A High-Tech Solution Wearable that can help balance?

By Dr. Lars I.E. Oddsson, PhD.

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In a previous blog post I wrote about a Low-Tech solution to improve balance function. Today is about a High-Tech Solution. Every other day we read about a new wearable coming to market, not to mention bullish research reports about the expected market growth of wearables. These are interesting times indeed! Technology is constantly becoming better, faster, smaller, cheaper and simpler. Improved battery technology, the emergence of MEMS sensors, faster low-power microprocessors, 3D printers and other new tools are helping designers come up with new exciting technologies. And I know there is even more to come!

Meet “Medical Grade Wearables”

With regards to Wearables, I want to make an important distinction between Consumer Market Wearables (which is what we have mostly seen to date), and the emerging category of “Medical Grade Wearables”. So what are the differences between Medical and Consumer Grade Wearables? Both of these categories may fit under the broader rubric of “Digital Health”. BUT, Medical Grade Wearables would be considered medical devices which are regulated by the FDA, and therefore subjected to higher standards of scrutiny – (MUCH higher) for manufacturing, safety and efficacy. Consumer Market Wearables are typically (all else being equal) “easier” to bring to market quickly. Don’t get me wrong, bringing any product to market is hard, but bringing a medical device to market is harder, a lot more expensive and takes a longer time. I predict we will be seeing a lot more about “Medical Grade Wearables” going forward and I think these technologies have the potential to change healthcare as we know it and for the (MUCH) better.

Early Wearables Development

Let me tell you a about a Medical Grade Wearable that I am involved with that should soon enter the market on prescription basis! Going back to the beginning nearly 15 years ago, this was purely a research project in my lab, the Injury Analysis and Prevention Lab at the NeuroMuscular Research Center at Boston University. Yes, we were working on wearables back then before it was even considered a category. Initially, we demonstrated the concept of this technology with a desktop PC, a force platform and motor vibrators. This was not wearable but it worked! The first wearable prototype we built was enclosed in a foot-long Tupperware box and programmed in assembly language. NOT user friendly but still a proof of concept. However, what we conceived and built for use in a research lab setting could not at the time be manufactured as a user friendly practical wearable device. Today, technology is sufficiently advanced for this to occur.

“Walkasins” – A Wearable Sensory Prosthesis

Walkasins are a wearable sensory prosthesis to replace lost foot pressure sensation in patients with peripheral neuropathy who have balance problems. Walkasins are developed by RxFunction Inc., a Minnesota-based start-up company funded by a grant from NIH. I am President, co-founder of the company and co-inventor of the technology. We have put together a GREAT team of experts from the rich Minnesota medtech ecosystem helping to move Walkasins to market. Walkasins consist of a thin shoe-sole insert that measures pressure under the foot reflecting the person’s state of balance. Sensory information in the form of gentle vibrations are delivered to the skin through a strap worn around just above the ankle. The user learns to interpret the vibration signals to control balance, it becomes a “new” balance sense. A subgroup of patients with peripheral neuropathy who experience balance problems and have sufficient sensation just above the ankle will benefit from using the device. Once registered with the FDA, Walkasins should become available on a prescription basis.

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“What can the average senior do to improve his or her balance?”

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This question was recently posted by Gary Jader, and it is a really important one. Let’s get directly to it and then fill in some details below for those interested. Here are some basic simple low-tech advice for the healthy average senior to improve or maintain your balance function.

First, if you experience sudden noticeable changes in your balance function, contact your doctor to figure out what is going on. Is it simply regular healthy aging or something else, a medical condition, vision problems or maybe some medications causing it? Get help figuring it out.

So here we go:

  1. Stay physically active on a regular basis, preferably daily. Anything is better than nothing. Walking and running is ok but specific balance exercises described in this article and Tai-Chi is much better (more on that below).
  2. Find ways to challenge your balance safely. You either “use it or lose it”. This means you cannot sit in a chair and exercise your balance using elastic exercise bands (many think so and no, it does not work!), nor can you stand up on one leg and hold on to something to stabilize yourself, the challenge is not sufficient. Make sure you feel it is somewhat difficult to keep balance during your exercise.
  3. If you don’t have the motivation or discipline to exercise balance on your own, find a training partner or join a gym or an exercise group. Make sure they offer specific balance training classes or have an exercise class that involves balance challenges.
  4. Exercise your mind during training, find ways to multitask. Studies have shown that individuals who react slowly during multitasking have a higher risk of falling. You can improve your multitasking skill with training.

This discussion ties into a recent post and a paper we published entitled “How to improve gait and balance function in elderly individuals – compliance with principles of training”. The paper describes a basic framework for balance training that can be adopted to essentially any individual or level of balance skill, be it old frail grandma, patients who are prone to fall, or even athletes. It also provides a review of previous studies that targeted balance function. Some of these did not comply with principles of training and therefore showed little or no improvement in function. For example, only improving strength is not likely to improve your balance, unless it is a limiting factor of your performance. For those interested I refer to the above article for further details. The conceptual framework described in the article has since been adopted and used in several research studies on subjects including healthy elderly individuals, fallers, those with fear of falling and patients with osteoporosis. More about those results in a later blog.

So what are some of these principles of training? Plenty of articles and books have been written about them and the intention here is not to go into much detail but rather point out a couple of important ones that may be particularly relevant for balance training. Overload is an important principle essentially meaning that challenging the body just beyond what it currently can do leads to a compensation and gradual adaptation to that overload. Continuity, periodicity and progression are pretty self-explanatory; training should be continuously ongoing, be periodic and include cycles of overload and rest, and over time the training challenge must increase progressively. Specificity is a very important principle, essentially you have to practice the skill you want to improve. Swimming is not going to improve your balance and neither is training strength training, unless it includes an element of balance. For example, a great simple exercise that challenges strength and balance is lunges, especially if you step on to a foam surface.

I have a background in Exercise Physiology and coaching; I helped elite athletes improve their performance including the physical, technical as well as emotional/psychological dimensions of their performance for many years. Improving performance in athletes is a matter of constantly pushing the boundaries of what you are able to do based on a detailed understanding of what is demanded in your specific event. Matching the profile of your capabilities across all dimensions of performance with the specific requirements of the event reveals “gaps” in your performance profile that are likely to be areas where improvement can be achieved. In principal, improving balance, mobility and physical function in non-athletes and even patients is pretty similar and this is where “compliance with principles of training” comes in. An intervention must adhere to principles of training to have the intended effect on performance.

Falls – the “often overlooked epidemic”, and what Dr. Sanjay Gupta forgot…

By Dr. Lars I.E. Oddsson, PhD.
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Have you seen this video? It is a nice report by Dr. Gupta of CNN about falls and injury? It is a few years old but still highly relevant, maybe even more so today as we are moving into the age of the “Silver Tsunami”.  You should take a couple of minutes to check it out here.

There are several important facts in the report such as:

“30 percent of seniors who break their hip die within a year.”,  “get rid of rugs” (people tend to trip on them and fall), and the importance of exercise to improve balance is mentioned. But the good Dr. Gupta actually forgot something important when he was asked this question by Katie Couric:

“What are the causes of these balance problems among the elderly population?”

This is a complex multifactorial problem and Dr. Gupta sort of looks like he is put on the spot! He refers to the patient in the story, Diane Schraeder, and that she happened to have an “inner ear problem, something that can be treated”. Sure, it is true that inner ear balance problems can be treated but that does not mean that they can be cured. Then Dr. Gupta replies that causes of balance problems can be dementia (not sure about that one…), “some vision problems” (yes!) and “some motor problems or just a little bit weak” (muscle weakness may not be a cause of balance problems but it may make it more difficult to correct balance). Dr. Gupta then correctly states “it can even be a new medication” that causes balance problems. Yes, it is well known that certain medications, on their own or in combination, can cause balance problems and increase the risk of falls. If this is something you experience you should review your medications with your doctor. Most of the time this can be mitigated.

So what did Dr. Gupta forget to mention as an important cause of balance problems? Peripheral Neuropathy! Something millions of patients suffer from!

Patients with Peripheral Neuropathy gradually lose sensation in their feet and foot pressure is a very important part of our sense of balance. In an upcoming blog we will discuss emerging technology that can help replace lost foot pressure sensation and provide new tactile sensory cues for balance!

A Low-Tech solution to improve balance function!

By Dr. Lars I.E. Oddsson, PhD.

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Image free to use. Please refer to source. By L. Oddsson.

This posting refers to an article published in 2007 that had been written and conceptualized several years earlier, long story to be shared at another time….  The abstract is shared below with a link to the actual article. More about the consequences of this article to follow in later blogs. We will also further discuss the content of the article for those who are interested.

European Review of Aging and Physical Activity

April 2007, Volume 4, Issue 1, pp 15-23

Lars I. E. Oddsson, Patrick Boissy, Itshak Melzer

Abstract

Most balance training regimens for elderly individuals focus on self-controlled exercises, although automatic postural responses after a balance perturbation are not under direct volitional control. We critically review the literature on this topic, and notice that several studies fail to comply with basic principles of training and therefore show little improvement in function. Some present the view that physical function in the too frail and too fit cannot be improved, which we instead argue would be the effect of nonspecific training programs. We propose a concept for balance training that incorporates voluntary exercises as well as perturbation and dual-task exercises to improve balance control. The program is performed on five different levels where levels 1–4 exercises focus on the skill to maintain balance and level 5 adds perturbation exercises that focus on the skill to recover balance as well as dual task exercises providing a cognitive load during execution of a balance motor task. Functional requirements for muscle strength and power are directly incorporated into the program. The feasibility of the concept has been demonstrated on elderly fallers. A randomized control trial is underway to investigate the effects on healthy elderly individuals. Further intervention studies using this concept are encouraged.

Article on How to Improve Gait and Balance Function

WHAT IF you have balance problems? Can technology help?

By Dr. Lars I.E. Oddsson, PhD.

Feel free to use pic but please refer to source. By L. Oddsson

Feel free to use pic but please refer to source. By L. Oddsson

Imagine the following – you wake up one morning feeling nauseous and the world is spinning around you! You instantly vomit when you try to get out of bed! It is like an invisible force is pushing making you weak and dizzy to the point where you feel unable to move! You try to roll around in bed and again, you vomit!

So what is going on here? These are signs that you may be experiencing an episode of Benign Paroxysmal Positional Vertigo! Wow, that’s a mouthful so it’s BPPV for short. The good news? As unpleasant and debilitating as this condition may be, it is benign and pretty much fixable by a physical therapist.

BPPV is a problem with the balance system and I used it here as a dramatic example of how important balance is for our everyday physical function, mobility, independence and quality of life. In fact, balance is a sense we rarely think about, until there is a problem. However, the brain is constantly monitoring our state of balance and automatically keeping us stable. For example, if you decide to stand on one leg, you don’t have to think about first shifting your weight over to the leg you plan to stand on, it happens automatically through a sequence of muscle actions. Think about it, if you ONLY lift one leg off the ground (which you can consciously decide to do), then you will actually begin to fall in the direction of the lifted leg. So, there is a lot more going on that actually prevents that from happening.

BPPV is only one of many diseases that affect balance and make life miserable for millions of people. So how does the balance system work? Well let’s save that for an upcoming blog. Thank You for now.

Oh sorry, so what actually causes BPPV? Here is the short explanation. Small crystals called otoconia, part of the vestibular system for balance in the inner ear, have actually come lose causing confusing signals to the brain about your state of balance. This “sensory conflict” can cause unpleasant nausea, vertigo and dizziness. Following a correct diagnosis, a trained physical therapist can move the head through a sequence of positions to move the otoconia back in position, sort of doing a 3D “labyrinth game”. Pretty interesting, right? In fact, this is sometimes called the “Epley maneuver” after Dr. Epley who figured this out.  Check out this link if you are interested to learn more!

Technology to treat BPPV

Finally, more on technology that can help balance? We will get to that in future blogs as well.