Augmenting Balance in Individuals With Cerebellar Ataxias

Study Overview
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Brief Summary
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This study evaluates the effectiveness of a 12-week in home balance training program with and without sensory augmentation for individuals with ataxia. Subjects wear a belt while performing balance exercises three times per week for 12 weeks. The belt measures body motion and has small vibrating elements called tactors mounted inside that when turned on, feel like a cell phone set to vibrate. The tactors provide information about body motion and indicate when and how to make a postural correction. Subjects will receive six weeks of balance training with the tactors turned on and six weeks of balance training with the tactors turned off.

Detailed Description
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Cerebellar ataxias are a group of degenerative neurological disorders, resulting in deficits in speech, limb control, balance, and gait. Individuals with degenerative cerebellar ataxias are at a high-risk of falling and have progressive impairments in motor coordination resulting in unsteadiness in gait and posture. No definitive treatment options are available for ataxia. There is therefore a critical need to identify strategies to improve motor function and reduce falls in patients with ataxia. Physical therapy has been demonstrated to improve motor function in subjects with cerebellar ataxia, but the gains in performance following balance training are modest. Sensory augmentation is a technique of augmenting or replacing compromised sensory information. In the context of sensory-based balance impairments, a sensory augmentation device provides cues of body motion that supplement an individual's remaining intact sensory systems. The investigators hypothesize that sensory augmentation may improve the effectiveness of balance training in individuals with ataxia, and aid in greater improvement in motor function than traditional physical therapy alone. Sensory augmentation has been shown to decrease body sway during real-time operation in a laboratory setting in individuals with vestibular deficits and peripheral neuropathy, and general age-related declines in balance performance. Preliminary results suggest that persistent improvements in balance performance exist over time periods of hours to days following a small number of training sessions. This study aims to characterize the effects of sensory augmentation in individuals with ataxia during static and dynamic balance exercises over a period of twelve weeks of in home balance training with and without vibrotactile sensory augmentation.

Official Title
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Augmenting Balance in Individuals With Cerebellar Ataxias

Conditions
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Cerebellar Ataxia

Intervention / Treatment
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* Behavioral: Sensory Augmentation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Report to be in good general health Are able to read and comprehend English Have been diagnosed with either an inherited or sporadic degenerative cerebellar or sensory ataxia Are able to stand for at least 30 seconds with no support Must be willing and able to comply with study schedule Must have wireless internet (WiFi) enabled in their home Must be able to perform the home based exercises safely (as assessed by clinical research staff) Exclusion Criteria: Are pregnant or believe subject might be pregnant Have been diagnosed with arthritis or other musculoskeletal disorder affecting joints, muscles, ligaments and/or nerves that affects the way subject moves Have a history of fainting Have a severe vision or hearing impairment that is not corrected by glasses or hearing aids Have sustained a fall in the last six months that resulted in hospitalization or serious injury Have corrected vision worse than 20/70 (considered threshold for moderate visual impairment) Are unable to feel the vibrotactile feedback on their torso through the standard t-shirt provided by the study team Have ankle dorsi-flexor/plantar-flexor weakness as demonstrated < 4/5 on manual muscle test Have limited ankle range of motion demonstrated by inability to dorsiflex to neutral with the knee extended Report lower extremity fracture/sprain in the past six months or more than one lower extremity total joint replacement Are medically unstable (e.g. chest pain upon exertion, dyspnea, infection) Have a history of any other neurological disease besides ataxia that might affect balance (e.g. cerebral vascular accident, Parkinson's disease, MS, ataxia) Have a body mass index (BMI) over 30 kg/m2, computed from subject height and weight

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Sensory Augmentation Group 1<br>Each subject in Group 1 will undergo 6 weeks of balance training with sensory augmentation followed by 6 weeks of balance training without sensory augmentation. | Behavioral: Sensory Augmentation<br>* Sensory augmentation is a technique of augmenting or replacing compromised sensory information. In the context of sensory-based balance impairments, a sensory augmentation device provides cues of body motion that supplement an individual's remaining intact sensory systems.<br>* Other names: haptic feedback;|
| Experimental: Sensory Augmentation Group 2<br>Each subject in Group 2 will undergo 6 weeks of balance training without sensory augmentation followed by 6 weeks of balance training with sensory augmentation. | Behavioral: Sensory Augmentation<br>* Sensory augmentation is a technique of augmenting or replacing compromised sensory information. In the context of sensory-based balance impairments, a sensory augmentation device provides cues of body motion that supplement an individual's remaining intact sensory systems.<br>* Other names: haptic feedback;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Scale for the assessment and rating of ataxia (SARA) | An 8-item scale including walking, standing, sitting, nose-to-finger movements, and fast alternating movements. Standard assessment scale for determining impairment level in individuals with ataxia. | pre balance training (week 1), mid balance training (week 6), post balance training (week 12) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in 10-meter Preferred Gait Speed | Preferred gait velocity will be measured while walking a 10-meter path. | pre balance training (week 1), mid balance training (week 6), post balance training (week 12) | 
| Change in 10-meter Fast Gait Speed | Fast gait velocity will be measured while walking a 10-meter path. | pre balance training (week 1), mid balance training (week 6), post balance training (week 12) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ataxia, balance training, vibrotactile biofeedback, sensory augmentation, cerebellar ataxia