walk2Wellness: Long-term Effects of Walkasins® Wearable Sensory Prosthesis

The purpose of this study is to investigate the long-term effects of Walkasins® use on clinical and subject-reported outcomes of balance and gait function, quality of life, physical activity/participation, pain, and medication use in persons with peripheral neuropathy who experience balance problems.

The main objectives of this single-arm study are to show a long-term (10 weeks), sustained improvement in Functional Gait Assessment (FGA) score \>4 following Walkasins use as compared to participants' initial baseline assessments and to examine a potential relationship between initial baseline assessment data and long-term outcomes. The previous finding of a short-term FGA change \>4 during Walkasins use (NCT02115633) justifies a pre-post study design to investigate the long-term effects of Walkasins use. Although the primary timeframe for the primary endpoint is 10 weeks, participants will return for follow-up visits at 26 weeks and 52 weeks of Walkasins use.

The investigators also intend to extend their observations of the short-term effects of Walkasins by replicating the randomized cross-over design of a previous short-term study. (The randomized cross-over replication will occur only during the baseline visit. The long-term study consists of a single arm.) This study may help to further refine the prescription criteria for Walkasins and determine whether or not the presence of a short-term response is indicative of long-term improvements.

A subset of 10 participants at the Harvard Medical School site will be enrolled in a pilot study to investigate possible structural and functional changes in cortical areas of the brain related to somatosensory connectivity using magnetic resonance imaging (MRI). Structural as well as functional MRI scans will be acquired at baseline and after 26 weeks of daily Walkasins use. An exploratory analysis of MRI data will be performed and related to functional clinical outcomes associated with Walkasins use over the same time period.

Eligibility Criteria:
Inclusion Criteria:

* Age: 18-90 years, male or female
* Formal diagnosis of sensory peripheral neuropathy prior to participating in the study
* Self-reported balance problems
* Ability for transfers or ambulation on level surfaces at fixed cadence as assessed by the physical therapist during the FGA
* FGA \<23, the cut-off score for high fall-risk
* Ability to understand and provide informed consent
* Foot size that allows Walkasins® to function appropriately
* Must be able to complete all functional outcome measures without the use of an assistive device

Exclusion Criteria:

* Inability to perceive vibration from Walkasins leg unit
* Use of ankle-foot orthosis for ambulation that prevents donning of Walkasins
* Acute thrombophlebitis including deep vein thrombosis
* Untreated lymphedema
* Untreated lesion of any kind, swelling, infection, inflamed area of skin or eruptions on the lower leg near product use
* Untreated fractures in the foot and ankle
* Severe peripheral vascular disease
* Musculoskeletal or other neurological conditions that prohibit use of Walkasins as determined by clinician
* Weighs more than 300 pounds
* Plans to begin balance physical therapy (PT) during the first ten weeks of the clinical trial (Ongoing or previous balance PT is not an exclusionary criterion.)