Research Report
Population: Pediatric
Swati M Surkar, MS, PT, Graduate Research Assistant, MMI, University of Nebraska Medical Center swati.surkar@unmc.edu
Regina Harbourne, PT, PhD, Assistant Professor, Duquesne University, Pittsburgh, PA harbourner@duq.edu
Max Kurz, PhD, Associate Professor, University of Nebraska Medical Center, Omaha, NE mkurz@unmc.edu
Keywords: Plasticity, Balance, Sensory Substitution, Postural Control
Purpose/Hypothesis: Multiple avenues of sensory input, motor output and different body systems interact to control static and dynamic balance [1]. Damage to any one or a combination of these resources results in postural instability [2]. The brain is capable of adapting to substitute sensory information following sensory loss [3]. Sensory substitution is a method of delivering sensory information obtained from an artificial sensory receptor to the brain via an intact sensory pathway [4]. However, no previous studies have investigated the effect of augmentation of sensory input to improve postural control in children with balance disorders (BD). The purpose of this investigation was to determine the feasibility of a sensory substitution device, the BrainPort, combined with an intensive balance training program to improve the balance in children with BD. Our hypothesis was that intensive motor learning training using the sensory substitution device would enhance the recovery of balance by promoting cross-modal sensory substitution plasticity.
Number of Subjects: Eight children (6 females; age= 6-14 years) with chronic BD due to vestibular dysfunction, resolved cancer, and developmental coordination disorder (DCD).
Materials/Methods: Children received three days of intensive balance training with the BrainPort, twice a day, for 2 hours under the guidance of a Pediatric Physical Therapist. The BrainPort provided feedback related to postural orientation via electrotactile stimulation on the tongue. After the three days of intensive supervised balance training, children received a home program, which consisted of balance activities with the BrainPort daily for two sessions of 20 minutes each, five days/week for eight weeks. We assessed the children’s balance pre and post-intervention using the Bruininks-Oseretsky Test (BOT) and center of pressure (CoP) sway measures (vision, no vision).
Results: There was significant improvement in BOT scores (Pre= 18.1+/-11.6; Post = 24.1+/-8.4; p=0.02) from pre-intervention to post-intervention. We did not find a significant change for any of the CoP sway measures (p>0.05). We further analyzed the BOT and CoP data by grouping the children by diagnosis. Overall, post-intervention scores increased from baseline in BOT by 78% in children with vestibular dysfunction and 67% in children with resolved cancer diagnoses as compared to 4% in children with DCD. The improvement in BOT scores was corroborated with a post-intervention decrease in medial-lateral sway with vision by 14% in children with vestibular dysfunction and 28% in children with resolved cancer diagnosis as compared to 5% in children with DCD. The children and their parents reported improvement in functional activities post-intervention.
Conclusion: Intensive balance training combined with augmented sensory feedback may be beneficial in improving balance and related functional activities in children with BD.
Clinical Relevance: Use of augmented sensory feedback potentially promotes balance recovery in some children, and may be a consideration for the rehabilitation of children with BD.
Citation:
Surkar, Swati M, MS, PT; Harbourne, Regina , PT, PhD; Kurz, Max , PhD. The feasibility of a sensory substitution device in improving postural control in children with balance disorders: Augmenting early brain plasticity.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/074_surkar-et-al/