Visual Perturbations for Balance Disorder

Overseen By Ethan T Swierski, B.S.

Age: 18+

Sex: Any

Trial Phase: Phase < 1

Sponsor: University of Florida

Disqualifiers: Cognitive disorder, Musculoskeletal injury, Neurological injury, Low vision, others

Compensation: Varies

Number of Visits: 2

540 Participants Needed

Trial Summary

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. ^{1 2 3 4 5}

How 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. ^{1 2 4 5 6}

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.

Eligibility 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 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.

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

Treatment Details

Interventions

• Intermittent Visual Perturbations

Trial Overview 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.

Participant Groups

Group I: Intervention - Vision for 7.5s and Occlusion for 3s Experimental Treatment 2 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 1.5s Experimental Treatment 2 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 0.75s Experimental Treatment 2 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 1.5s Experimental Treatment 2 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 1.5s Experimental Treatment 2 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 Transmission Experimental Treatment 2 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 Transmission Experimental Treatment 2 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 Off Experimental Treatment 2 Interventions

Participants will complete the balance beam walking practice while wearing the goggles, but they will not be turned on.

Group IX: Control - No Goggles Placebo Group 2 Interventions

Participants will complete the balance beam walking practice without any changes to vision.

Who Is Running the Clinical Trial?

University of Florida

Lead Sponsor

Trials

1,428

Recruited

987,000+

National Institutes of Health (NIH)

Collaborator

Trials

2,896

Recruited

8,053,000+

National Institute of Neurological Disorders and Stroke (NINDS)

Collaborator

Trials

1,403

Recruited

655,000+

Findings from Research

The novel virtual reality head stability test (VR_HST) effectively detected significant differences in postural sway and head oscillations between 17 patients with vestibular dysfunction and 16 control participants, indicating its potential as a sensitive assessment tool.

Patients exhibited larger head oscillations, particularly in pitch, yaw, and roll, during balance tasks, suggesting that the VR_HST could help tailor individualized treatment strategies for those with vestibular issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A virtual reality head stability test for patients with vestibular dysfunction. Lubetzky, AV., Hujsak, BD.[2019]

People with multiple sclerosis (PwMS) showed greater variability in trunk sway when exposed to anterior-posterior optical flow perturbations compared to matched controls, indicating they are more affected by these types of balance challenges.

The study suggests that optical flow perturbations could be a useful tool for screening balance deficits in PwMS, as both types of perturbations increased variability in balance, but the anterior-posterior perturbations had a more pronounced effect.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effects of Optical Flow Perturbations on Standing Balance in People With Multiple Sclerosis. Elie, OS., Franz, JR., Selgrade, BP.[2023]

The chapter highlights the importance of multisensory integration, particularly the interaction between visual and vestibular systems, in maintaining balance, which is crucial for understanding balance disorders.

It discusses how visual motion can influence postural control and the rehabilitation strategies for patients with visual vertigo, emphasizing the use of repeated exposure to visual stimuli to alleviate symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Multisensory integration in balance control. Bronstein, AM.[2022]

This study utilized a novel virtual reality system to investigate how different amplitudes and velocities of visual perturbations affect human body sway, revealing that increased visual input amplitude leads to greater hip displacement in balance.

The findings indicate that the optimal visual input velocity for maintaining balance is around 5 degrees per second, as this velocity produced the highest gain in body sway response, enhancing our understanding of how visual information is processed for postural control.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Identification of human balance control responses to visual inputs using virtual reality. Mohebbi, A., Amiri, P., Kearney, RE.[2022]

Chronic patients with bilateral vestibular hypofunction (BVH) showed significantly worse posture stability in total darkness compared to healthy controls, indicating their reliance on visual input for balance.

BVH patients improved their posture stability when using visual targets and eye movements, suggesting they depend more on these signals than healthy individuals to maintain balance, especially in challenging conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How Eye Movements Stabilize Posture in Patients With Bilateral Vestibular Hypofunction. Lacour, M., Dosso, NY., Heuschen, S., et al.[2020]

In a study involving 24 Parkinson's patients and 19 control volunteers, it was found that changes in visual information significantly affected balance in Parkinson's patients, highlighting their vulnerability to visual stimuli.

Unlike the control group, Parkinson's patients showed notable differences in their postural control when exposed to static versus moving visual fields, indicating the need for tailored assessment and rehabilitation strategies for balance disorders in these patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Balance in Parkinson's disease patients changing the visual input. Suarez, H., Geisinger, D., Ferreira, ED., et al.[2022]

References

1. Netherlands pubmed.ncbi.nlm.nih.gov

A virtual reality head stability test for patients with vestibular dysfunction. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

The Effects of Optical Flow Perturbations on Standing Balance in People With Multiple Sclerosis. [2023]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Multisensory integration in balance control. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Identification of human balance control responses to visual inputs using virtual reality. [2022]

5. Switzerland pubmed.ncbi.nlm.nih.gov

How Eye Movements Stabilize Posture in Patients With Bilateral Vestibular Hypofunction. [2020]

6. Brazil pubmed.ncbi.nlm.nih.gov

Balance in Parkinson's disease patients changing the visual input. [2022]