Improvements in balance control for multiple sclerosis patients with vibro-tactile biofeedback of trunk sway
ECTRIMS Online Library. Yaldizli Ö. 09/13/19; 278640; P1440
Özgür Yaldizli
Özgür Yaldizli
Contributions
Abstract

Abstract: P1440

Type: Poster Sessions

Abstract Category: RIMS - Symptoms Management (including cognition, fatigue, imbalance)

J. Allum1, C. Schouenborg1, N. Lutz2, H. Rust3,4, B. Fischer-Barnicol3, V. Haller3, J. Kuhle3, T. Derfuss3, L. Kappos3, Ö. Yaldizli3,5

1Department of ORL, University Hospital Basel, Basel, 2Health Department, Bern University of Applied Sciences, Bern, 3Neurologic Clinic and Policlinic, Departments of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland, 4Division of Brain Sciences, Imperial College London, London, United Kingdom, 5Translational Imaging in Neurology (ThINK), University Hospital Basel, Basel, Switzerland

Introduction: Balance deficits are frequent in multiple sclerosis (MS). Previous studies have shown that vibrotactile feedback (VTf) of trunk sway improves MS patients' balance control compared to training without VTf.
Objectives: To determine how much VTf training is needed to obtain the best results with VTf. Moreover, we sought to investigate how long the carry-over benefit lasts once VTf training terminates and whether the benefit is similar for stance and gait tasks.
Methods: We included 14 MS patients with balance deficits: 4 male, 3/14 progressive MS, mean age 53.8 ± 7.5, disease duration 10.5±12.6 years; median EDSS 3.0. Patients trained stance and gait tasks 2x per week with VTf for 4 weeks to determine when balance control with and without VTf no longer improved. The VTf thresholds were based on 90% ranges of trunk sway amplitudes and velocities for stance and gait tasks, respectively, measured before each week's training sessions. Patients were then assessed weekly without VTf for another 4 weeks and 6 months later to determine when retention of improvement ended. The difference in trunk sway between the very first assessment and subsequent assessments was used to measure improvement. Balance was measured with gyroscopes mounted at the lower trunk. The gyroscope signals drove directionally active VTf in a head-band.
Results: VTf showed a 25% decrease in a global combined balance control index (BCI) of all tasks and measures (p< 0.004) for each of the 4 weeks of VTf training. The improvement was to within the range of healthy controls, and slightly less significant without VTf (p< 0.01). After cessation of training, the BCI showed an average 21% carry-over effect each week (p< 0.02) lasting over 1 month. At 6 months the carry-over effect was not present anymore. Improvement was present for both stance and gait tasks. For example, VTf improved trunk roll by 26% during walking with head extension-flexion movements (p< 0.02) and increased gait speed (30%) without an increase in trunk sway velocity.
Conclusions: VTf training yields clinically relevant reductions (to within normal limits) in sway during stance and gait, and improved gait speed. This research provides guidelines for the practical application of VTf for improved balance control in MS patients. The reduction of retained improvement 2-6 months after training is an estimate of the time when patients need to return to the clinic to receive VTf training again, but needs precise definition.
Disclosure: The study is funded by the ProPatient Stiftung, University Hospital Basel and the Freiwillige Akademische Gesellschaft Basel, Switzerland.
- JHJ Allum worked as a consultant for Balance International Innovations GmbH, Iseltwald, Switzerland.
- C Schouenborg has nothing to disclose.
- N Lutz has nothing to disclose.
- H Rust has nothing to disclose.
- B Fischer-Barnicol has nothing to disclose.
- V Haller received travel support from Merck and Biogen
- J Kuhle received speaker fees, research support, travel support, and/or served on advisory boards by ECTRIMS, Swiss MS Society, Swiss National Research Foundation [320030_160221], University of Basel, Bayer, Biogen, Genzyme, Merck, Novartis, Protagen AG, Roche, Teva.
- T Derfuss received speaker fees, research support, travel support, and/or served on Advisory Boards or Steering Committees of Novartis Pharma, Merck, Biogen, Teva, Bayer-Schering, GeNeuro, Mitsubishi Pharma, MedDay, Roche, and Genzyme; he received research support from Biogen, Novartis, Swiss National Research Foundation, University of Basel, and Swiss MS Society.
- L Kappos' Institution (University Hospital Basel) received in the last 3 years and used exclusively for research support at the Department: steering committee, advisory board and consultancy fees from Actelion, Almirall, Bayer, Biogen, Celgene/Receptos, df-mp, Excemed, Genzyme, Japan Tobacco, Merck, Minoryx, Mitsubishi Pharma, Novartis, Roche, sanofi-aventis, Santhera, Teva, Vianex and royalties for Neurostatus-UHB products. For educational activities the institution received payments and honoraria from Allergan, Almirall, Baxalta, Bayer, Biogen, CSL-Behring, Desitin, Excemed, Genzyme, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, Teva. L. Kappos has served in the last 24 months as international or local principal investigator for the following drug studies BOLD EXT., EXPAND (Siponimod, Novartis), DECIDE, DECIDE EXT. (Daclizumab HYP, Biogen), ENDORSE (DMF, Biogen), FINGORETT, FTY-UMBRELLA, INFORMS, INFORMS EXT LONGTERMS. (Fingolimod, Novartis), MOMENTUM (Amiselimod, Mitsubishi) OCRELIZUMAB PHASE II EXT., OPERA, ORATORIO and extensions (Ocrelizumab, Roche), REFLEXION (IFN β-1a, Merck), STRATA EXT, TOP (Natalizumab, Biogen), TERIFLUNOMIDE EXT, TERRIKIDS (Teriflunomide, Sanofi-Aventis) and ASCLEPIOS I/II (Ofatumumab, Novartis). The Research of the MS Center in Basel has been supported by grants from Bayer, Biogen, Novartis, the Swiss MS Society, the Swiss National Research Foundation, the European Union. In the last 24 months the institution also received grants for patient services from Bayer, Merck and CSL-Behring. L. Kappos is a member in the Editorial Boards of the following journals: 'Journal of Neurology', 'Multiple Sclerosis Journal', 'Neurology and Clinical Neuroscience', 'Multiple Sclerosis and Related Disorders', 'Clinical and Translational Neuroscience'. Honoraria and other payments for all these activities have been exclusively used for funding of research at the department.
- Ö Yaldizli´s Institution University Hospital Basel received grants from ECTRIMS/MAGNIMS, University of Basel, Pro Patient Stiftung University Hospital Basel, Free Academy Basel, Swiss Multiple Sclerosis Society and advisory board fees from Sanofi Genzyme, Biogen and Novartis Poland exclusively used for support of research and educational activities

Abstract: P1440

Type: Poster Sessions

Abstract Category: RIMS - Symptoms Management (including cognition, fatigue, imbalance)

J. Allum1, C. Schouenborg1, N. Lutz2, H. Rust3,4, B. Fischer-Barnicol3, V. Haller3, J. Kuhle3, T. Derfuss3, L. Kappos3, Ö. Yaldizli3,5

1Department of ORL, University Hospital Basel, Basel, 2Health Department, Bern University of Applied Sciences, Bern, 3Neurologic Clinic and Policlinic, Departments of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland, 4Division of Brain Sciences, Imperial College London, London, United Kingdom, 5Translational Imaging in Neurology (ThINK), University Hospital Basel, Basel, Switzerland

Introduction: Balance deficits are frequent in multiple sclerosis (MS). Previous studies have shown that vibrotactile feedback (VTf) of trunk sway improves MS patients' balance control compared to training without VTf.
Objectives: To determine how much VTf training is needed to obtain the best results with VTf. Moreover, we sought to investigate how long the carry-over benefit lasts once VTf training terminates and whether the benefit is similar for stance and gait tasks.
Methods: We included 14 MS patients with balance deficits: 4 male, 3/14 progressive MS, mean age 53.8 ± 7.5, disease duration 10.5±12.6 years; median EDSS 3.0. Patients trained stance and gait tasks 2x per week with VTf for 4 weeks to determine when balance control with and without VTf no longer improved. The VTf thresholds were based on 90% ranges of trunk sway amplitudes and velocities for stance and gait tasks, respectively, measured before each week's training sessions. Patients were then assessed weekly without VTf for another 4 weeks and 6 months later to determine when retention of improvement ended. The difference in trunk sway between the very first assessment and subsequent assessments was used to measure improvement. Balance was measured with gyroscopes mounted at the lower trunk. The gyroscope signals drove directionally active VTf in a head-band.
Results: VTf showed a 25% decrease in a global combined balance control index (BCI) of all tasks and measures (p< 0.004) for each of the 4 weeks of VTf training. The improvement was to within the range of healthy controls, and slightly less significant without VTf (p< 0.01). After cessation of training, the BCI showed an average 21% carry-over effect each week (p< 0.02) lasting over 1 month. At 6 months the carry-over effect was not present anymore. Improvement was present for both stance and gait tasks. For example, VTf improved trunk roll by 26% during walking with head extension-flexion movements (p< 0.02) and increased gait speed (30%) without an increase in trunk sway velocity.
Conclusions: VTf training yields clinically relevant reductions (to within normal limits) in sway during stance and gait, and improved gait speed. This research provides guidelines for the practical application of VTf for improved balance control in MS patients. The reduction of retained improvement 2-6 months after training is an estimate of the time when patients need to return to the clinic to receive VTf training again, but needs precise definition.
Disclosure: The study is funded by the ProPatient Stiftung, University Hospital Basel and the Freiwillige Akademische Gesellschaft Basel, Switzerland.
- JHJ Allum worked as a consultant for Balance International Innovations GmbH, Iseltwald, Switzerland.
- C Schouenborg has nothing to disclose.
- N Lutz has nothing to disclose.
- H Rust has nothing to disclose.
- B Fischer-Barnicol has nothing to disclose.
- V Haller received travel support from Merck and Biogen
- J Kuhle received speaker fees, research support, travel support, and/or served on advisory boards by ECTRIMS, Swiss MS Society, Swiss National Research Foundation [320030_160221], University of Basel, Bayer, Biogen, Genzyme, Merck, Novartis, Protagen AG, Roche, Teva.
- T Derfuss received speaker fees, research support, travel support, and/or served on Advisory Boards or Steering Committees of Novartis Pharma, Merck, Biogen, Teva, Bayer-Schering, GeNeuro, Mitsubishi Pharma, MedDay, Roche, and Genzyme; he received research support from Biogen, Novartis, Swiss National Research Foundation, University of Basel, and Swiss MS Society.
- L Kappos' Institution (University Hospital Basel) received in the last 3 years and used exclusively for research support at the Department: steering committee, advisory board and consultancy fees from Actelion, Almirall, Bayer, Biogen, Celgene/Receptos, df-mp, Excemed, Genzyme, Japan Tobacco, Merck, Minoryx, Mitsubishi Pharma, Novartis, Roche, sanofi-aventis, Santhera, Teva, Vianex and royalties for Neurostatus-UHB products. For educational activities the institution received payments and honoraria from Allergan, Almirall, Baxalta, Bayer, Biogen, CSL-Behring, Desitin, Excemed, Genzyme, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, Teva. L. Kappos has served in the last 24 months as international or local principal investigator for the following drug studies BOLD EXT., EXPAND (Siponimod, Novartis), DECIDE, DECIDE EXT. (Daclizumab HYP, Biogen), ENDORSE (DMF, Biogen), FINGORETT, FTY-UMBRELLA, INFORMS, INFORMS EXT LONGTERMS. (Fingolimod, Novartis), MOMENTUM (Amiselimod, Mitsubishi) OCRELIZUMAB PHASE II EXT., OPERA, ORATORIO and extensions (Ocrelizumab, Roche), REFLEXION (IFN β-1a, Merck), STRATA EXT, TOP (Natalizumab, Biogen), TERIFLUNOMIDE EXT, TERRIKIDS (Teriflunomide, Sanofi-Aventis) and ASCLEPIOS I/II (Ofatumumab, Novartis). The Research of the MS Center in Basel has been supported by grants from Bayer, Biogen, Novartis, the Swiss MS Society, the Swiss National Research Foundation, the European Union. In the last 24 months the institution also received grants for patient services from Bayer, Merck and CSL-Behring. L. Kappos is a member in the Editorial Boards of the following journals: 'Journal of Neurology', 'Multiple Sclerosis Journal', 'Neurology and Clinical Neuroscience', 'Multiple Sclerosis and Related Disorders', 'Clinical and Translational Neuroscience'. Honoraria and other payments for all these activities have been exclusively used for funding of research at the department.
- Ö Yaldizli´s Institution University Hospital Basel received grants from ECTRIMS/MAGNIMS, University of Basel, Pro Patient Stiftung University Hospital Basel, Free Academy Basel, Swiss Multiple Sclerosis Society and advisory board fees from Sanofi Genzyme, Biogen and Novartis Poland exclusively used for support of research and educational activities

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