Long-term Use of a Sensory Neuroprosthesis Improves Function in a Patient with Peripheral Neuropathy: a Case Report

Abstract

Background:Peripheral neuropathy (PN) can result in either partial or complete loss of distal sensation resulting in an increased fall risk. Walkasins® uses a shoe insert to detect the magnitude and direction of sway and sends signals to a leg unit that provides sensory balance cues. The objective of this case report is to describe the long-term influence of the Walkasins® lower limb sensory neuroprosthesis on balance and gait for an individual with diabetic PN.Case Description:A fifty-one-year-old male with a 3-year history of PN and a 10-year history of type II diabetes mellitus was fitted with Walkasins® and utilized the shoe inserts 8-10 hours/day for more than 1 year. Although, vibration and tactile thresholds were severely impaired at his 1st metatarsophalangeal joint and the lateral malleolus bilaterally he could perceive tactile stimuli from the Walkasins® above the ankles.Outcomes:Following Walkasins® use, his Activities-specific Balance Confidence Scale (ABC) scores improved from 33% to 80%. His mean Vestibular Activities of Daily Living (VADL) scores decreased from 3.54 to 1. His Functional Gait Assessment (FGA) scores increased from 13/30 to 28/30 and his miniBESTest scores improved from 15/28 to 26/28. Gait speed increased from 0.23 m/sec to 1.5 m/sec. The patient described a decrease in pain and cramping throughout his lower extremities and an increase in function.Discussion:Gait and balance improved with the use of the Walkasins® and participation in the Neuro Wellness Program. This improvement suggests that the use of sensory substitution devices, such as the Walkasins®, may replace sensory deficits related to gait and balance dysfunction experienced by patients with PN. Further research is needed to determine if other patients will have a similar response and what the necessary threshold of sensory function is to benefit from use of the Walkasins®.

The Effects of a Wearable Sensory Prosthesis on Gait and Balance Function After 10 Weeks of Use in Persons With Peripheral Neuropathy and High Fall Risk – The walk2Wellness Trial

“…Consequently, we hypothesize that any balance-related therapy or training activity in conjunction with wearing the device would provide an additive effect to overall function and balance outcomes. This hypothesis is supported by our recent case study (Wrisley et al, 2018(Wrisley et al, , 2020 as well as our previous inclinic study where subjects following a baseline assessment were randomized to either wearing the device turned on or turned off while performing a brief 10-15 min standardized balance activity session with a physical therapist (Koehler-McNicholas et al, 2019). Ten of 15 subjects in the on group increased their FGA scores by at least 4 points compared to five of 16 in the off group (p < 0.05).…”

“…Other wearable neuromodulation technologies have been used as a treatment modality in a home setting, although typically only worn in conjunction with a home therapy program for balance and mobility in different categories of subjects, e.g., multiple sclerosis (Leonard et al, 2017) and healthy elderly (Bao et al, 2018). A recent case study of a patient with PN wearing Walkasins for a year (Wrisley et al, 2018(Wrisley et al, , 2020, found dramatic improvements in gait and balance outcomes when daily continuous device use was combined with balance therapy. Prior to using Walkasins, the patient had received balance therapy twice a week for over 5 months by an expert physical therapist (DW) and had plateaued in his improvements (Wrisley et al, 2018(Wrisley et al, , 2020).…”

“…A recent case study of a patient with PN wearing Walkasins for a year (Wrisley et al, 2018(Wrisley et al, , 2020, found dramatic improvements in gait and balance outcomes when daily continuous device use was combined with balance therapy. Prior to using Walkasins, the patient had received balance therapy twice a week for over 5 months by an expert physical therapist (DW) and had plateaued in his improvements (Wrisley et al, 2018(Wrisley et al, , 2020). In the current study, in an attempt to isolate the effect of long-term device use on clinical outcomes, subjects were instructed to wear the device as much as possible and were not allowed to participate in any additional balance training or therapy.…”

“…The concept of sensory substitution related to brain plasticity was laid out by Bach-y-Rita and colleagues, initially for vision and the vestibular system (Bach-y-Rita et al, 1969;Bach-y-Rita, 2004) and other sensory systems (Tyler et al, 2003;Bach-y-Rita, 2004). Recent efforts include wearable systems showing benefits to patients with vestibular loss (Hegeman et al, 2005;Wall et al, 2009;Basta et al, 2011;Yamanaka et al, 2016), PN (Wall et al, 2012;Wrisley et al, 2018Wrisley et al, , 2020 and Parkinson's Disease (Rossi-Izquierdo et al, 2013;Lee et al, 2015). Combining wearable neurostimulation with balance therapy has shown benefits in patients with multiple sclerosis (Leonard et al, 2017), cerebellar ataxia (Cakrt et al, 2012), stroke (Badke et al, 2011) traumatic brain injury (Ptito et al, 2020) and in-home balance therapy (Bao et al, 2018).…”