the MS group (P < .001) but not in controls (P = .5). Falls during the SOT were reduced by 35% with weights in the MS group versus without weights (P < .001), with the greatest number of falls occurring in the most challenging SOT conditions. CONCLUSIONS: During a single testing session, torso-weighting produced significant improvements in postural stability and fall reduction during the SOT for people with MS but no change in controls. Further research is needed to determine whether torso-weighting has the potential to reduce falls in MS during real-world activities.

Gait changes with balance-based torso-weighting in people with multiple sclerosis.

BACKGROUND AND PURPOSE: People with multiple sclerosis (PwMS) commonly have mobility impairments that may lead to falls and limitations in activities. Physiotherapy interventions that might improve mobility typically take several weeks. Balance-based torso-weighting (BBTW), a system of strategically placing light weights to improve response to balance perturbations, has resulted in immediate small improvements in clinical measures in PwMS, but changes in spatiotemporal gait parameters are unknown. The purpose was to investigate the effects of BBTW on gait parameters in PwMS and healthy controls. METHODS DESIGN: This study is a non-randomized controlled experiment. PARTICIPANTS: This study included 20 PwMS and 20 matched healthy controls PROCEDURES: People with multiple sclerosis walked on an instrumented mat at their fastest speed for three trials each in two conditions: without BBTW then with BBTW. Healthy controls walked in both conditions at two speeds: their fastest speed and at velocities equivalent to their matched PwMS. RESULTS: Averaged gait trials showed that, with BBTW, PwMS had significantly increased velocity (p = 0.002), cadence (p = 0.007) and time spent in single-limb support (p = 0.014), with decreased time in double-limb support (p = 0.004). Healthy controls increased velocity (p = 0.012) and cadence (p = 0.015) and decreased support base (p = 0.014) in fast trials with BBTW; at matched velocities, step length (p = 0.028) and support base (p = 0.006) were significantly different from PwMS. All gait variables in healthy controls at fast speeds were significantly different from PwMS walking at their fastest speeds. DISCUSSION: All participants showed increases in gait velocity and cadence during fast walk with BBTW. Improvements in time spent in single-limb and double-limb support by PwMS with BBTW may reflect greater stability in gait. Future research might ascertain if these immediate improvements could enhance effectiveness of longer-term physiotherapy on functional mobility in PwMS.

In-home measurement of the effect of strategically weighted vests on ambulation.

Strategically weighted vests are currently being used to treat patients with Parkinson's, Multiple Sclerosis, and ataxia. While studies have been conducted to demonstrate the effectiveness of these vests, there has been very little research into the mechanisms that give rise to the vest's results. This study demonstrates the ability to capture gait parameters from depth images[1] in the home with sufficient sensitivity to support future investigation of the weighted vest intervention. The study also explores multiple metrics, using in-home gait sensing, to study a subject's ambulatory ability including gait mechanics, uncertainty in motion, and gait cadence. We then investigate the effects of these vests on a subject's ambulation by examining these metrics both before and after the vest is worn. While only four subjects were used, results are promising, showing a statistically significant and clinically significant change in many of these metrics as a result of the vest. The cases presented here concern two subjects, one with a "tight" gait caused by Progressive Supranuclear Palsy, and the second with an excessively "loose" gait due to Parkinson's disease. We show that in both subjects, using the vest immediately moved the metrics in a direction beneficial to the subject's clinical condition. This result concurs with clinical observations as measured using various clinical fall risk instruments.

Randomized clinical trial of balance-based torso weighting for improving upright mobility in people with multiple sclerosis.

BACKGROUND: Torso weighting has sometimes been effective for improving upright mobility in people with multiple sclerosis, but parameters for weighting have been inconsistent. OBJECTIVE: To determine whether balance-based torso weighting (BBTW) has immediate effects on upright mobility in people with multiple sclerosis. METHODS: This was a 2-phase randomized clinical trial. In phase 1, 36 participants were randomly assigned to experimental and control groups. In phase 2, the control group was subsequently randomized into 2 groups with alternate weight-placement. Tests of upright mobility included: timed up and go (TUG), sharpened Romberg, 360-degree turns, 25-foot walk, and computerized platform posturography. Participants were tested at baseline and again with weights placed according to group membership. In both phases, a physical therapist assessed balance for the BBTW group and then placed weights to decrease balance loss. In phase 1, the control group had no weights placed. In phase 2, the alternate treatment group received standard weight placement of 1.5% body weight. RESULTS: People with BBTW showed a significant improvement in the 25-foot walk (P = .01) over those with no weight, and the TUG (P = .01) over those with standard weight placement. BBTW participants received an average of 0.5 kg, less than 1.5% of any participant's body weight. CONCLUSION: BBTW can have immediate advantages over a nonweighted condition for gait velocity and over a standardized weighted condition for a functional activity in people with multiple sclerosis (MS) who are ambulatory but have balance and mobility abnormalities.

Balance-based torso-weighting may enhance balance in persons with multiple sclerosis: preliminary evidence.

OBJECTIVE: To determine whether weight placed on the trunk in response to directional balance loss would enhance function and stability in people with multiple sclerosis (MS). DESIGN: Quasi-experimental study in which subjects served as their own controls. SETTING: Research laboratory. PARTICIPANTS: Subjects (N=16) age 20 to 65 years with MS recruited through the Northern California Chapter of the National Multiple Sclerosis Society. INTERVENTIONS: Balance-based torso-weighting where up to 1.5% body weight was placed in a garment on the trunk. Subjects were tested at baseline and then in randomly ordered balance-based torso-weighting and nonweighted garment conditions. MAIN OUTCOME MEASURES: Sharpened Romberg, eyes open (SREO) and Sharpened Romberg, eyes closed, computerized dynamic platform posturography (CDPP), Timed Up & Go (TUG), and 25-foot timed walk. RESULTS: Significant improvement (P<.014) was found with SREO in the balance-based torso-weighting compared with nonweighted conditions. CDPP eyes open and TUG showed improvements (P<.03) from baseline to balance-based torso-weighting and nonweighted conditions. CONCLUSIONS: Improved performance in a group of adults with MS was seen when light weights were placed on the torso to counteract balance loss. Placement of weights may have the potential to produce immediate improvements in balance in this population.

Balance-based torso-weighting in a patient with ataxia and multiple sclerosis: a case report.

OBJECTIVE: The use of external body weights, although controversial, is occasionally employed to improve balance or mobility in patients with ataxia or tremor. This case report describes the effect of torso-weighting to counteract directional balance loss in a woman with relapsing/remitting multiple sclerosis. CASE DESCRIPTION: Clinical examination of a 40-year-old woman after multiple sclerosis exacerbation revealed loss of balance in the posterior direction during quiet standing as well as loss of dynamic balance in the posterior and lateral directions. The patient's standing posture was with her trunk posterior to her pelvis. She exhibited decreased strength in both extremities and trunk, diminished sensation in the right lower extremity and palms, and an unstable ataxic gait. Difficulty with walking and severe fatigue and dizziness were also reported. Standing balance and alignment were examined during (1) quiet standing with eyes open and eyes closed, (2) transitional movements, and (3) multidirectional trunk perturbations. The patient demonstrated a loss of balance and alignment in the posterior direction in all tests. INTERVENTION: Based on balance examination results, the patient was fitted with a 0.5-lb vest containing 1.5-lb of additional weight placed anteriorly on the torso at the level of the umbilicus. Progressive balance, gait, and functional activities were repeated both with and without weighting the torso over six weeks. OUTCOME: Immediately on weighting, the patient demonstrated less sway in quiet standing, increased stability when perturbed, improved body alignment, and less ataxia during gait. The patient was able to accomplish more challenging activities with better balance while weighted. Functional improvement in walking and improved control during balance activities were demonstrated in later treatment sessions without weighting. CONCLUSION: Placing small amounts of weight asymmetrically on the torso, based on directional loss of balance and alignment, seemed to assist this patient in maintaining balance during static and dynamic activities. Additional research may help determine whether this intervention is applicable to others with directional losses of balance, ataxia, or multiple sclerosis to improve balance control.