Preliminary Study of Vibrotactile Feedback during Home-Based Balance and Coordination Training in Individuals with Cerebellar Ataxia

Abstract

Intensive balance and coordination training is the mainstay of treatment for symptoms of impaired balance and mobility in individuals with hereditary cerebellar ataxia. In this study, we compared the effects of home-based balance and coordination training with and without vibrotactile SA for individuals with hereditary cerebellar ataxia. Ten participants (five males, five females; 47 ± 12 years) with inherited forms of cerebellar ataxia were recruited to participate in a 12-week crossover study during which they completed two six-week blocks of balance and coordination training with and without vibrotactile SA. Participants were instructed to perform balance and coordination exercises five times per week using smartphone balance trainers that provided written, graphic, and video guidance and measured trunk sway. The pre-, per-, and post-training performance were assessed using the Scale for the Assessment and Rating of Ataxia (SARA), SARAposture&gait sub-scores, Dynamic Gait Index, modified Clinical Test of Sensory Interaction in Balance, Timed Up and Go performed with and without a cup of water, and multiple kinematic measures of postural sway measured with a single inertial measurement unit placed on the participants’ trunks. To explore the effects of training with and without vibrotactile SA, we compared the changes in performance achieved after participants completed each six-week block of training. Among the seven participants who completed both blocks of training, the change in the SARA scores and SARAposture&gait sub-scores following training with vibrotactile SA was not significantly different from the change achieved following training without SA (p>0.05). However, a trend toward improved SARA scores and SARAposture&gait sub-scores was observed following training with vibrotactile SA; compared to their pre-vibrotacile SA training scores, participants significantly improved their SARA scores (mean=−1.21, p=0.02) and SARAposture&gait sub-scores (mean=−1.00, p=0.01). In contrast, no significant changes in SARAposture&gait sub-scores were observed following the six weeks of training without SA compared to their pre-training scores immediately preceding the training block without vibrotactile SA (p>0.05). No significant changes in trunk kinematic sway parameters were observed as a result of training (p>0.05). Based on the findings from this preliminary study, balance and coordination training improved the participants’ motor performance, as captured through the SARA. Vibrotactile SA may be a beneficial addition to training regimens for individuals with hereditary cerebellar ataxia, but additional research with larger sample sizes is needed to assess the significance and generalizability of these findings.

A Systematic Review of the Long-Term Effects of Using Smartphone- and Tablet-Based Rehabilitation Technology for Balance and Gait Training and Exercise Programs

“…Participants were trained through biofeedback (n = 8), recommended exercises (n = 4), or exergames (n = 2). Table 4 reports that five studies used visual and vibrotactile biofeedback in real-time as an intervention [39][40][41]45,46]. Two studies used the Smarter Balance System (SBS) [39,40].…”

“…The SBS's app stored anonymized exercise data in the smartphone's internal storage and transmitted the stored data to a secure database using Wi-Fi or the Global System for Mobile Communications (GSM). The other three studies used the same smartphone balance trainer [41,45,46]. The smartphone was equipped with two Apple iPods (sixth-generation iPod touch, 2015) as a sensing unit and a user interface unit, respectively.…”

“…A custom belt was also designed, which included a "tactor bud" consisting of a controller board, a battery, and four vibration motors (i.e., tactors). The three studies assessed trunk sway by attaching the sensor unit to a participant's lower back at approximately the L4/L5 spinal level [41,45,46]. The four tactors for vibrotactile biofeedback were aligned with the navel, lumbar spine, and right and left sides of the trunk.…”

“…Table 4 lists the training type, period, and location for all 14 studies. Gait training was used in two studies [37,43], whereas balance training was used in 12 studies [38][39][40][41][42][44][45][46][47][48][49][50]. Among 12 studies using balance training, six studies provided balance training only [39,40,[44][45][46]49], and the other six studies provided strength training (n = 1) [38], strength and flexibility training (n = 1) [48], coordination training (n = 1) [41], resistance training (n = 1) [47], cognitive training (n = 1) [50], or strength and cognitive training (n = 1) [42] in addition to balance training.…”

“…Although all 14 studies involved at least four weeks of balance and gait training, the training periods were varied. Six weeks of training were the most common (n = 6) [37,[39][40][41]44,50], followed by 12 weeks (n = 2) [38,47], then four weeks (n = 2) [43,49], eight weeks (n = 2) [45,46], and six months (n = 2) [42,48]. Additionally, three studies performed the retention assessments.…”