Improved Sway Velocity and Directional Balance Improvement In Two Individuals With Spinocerebellar Ataxia With Balance-Based Torso-Weighting Cynthia Gibson-Horn

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  • Improved Sway Velocity and Directional Balance Improvement In Two Individuals With Spinocerebellar Ataxia With Balance-Based Torso-Weighting Cynthia Gibson-Horn PT, Susan Perlman MD MethodsAbstract Background Results ConclusionsReferences OBJECTIVE: To determine immediate and short-term impact of application of Balance- Based Torso-Weighting (BBTW) and BalanceWear Therapy (BWT) on sway patterns in patients with spinocerebellar ataxia (SCA). BACKGROUND: Patients with SCA exhibit impairments in balance and mobility impairments which often result in falls. BBTW demonstrated immediate improvement in gait and balance in MS studies. BWT involves the patient wearing BalanceWear; incorporating targeted weighted sensory inputs which are strategically placed to augment neuro-sensory information. DESIGN/METHOD: Sway velocity, direction, and magnitude were measured with ADPM sensors placed posteriorly at the lumbosacral junction before and after BBTW immediately and after either 3 or 10 days of BWT with two individuals with midline cerebellar atrophy confirmed by MRI. PRIMARY OUTCOME MEASURES: Sway RESULTS: In Patient 1, a 46 year old woman with a 12 year history of a slowly progressive cerebellar syndrome with upper motor neuron features the composite score (CS) was reduced from 95 to 49 m/s immediately from pre-BBTW to post-BBTW. Patient 1 wore the BWT for 18 hours over two days and was retested 15 hours after BWT. On day three; her CS was reduced from 95 to 24 m/s and direction of sway improved. In Patient 2, a 72 year old woman with a 6 year history of a slowly progressive, idiopathic, cerebellar syndrome the composite score (CS) of sway velocity improved from 98 to 71 m/s from pre-BBTW to post-BBTW same session. Patient 2 wore BWT 10 hours each day for 10 days. On day 11 she was retested without BWT. Her CS was reduced from 98 to 68 m/s. Her directional imbalance improved. CONCLUSION: Application of BBTW and BWT may be beneficial in reducing sway and improving directional stability in patients with SCA. More research is indicated in this patient population, where minimal information is available for symptom management of falls and mobility challenges. Cynthia GibsonHorn MTI 2015 Printed by Balance-Based Torso-Weighting Protocol Patient stood with their feet in the Romberg position Observation of body sway Resistive Rotations and Perturbations applied at upper and lower torso Anterior Posterior Lateral Small Weighted TSIs were applied strategically in BalanceWear to improve the loss of balance and alleviate the rotational asymmetry found in the BBTW (3-5) Patient was instructed to wear BalanceWear for 8 hours per/day and remove BalanceWear the night before retesting on either day 3 or 11 Measurement: Clinical Test of Sensory Integration of Balance (CTSIB) One Opal movement monitor with triaxial accelerometers, gyroscopes, and magnetometers was applied at the LS junction Patient stood with their arms at their side in a comfortable position Verbal instructions given according to the APDM protocol Before the BBTW protocol With TSIs wearing BalanceWear day one Without BalanceWear Eyes open, hard surface Eyes closed, hard surface Sensor Eyes open, foam surface Eyes closed, foam surface. Postural disorders in cerebellar ataxia are a major cause of imbalance and falls.(1) Large sway velocities are associated with falls in the elderly (2) and may also result in falls in people with SCA. (2) Balance-Based Torso-Weighting (BBTW) is a new treatment for balance and gait impairment. BBTW is associated with improving balance and gait in several studies in people with MS.(3-5) During BBTW patient-specific directional static and dynamic imbalance is identified in all planes of movement while the patient stands in the Romberg position. Perturbations are tested and rated from no loss [0] to loss in all direction equaling a fall [48]. BalanceWear Therapy (BWT) involves obtaining a customized balance orthosis the patient wears with strategically placed targeted somatosensory stimulating inputs (TSIs) in the form of small weights titrated to improve three dimensional control of balance in the Romberg position and dynamically. This case report series is the first to demonstrate the use of APDM motion sensors on sway and directional loss of balance in Clinical Test of Sensory Integration of Balance (CTSIB) in people with cerebellar ataxia and BalanceWear Therapy (BWT). The CTSIB protocol helps determine which sensory system (visual, somatosensory, or vestibular) a subject relies on to maintain balance.(6) APDM has further bolstered the quality of the test by instrumenting it with Mobility Lab software.. BalanceWear Therapy was successful in improving postural control; velocity and direction of imbalance immediately, same session in two patients with SCA. In the short-term when BalanceWear was removed there appeared to be carryover in ability on the CTSIB. Future research should involve testing twice on the APDM to account for learning and on greater numbers of individuals with SCA to determine if falls and risk decreases, and mobility improves over time. 1.Marquer A, Barbieri G, Perennou D. The assessment and treatment of postural disorders in cerebellar ataxia: a systematic review (2014). Annals of Physical and Rehabilitation Medicine 57(2):67-78. 2.Muir J, Kiel D, Hannan M, Magaziner J, Rubin C. Dynamic parameters of balance which correlate to elderly persons with a history of falls (2013) 8(8) e70566. 3.Gorgas AM, Widener GL, Gibson-Horn C, Allen DD. Gait changes with balance-based torso-weighting in people with multiple sclerosis (2014). Physiother Res Int 20(1):45-53. 4.Hunt CM, Widener G, Allen DD. Variability in postural control with and without balance-based torso-weighting in people with multiple sclerosis and healthy controls (2015). Phys Ther 94(10):1489-1498. 5.Widener GL, Allen DD, Gibson-Horn C. Randomized clinical trial of balance-based torso weighting for improving upright mobility in people with multiple sclerosis (2009). Neurorehabil Neural Repair 23(8):784-791 6.Shumway-Cook A, Horak FB. Assessing the influence of sensory interaction of balance. Suggestion from the field (1986). Phys Ther 66(10):1548- 1550.. Sway Scores Improve with BalanceWear Therapy Sway Direction Improve With BalanceWear Therapy Patient 1 Patient 2 Scores in the green range are normal DXAge BWT Patient 1SCA46 3 days Patient 2SCA72 10 days Demographics m/sec Sway Reduction Associated with Decreased Fall Risk (2) TSIs are Individual specific, based on each persons balance loss