Assessment of Postural Orientation and Equilibrium In Early Amyotrophic Lateral Sclerosis (ALS)
調査の概要
状態
条件
詳細な説明
ALS is a progressive neurodegenerative disorder involving primarily upper and lower motor neurons. The progressive loss in motor neurons leads to weakness, fatigue, spasticity, and loss of balance. Falls are reported in 30-35% of ALS patients prior to enrolment to ALS clinic. This early loss of balance may not be detected by the classical neurological exam, or the standard clinical balance scales. Understanding the impairments in the balance control system which leads to fall during the course of ALS is a prerequisite for the clinical decision-making process in order to develop a proper balance rehabilitation program and fall prevention strategies for these patients.
Patients and control subjects will undergo balance system evaluation consisting of the following testing:
Sensory Organization Test Protocol
Standardized EquiTest assessment protocol:
Sensory Organization Test (SOT) - will be used to measure change how well participants maintain balance under progressively more difficult test conditions, which either disrupt or remove visual and proprioceptive feedback. Visual and proprioceptive environments will be altered systematically for fixed support and sway-referenced support and surround conditions, and under normal (eyes open), absent (eyes closed), and sway-referenced vision (eyes sway-referenced). Under sway-referenced conditions, the platform on which the subject stands and/or the visual surround also move proportionally to their AP sway. During SRC the floor and visual surround are controlled by a servomechanism (Gain=1.0) to follow movements of the subjects' center of gravity. Sway-referencing eliminates accurate somatosensory and/or visual information used to orient the body. Performance under sway-referenced visual conditions shows the participant's ability to suppress conflicting visual inputs and to rely on alternative systems for maintaining equilibrium (table 1).
Participants are carefully positioned on the platform by aligning the lateral malleoli with the axis of rotation of the platform and visual surround. Participants wear a harness during all testing, which protects participants from falling. As an additional safety measure, the technician stands behind the participant. There are three trials per condition with each trial lasting 20 seconds. When a participant takes a step, touches the surround panels, or needs assistance from the technician, that trial is marked as a fall and the participant receives an equilibrium score of zero for that trial.
In addition to the ES, movement strategy scores (MSS) will be measured by horizontal shear forces. Movement strategy scores reflect the relative use of movement about the ankle, hips and upper body to maintain balance during the SOT. Scores around 100 reflect a predominant use of ankle strategy to maintain balance, whereas low scores are indicative of the use of hip strategies to restore stability.
- Motor Control Test Protocol The Motor Control Test (MCT), using the same apparatus will be performed to examine postural responses to external perturbations. During the MCT, subjects will receive perturbation from the force platform. Perturbations are expressed as translation movement (medium horizontal anterior to posterior movements of less than 1 sec. duration) or as rotation movements (at 6.0 degrees per second, which cause ankle dorsiflexion or plantarflexion). Six forward and six backward translations are generated. Five toes up and five toes down rotations are generated. The computer assures random delays of 1.5 to 2.5 seconds between translation trials and 3.0 to 5.0 seconds between rotation trials. During each perturbation, the computer monitors the subjects sway responses, measuring forces exerted against the dual force plate. These forces are expressed as weight symmetry and strength symmetry. Weight symmetry measures the distribution of total body weight over each leg, independent of other response strength and strength symmetry measures. Weight symmetry scores near 100 indicate a symmetrical weight distribution (EquiTest manual, 1991).
Outcome variables:
i. Sensory Organization Test (SOT) scores on conditions 1-6. ii. Movement Strategy Score on conditions 1-6 iii. Weight Symmetry Score on conditions 1-6
研究の種類
入学 (実際)
連絡先と場所
研究場所
-
-
North Carolina
-
Charlotte、North Carolina、アメリカ、28207
- Carolinas ALS Clinical Research Center
-
-
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
サンプリング方法
調査対象母集団
説明
Inclusion Criteria:
Inclusion Criteria for subjects with early ALS:
- Probable or definite ALS according to World Federation of Neurology diagnostic criteria4.
Early stage ALS defined as presence of:
- Normal lower extremities muscle strength (≥ 4/5 in manual muscle strength or ≥ 80% in the computerized dynamometer quantitative muscle strength);
- ALSFRS score of ≥ than 30;
- FVC of ≥75% predicted;
- Ambulatory without the use of any assistive device.
- 18 - 75 years of age.
- Able to provide informed consent.
Inclusion Criteria for control subjects:
- Healthy 18 - 75 years of age without significant medical condition as defined by the investigator.
- Able to provide informed consent.
- Not having any of the exclusion criteria listed below.
Exclusion Criteria:
- Age < 18 or > 75 years.
- History of falls (2 or more in the last year), history of fainting, history of cerebrovascular accident (CVA) or myocardial infarction (MI), history of lower limb joint replacement.
- History of neuromuscular dysfunction "except diagnosis of ALS for individuals with ALS".
- Post-traumatic, septic, inflammatory, or neuropathic arthritis.
- Lower extremity injury/surgery that may effect balance.
- Vestibular pathology (i.e., inner ear problems, vertigo, meniere's).
- Peripheral neuropathy.
- Parkinson's Disease.
- Currently taking anti-convulsive medications (e.g., clonazepam, diazepam, lorazepam,phenytoin, zonegran, carbamazepine, depakote, gabapentin, lamotrigine, lamotrigine, oxcarbazepine, tiagabine, topiramate)
- Diabetes Mellitus.
- No history of neurological or medical condition that may interfere with balance as defined by investigators.
研究計画
研究はどのように設計されていますか?
デザインの詳細
この研究は何を測定していますか?
主要な結果の測定
結果測定 |
時間枠 |
---|---|
SOT equilibrium scores on conditions 1-6.
時間枠:9 monthes
|
9 monthes
|
二次結果の測定
結果測定 |
時間枠 |
---|---|
MSS on conditions 1-6 Weight Symmetry Score on conditions 1-6 DGI score TUG score POMA-B score
時間枠:9 months
|
9 months
|
協力者と研究者
捜査官
- 主任研究者:Mohammed Sanjak, PhD, PT, MBA、Carolinas Healthcare Sysetm
研究記録日
主要日程の研究
研究開始
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。