scholarly journals Gait and Balance Function Improves After 10 Weeks of Using a Wearable Sensory Neuroprosthesis in Persons with Peripheral Neuropathy and High Fall Risk - the walk2Wellness Trial

2020 ◽  
Author(s):  
Lars I E Oddsson ◽  
Teresa Bisson ◽  
Helen S Cohen ◽  
Laura Jacobs ◽  
Mohammad Khoshnoodi ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Gait Speed ◽  
Fall Risk ◽  
Patient Reported Outcomes ◽  
Foot Pressure ◽  
Balance Test ◽  
Tactile Stimuli ◽  
Patient Reported ◽  
Abc Scale ◽  
Balance Problems

Background: Patients with sensory peripheral neuropathy (PN) commonly present with gait and balance problems increasing their risk of falls. The multi-site walk2Wellness trial investigates effects of long-term, home-based daily use of a wearable lower limb sensory neuroprosthesis on gait function, balance, quality of life and fall rates in a cohort of PN patients. The device (Walkasins®, RxFunction Inc., MN, USA) is designed to replace lost nerve function related to foot pressure sensation by providing directional tactile cues around the ankle reflecting foot pressure measurements during standing and walking activities. We hypothesized that previously shown short-term in-clinic improvements in gait and balance would be sustained after 10 weeks of use. Methods: Participants had a PN diagnosis with loss of plantar sensation associated with gait and balance problems, a Functional Gait Assessment (FGA) score <23 (cut-off for high fall risk), and ability to sense Leg Unit tactile stimuli. Clinical outcomes included FGA, Gait Speed, Timed Up&Go (TUG) and Four-Stage Balance Test. Patient-reported outcomes included Activities-Specific Balance Confidence (ABC) scale, Vestibular Disorders Activities of Daily Living Scale (VADL), PROMIS participation and satisfaction scores, pain rating, and falls. Evaluations were performed at baseline visit and after 2, 6, and 10 weeks. Subjects were not made aware of any changes in outcomes and no additional balance interventions were allowed. Results: Forty-five participants of 52 enrolled across four sites completed all in-clinic assessments. FGA scores improved from 15.0 at baseline to 19.1 at 10 weeks (p<0.000001), normal and fast gait speed from 0.86m/s to 0.95m/s (p<0.00005) and 1.24m/s to 1.33m/s (p<0.002), respectively, and TUG from 13.8s to 12.5s (p<0.012). Four-Stage Balance Test did not improve significantly. Several patient-reported outcomes were in normal range at baseline and remained largely unchanged. Interestingly, while FGA scores improved similarly across the baseline range, subjects with baseline ABC scores lower than 67% (cut-off for high fall risk) showed an increase in their ABC scores (from 49.9% to 59.3%, p<0.01), whereas subjects with baseline ABC scores above 67% showed a decrease (from 76.6% to 71.8%, p<0.019). Subjects who reported falls in the prior six months (n=25) showed a decrease in the number of fall-risk factors (from 5.1 to 4.3, p<0.023) as well as a decrease in fall rate from 13.8 to 7.4 falls/1000 days (p<0.014). Four subjects in the pre-study non-faller group (n=20) fell during the 10 weeks of the study. Conclusion: A wearable sensory neuroprosthesis may provide a new way to treat gait and balance problems and manage falls in high fall-risk patients with PN. Trial registration: ClinicalTrials.gov (#NCT03538756)

scholarly journals Identifying Foot and Ankle Patients at Risk to Fall Based on Patient Reported Outcomes Assessments

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0002
Author(s):  
Judith Baumhauer ◽  
Jack Teitel ◽  
Allison McIntyre ◽  
David Mitten ◽  
Jeff Houck
Keyword(s):  
At Risk ◽  
Effect Size ◽  
Fall Risk ◽  
Patient Reported Outcomes ◽  
The United States ◽  
Foot And Ankle ◽  
Falls Risk ◽  
Orthopaedic Patients ◽  
Patient Reported ◽  
Patients At Risk

Category: Other Introduction/Purpose: Each year approximately 30-40% of people over the age of 65 fall. Approximately one half of these falls result in an injury with the estimated annual direct medical costs of $30 billion. Pain, mobility issues, neuropathy and post-operative weight bearing limitations make foot and ankle patients particularly vulnerable to falls. Current approaches to determine at risk patients are cumbersome and time consuming requiring performance testing and “hands on” clinical assessment. The efficiency of obtaining PRO, such as PROMIS, in the clinical arena has been well documented. The purpose of this study is determine if patient reported outcomes (PROMIS) can identify orthopaedic and specifically foot and ankle patients at risk to fall. Methods: Prospective patient reported outcomes (PROMIS CAT physical function, pain interference and depression and CMS fall risk assessment questions) and patient demographics were collected for all patients at each clinic visit from an academic orthopaedic multi-specialty practice between January 2015 and November 2017. Standardized yes/no validated self-reported fall risk questions include: “Have you fallen in the last year?” and “Do you feel you are at risk of falling?” Histograms, t-tests, confidence intervals and effect size were used to determine the fall risk “YES” patients were different than the “NO” for ALL orthopaedic patients and specifically foot and ankle patients. Logistic Regression was used to determine if age, gender, height, weight, and PROMIS scales predicted self-reported falls risk. Results: 94,761 orthopaedic patients comprising 315,273 visits (44% male, mean age 53.7+/-17 years) and 13,720 foot/ankle patients comprising 33,480 visits (37% male, mean age 52.7+/-16.1 years) had complete data for analysis. Table 1 provides the means/SD/p-values/effect sizes for patient self-identifying at risk to fall stratified by PROMIS PF/ PI/Dep t-scores. Although all PROMIS scores demonstrated significant impairment between patients at risk designation (yes/no), PROMIS PF had the largest effect size for ALL Ortho and FOOT AND ANKLE patients (0.8 and 0.7 respectively). Patients who are at risk to fall have PROMIS PF t-scores >1.5 lower than the United States normative population while the patients not at risk are less <1 SD. In the adjusted regression models gender and PROMIS PF had the largest coefficients. Conclusion: Falls are a major threat to quality of life and independence yet prevention/treatment strategies are difficult to implement across a health system. There is also a tremendous societal cost with orthopaedic surgeons often the recipient of these debilitated patients. PROMIS assessments are part of the AOFAS OFAR initiative to track patient recovery with treatment and can additional be used to fulfill a quality indicator requirement by CMS. This study demonstrates these assessments (PROMIS threshold values) can also be linked to self-report falls risk (yes/no) and may identify patients at risk with no face to face time required from the provider.

Chemotherapy-induced peripheral neuropathy—patient-reported outcomes compared with NCI-CTCAE grade

2019 ◽  
Vol 27 (12) ◽  
pp. 4771-4777 ◽  
Author(s):  
Aaron C. Tan ◽  
J. Matt McCrary ◽  
Susanna B. Park ◽  
Terry Trinh ◽  
David Goldstein
Keyword(s):  
Peripheral Neuropathy ◽  
Patient Reported Outcomes ◽  
Patient Reported

scholarly journals Physical Impairments, Sensory Disturbance and Functional Ability in Cancer Patient With and Without Chemotherapy-induced Peripheral Neuropathy Symptoms

2021 ◽  
Author(s):  
Nida Rattanakrong ◽  
Noppawan Promma ◽  
Chanatsupang Saraboon ◽  
Pooriput Waongenngarm
Keyword(s):  
Peripheral Neuropathy ◽  
Cancer Survivors ◽  
Functional Ability ◽  
Sensory Disturbance ◽  
Cross Sectional ◽  
Physical Impairments ◽  
Eyes Closed ◽  
Patient Reported ◽  
Romberg Test ◽  
Abc Scale

Abstract ObjectiveThe present study examined the objective and patient-reported measures of physical impairments, sensory disturbance and functional ability between cancer patients with and without chemotherapy-induced peripheral neuropathy (CIPN) symptoms.Methods41 cancer survivors exposed to neurotoxic chemotherapies were conveniently recruited and completed a single cross-sectional assessment of patient-reported outcomes (VAS for pain intensity and ABC scale) and objective assessments (SWM test, TUG test, 5xSTS test, Romberg test with eyes open and eyes closed, 6MWT, and FAB scale).ResultsCancer patients who had undergone chemotherapy with CIPN symptoms did significantly worse in the SWM test, TUG test, 5xSTS test, Romberg test with eyes closed, 6MWT, FAB scale, and ABC scale (p<0.05) when compared with cancer survivors without CIPN symptoms.ConclusionCancer survivors with CIPN symptoms have lower physical performance, sensory perception, and functional ability, which may increase the risk of falling and disability. These findings further emphasize the need for effective rehabilitation and interventions to treat CIPN symptoms and related physical impairment and functional deficits.

Effects of a home-based step training programme on balance, stepping, cognition and functional performance in people with multiple sclerosis – a randomized controlled trial

2015 ◽  
Vol 22 (1) ◽  
pp. 94-103 ◽  
Author(s):  
Phu Hoang ◽  
Daniel Schoene ◽  
Simon Gandevia ◽  
Stuart Smith ◽  
Stephen R Lord
Keyword(s):  
Randomized Controlled Trial ◽  
Gait Speed ◽  
Fall Risk ◽  
Functional Performance ◽  
Controlled Trial ◽  
Intervention Group ◽  
Training Programme ◽  
Control Group ◽  
Balance Test ◽  
Randomized Controlled

Background: Stepping impairments increase fall risk in people with MS. No studies have evaluated step training for reducing fall risk in this population. Objectives: To determine if step training can improve physical and neuropsychological measures associated with falls in MS. Methods: 50 PwMS with moderate disability participated in a randomized controlled trial in which intervention group participants ( n = 28) performed step training for 12 weeks while controls ( n = 22) continued usual physical activity. The primary outcomes were choice stepping reaction time (CSRT) and Stroop stepping test (SST) time. Secondary outcomes included balance test (postural sway, CSRT components), gait speed and cognitive tests, nine-hole peg test (9-HPT) and MS functional composite (MSFC) score. Results: 44 participants completed the study and no adverse events were reported. Compared with the control group, the intervention group performed significantly better at retest in CSRT and SST times, and tests of sway with eyes open, 9-HPT, single and dual task gait speed and MSFC score. There was a non-significant trend for fewer falls in the intervention group. Conclusions: The findings indicate that the step training programme is feasible, safe and effective in improving stepping, standing balance, coordination and functional performance in people with MS.

scholarly journals Use of a Short Version of the Activities-specific Balance Confidence Scale in Multiple Sclerosis

2019 ◽  
Vol 21 (1) ◽  
pp. 15-21
Author(s):  
Tyler A. Wood ◽  
Douglas A. Wajda ◽  
Jacob J. Sosnoff
Keyword(s):  
Multiple Sclerosis ◽  
Internal Consistency ◽  
Fall Risk ◽  
Convergent Validity ◽  
Internal Consistency Reliability ◽  
Self Report ◽  
Balance Confidence ◽  
Patient Reported ◽  
Good Internal Consistency ◽  
Abc Scale

Abstract Background: Multiple sclerosis (MS) is a neurologic disease that results in balance and mobility impairments that are associated with elevated fall risk. One common patient-reported outcome measure of balance is the 16-item Activities-specific Balance Confidence (ABC) scale. The ABC scale is valid and reliable in assessing balance confidence in people with MS. However, a shorter, six-question version of the ABC scale, the ABC-6 scale, has been proposed to save time in a clinical setting. Thus, we assessed the convergent validity and internal consistency reliability of the ABC-6 scale in people with MS. Methods: A total of 221 participants were included in this secondary analysis to compare the ABC-6 scale with the ABC scale. Convergent validity and internal consistency reliability were applied to participants based on fall history and physiological fall risk. Results: Statistical analysis indicated a main effect of group of the ABC and ABC-6 scales (P &lt; .001). Both scales showed good to very good internal consistency (Cronbach α range, 0.832–0.975) and good reliability (intraclass correlation coefficient score range, 0.888–0.941). Furthermore, both versions had moderate convergent validity. Sensitivity ranged from 30% to 97%, and specificity ranged from 64% to 100% across groups tested. Conclusions: The ABC and ABC-6 scales demonstrated good internal consistency reliability and moderate convergent validity in predicting balance confidence in people with MS. However, poor sensitivity of both versions in distinguishing between MS groups at risk for falls may call into question the usefulness of this self-report measure.

Abstract 46: A New Rehabilitation Strategy to Improve Gait Speed and Balance Self-Efficacy Following Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Dorian K Rose ◽  
Lou DeMark ◽  
Christy Conroy ◽  
Emily Fox ◽  
David Clark
Keyword(s):  
Lower Extremity ◽  
Gait Speed ◽  
Fall Risk ◽  
Step Length ◽  
Walk Test ◽  
Post Intervention ◽  
Backward Walking ◽  
Balance Confidence ◽  
Post Stroke ◽  
Abc Scale

Introduction: Impaired balance and decreased balance confidence contribute to slow gait speed and increased fall risk post-stroke. Standard balance exercises and gait training do not adequately address these impairments. Backward Walking Training (BWT), incorporating the unique postural and lower extremity motor control demands of walking backward, may reduce these gait impairments. This study compared the effects of BWT to Forward Walking Training (FWT) on forward and backward gait speed, dynamic balance and balance confidence. Methods: Thirty adults with first time stroke (18 male; 15 right hemisphere lesion; mean time post-stroke 12.7±6.6 months; mean age 58.8±10.1 yrs; mean Lower Extremity Fugl-Meyer Motor Score 22.7±1.4) were randomized to receive eighteen exercise sessions (3x/week for 6 weeks) of BWT (n=15) or FWT (n=15) consisting of 20 minutes training on a treadmill with Body Weight Support followed by 20 minutes overground. Gait was facilitated by a physical therapist-led team. Speed, limb loading and bout duration were progressed across sessions. The Ten Meter Walk Test (10MWT), Activities-Specific Balance Confidence (ABC) Scale, 3-meter Backward Walk Test (3MBWT), Functional Gait Assessment (FGA) and spatial-temporal gait characteristics were assessed pre- and post-intervention. Results: Pre- to post-intervention increases in the 3MBWT (BWT: 0.23±0.4 to 0.32±0.06 m/s ; FWT 0.21±0.4 to 0.23±0.04 m/s: ), ABC (BWT: 55.2±5.2% to 61.8±7.1% ; FWT: 52.9±6.5% to 53.5±6.2%: ), 10MWT (BWT: 0.42±0.07 to 0.51±0.08 m/s ; FWT: 0.44±0.08 to 0.47±0.07 m/s ) and backward paretic step length (BWT: 0.19±0.04 to 0.34±0.03 cm ; FWT: 0.21±0.03 to 0.20±0.04 cm were greater for the BWT than the FWT group. These gains were all statistically significant (p < 0.01). Group differences in FGA did not reach statistical significance. Conclusions: The greater increase in backward paretic step length, backward walking speed and balance confidence observed in the BWT group are all known contributors to reduced fall risk. BWT may be an important addition to the rehabilitation plan for individuals post-stroke. A longitudinal examination of fall incidence following BWT is the next important step in determining the overall utility of this novel rehabilitation approach.

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