Visual Perturbations for Balance Disorder
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Phase < 1
Recruiting
Sponsor: University of Florida
Disqualifiers: Cognitive disorder, Musculoskeletal injury, Neurological injury, Low vision, others
Trial Summary
What is the purpose of this trial?The purpose of this research study is to determine if intermittent visual perturbations can improve balance training. The investigators will quantify differences in body movement, muscle activity, and beam walking performance during and after practice walking on a balance beam that is 1" high. The investigators will ask the participants to come to the laboratory twice (2 sessions). The first session will not last more than 3 hours. The second session will not last more than 1 hour and will be two weeks after the first session. In total, the maximum amount of time the participant would be asked to participate is 4 hours.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications.
What data supports the effectiveness of the treatment Intermittent Visual Perturbations for balance disorder?
Research shows that visual inputs can significantly influence balance control, as seen in studies where visual perturbations affected balance in people with multiple sclerosis and improved posture stability in patients with vestibular dysfunction. This suggests that using visual perturbations could help identify and potentially improve balance issues in patients with balance disorders.
12345How does the treatment Intermittent Visual Perturbations differ from other treatments for balance disorders?
Intermittent Visual Perturbations is unique because it uses visual stimuli to challenge and improve balance by creating controlled visual disturbances, unlike traditional treatments that may focus on physical exercises or medication. This approach leverages the brain's reliance on visual information to maintain balance, offering a novel way to address balance issues.
12456Eligibility Criteria
This trial is for individuals with balance disorders. Participants will need to attend two lab sessions, the first lasting up to 3 hours and a follow-up after two weeks lasting up to 1 hour. Specific inclusion or exclusion criteria are not provided.Inclusion Criteria
I am willing to be assigned to any study group and follow all study procedures.
I am between 18-30 or 65-89 years old.
I can walk by myself for 10 minutes without stopping.
Exclusion Criteria
I have a recent leg injury that hurts when I walk or limits my walking.
I have a cognitive disorder that affects my daily independence.
I have a history of neurological issues like stroke or MS.
+4 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
1-2 weeks
Training and Testing
Participants undergo balance training and testing with intermittent visual perturbations using goggles. The first session includes a pre-test, 30 minutes of training, and a post-test.
1 day
1 visit (in-person)
Follow-up Testing
Participants return for a post-test to assess retention of balance training improvements.
1 day
1 visit (in-person)
Follow-up
Participants are monitored for balance changes between the initial training and follow-up sessions.
2 weeks
Participant Groups
The study tests whether wearing visual occlusion goggles while walking on a low-height balance beam can improve balance training outcomes. It measures body movement, muscle activity, and performance on the beam.
9Treatment groups
Experimental Treatment
Placebo Group
Group I: Intervention - Vision for 7.5s and Occlusion for 3sExperimental Treatment2 Interventions
Participants will complete the balance beam walking practice while wearing the goggles. Vision time will be set to 7.5s, and the occlusion time will be set to 3s for the duration of the practice time.
Group II: Intervention - Vision for 7.5s and Occlusion for 1.5sExperimental Treatment2 Interventions
Participants will complete the balance beam walking practice while wearing the goggles. Vision time will be set to 7.5s, and the occlusion time will be set to 1.5s for the duration of the practice time.
Group III: Intervention - Vision for 7.5s and Occlusion for 0.75sExperimental Treatment2 Interventions
Participants will complete the balance beam walking practice while wearing the goggles. Vision time will be set to 7.5s, and the occlusion time will be set to 0.75s for the duration of the practice time.
Group IV: Intervention - Vision for 3.75s and Occlusion for 1.5sExperimental Treatment2 Interventions
Participants will complete the balance beam walking practice while wearing the goggles. Vision time will be set to 3.75s, and the occlusion time will be set to 1.5s for the duration of the practice time.
Group V: Intervention - Vision for 15s and Occlusion for 1.5sExperimental Treatment2 Interventions
Participants will complete the balance beam walking practice while wearing the goggles. Vision time will be set to 15s, and the occlusion time will be set to 1.5s for the duration of the practice time.
Group VI: Intervention - Low Visible Light TransmissionExperimental Treatment2 Interventions
Participants will complete the balance beam walking practice while wearing the goggles. Vision time will be set to 7.5s, and the occlusion time will be set to 1.5s for the duration of the practice time. The visible light transmission will be set to a low value around 20% instead of total blackout for the occlusion time.
Group VII: Intervention - High Visible Light TransmissionExperimental Treatment2 Interventions
Participants will complete the balance beam walking practice while wearing the goggles. Vision time will be set to 7.5s, and the occlusion time will be set to 1.5s for the duration of the practice time. The visible light transmission will be set to a high value around 90% instead of total blackout for the occlusion time.
Group VIII: Intervention - Goggles Worn But Turned OffExperimental Treatment2 Interventions
Participants will complete the balance beam walking practice while wearing the goggles, but they will not be turned on.
Group IX: Control - No GogglesPlacebo Group2 Interventions
Participants will complete the balance beam walking practice without any changes to vision.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
The University of FloridaGainesville, FL
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Who Is Running the Clinical Trial?
University of FloridaLead Sponsor
National Institutes of Health (NIH)Collaborator
National Institute of Neurological Disorders and Stroke (NINDS)Collaborator
References
A virtual reality head stability test for patients with vestibular dysfunction. [2019]The contribution of visual information to standing balance in patients with vestibular dysfunction varies between patients. Sensitive tools to detect kinematic response to visual perturbation are needed to individualize treatment.
The Effects of Optical Flow Perturbations on Standing Balance in People With Multiple Sclerosis. [2023]Multiple sclerosis is a neurodegenerative disease that causes balance deficits, even in early stages. Evidence suggests that people with multiple sclerosis (PwMS) rely more on vision to maintain balance, and challenging balance with optical flow perturbations may be a practical screening for balance deficits. Whether these perturbations affect standing balance in PwMS is unknown. Therefore, the purpose of this study was to examine how optical flow perturbations affect standing balance in PwMS. We hypothesized that perturbations would cause higher variability in PwMS compared with matched controls during standing and that standing balance would be more susceptible to anterior-posterior (A-P) perturbations than medial-lateral (M-L) perturbations. Thirteen PwMS and 13 controls stood under 3 conditions: unperturbed, M-L perturbation, and A-P perturbations. A-P perturbations caused significantly higher A-P trunk sway variability in PwMS than controls, although both groups had similar center-of-pressure variability. Both perturbations increased variability in A-P trunk sway and center of pressure. Trunk variability data supported the hypothesis that PwMS were more susceptible to optical flow perturbations than controls. However, the hypothesis that A-P perturbations would affect balance more than M-L perturbations was partially supported. These results suggest potential for optical flow perturbations to identify balance deficits in PwMS.
Multisensory integration in balance control. [2022]This chapter provides an introduction to the topic of multisensory integration in balance control in, both, health and disease. One of the best-studied examples is that of visuo-vestibular interaction, which is the ability of the visual system to enhance or suppress the vestibulo-ocular reflex (VOR suppression). Of clinical relevance, examination of VOR suppression is clinically useful because only central, not peripheral, lesions impair VOR suppression. Visual, somatosensory (proprioceptive), and vestibular inputs interact strongly and continuously in the control of upright balance. Experiments with visual motion stimuli show that the visual system generates visually-evoked postural responses that, at least initially, can override vestibular and proprioceptive signals. This paradigm has been useful for the study of the syndrome of visual vertigo or vision-induced dizziness, which can appear after vestibular disease. These patients typically report dizziness when exposed to optokinetic stimuli or visually charged environments, such as supermarkets. The principles of the rehabilitation treatment of these patients, which use repeated exposure to visual motion, are presented. Finally, we offer a diagnostic algorithm in approaching the patient reporting oscillopsia - the illusion of oscillation of the visual environment, which should not be confused with the syndrome mentioned earlier of visual vertigo.
Identification of human balance control responses to visual inputs using virtual reality. [2022]Human upright balance is maintained through feedback mechanisms that use a variety of sensory modalities. Vision senses information about the position and velocity of the visual surround motion to improve balance by reducing the sway evoked by external disturbances. This study characterized the effects of visual information on human anterior-posterior body sway in upright stance by presenting perturbations through a virtual reality system. This made it possible to use a new visual perturbation signal, based on trapezoidal velocity pulses, whose amplitude and velocity could be controlled separately. To date, the influences of visual field position and velocity have only been studied independently due to the experimental limitations. The hip displacement, ankle torques, shank angles, and surface EMGs of four major ankle muscles were measured bilaterally as outputs. We found that the root mean square (RMS) hip displacement (body angle) increased systematically with visual input amplitude. However, for each amplitude, the RMS body angle increased when input velocity was changed from 2 to 5 degrees per second (dps) and then decreased from 5 to 10 dps. Spectral analysis was used to compute frequency response over a frequency range from 0.04 to 0.6 Hz. The gain of body sway relative to the perturbation increased with frequency, whereas the coherence declined. Moreover, as the stimulus amplitude increased, the gain generally decreased, whereas the mean coherence values always increased. The mean gains and mean coherence values were greatest for the velocity of 5 dps. This study presents a novel experimental approach to study human postural control and augments our knowledge of how visual information is processed in the central nervous system to maintain balance.NEW & NOTEWORTHY In this paper, we developed a new methodological approach to study the effects of visual information on dynamic body sway. We used VR to apply visual perturbations to induce AP body sway. We designed a new visual stimulus waveform based on trapezoidal velocity pulses whose peak-to-peak amplitude and velocity could be modulated independently. Subsequently, we investigated how the amplitude and velocity of visual field motion influence the postural responses evoked in healthy adults.
How Eye Movements Stabilize Posture in Patients With Bilateral Vestibular Hypofunction. [2020]Chronic patients with bilateral vestibular hypofunction (BVH) complain of oscillopsia and great instability particularly when vision is excluded and on irregular surfaces. The real nature of the visual input substituting to the missing vestibular afferents and improving posture control remains however under debate. Is retinal slip involved? Do eye movements play a substantial role? The present study tends to answer this question in BVH patients by investigating their posture stability during quiet standing in four different visual conditions: total darkness, fixation of a stable space-fixed target, and pursuit of a visual target under goggles delivering visual input rate at flicker frequency inducing either slow eye movements (4.5 Hz) or saccades (1.2 Hz). Twenty one chronic BVH patients attested by both the caloric and head impulse test were examined by means of static posturography, and compared to a control group made of 21 sex-and age-matched healthy participants. The posturography data were analyzed using non-linear computation of the center of foot pressure (CoP) by means of the wavelet transform (Power Spectral Density in the visual frequency part, Postural Instability Index) and the fractional Brownian-motion analysis (stabilogram-diffusion analysis, Hausdorff fractal dimension). Results showed that posture stability was significantly deteriorated in darkness in the BVH patients compared to the healthy controls. Strong improvement of BVH patients' posture stability was observed during fixation of a visual target, pursuit with slow eye movements, and saccades, whereas the postural performance of the control group was less affected by the different visual conditions. It is concluded that BVH patients improve their posture stability by (1) using extraocular signals from eye movements (efference copy, muscle re-afferences) much more than the healthy participants, and (2) shifting more systematically than the controls to a more automatic mode of posture control when they are in dual-task conditions associating the postural task and a concomitant visuo- motor task.
Balance in Parkinson's disease patients changing the visual input. [2022]The description of the postural responses in Parkinson's disease patients when visual information changes from a stable to a moving visual field analyzing the impact on balance in these patients.