Telerehabilitation of Balance Clinical and Economic Decision Support System

Launched by UNIVERSITY COLLEGE, LONDON · Jul 29, 2024

Keywords

ClinConnect Summary

This clinical trial, called the TeleRehabilitation of Balance Clinical and Economic Decision Support System (TeleRehab DSS), is studying a new way to help older adults and individuals with specific conditions, like stroke, mild cognitive impairment (MCI), vestibular disorders, or long Covid, improve their balance and reduce the risk of falls. The study is exploring an innovative exercise program that uses a lightweight headset to project 3D images of a physiotherapist into participants' homes. This virtual program gives personalized instructions and feedback while monitoring how well participants are doing, making it easier for them to follow along without needing frequent in-person visits.

To be eligible for this trial, participants should be aged between 50 and 80 years, able to walk independently (with or without a walking stick), and meet certain cognitive and health criteria. Participants can expect to engage in a program that combines various exercises, memory training, and even interactive games to enhance their balance and overall physical function. The study is also collecting information on the program's safety and effectiveness, so it aims to improve balance care for those who need it most. If you're interested in participating, please check if you meet the eligibility criteria and consult with your healthcare provider for more information.

Gender

ALL

Eligibility criteria

• ALL PARTICIPANT Inclusion Criteria:
• • Age 50-80 years
• • community dwelling able to walk 500-m independently or with a stick
• • Montreal Cognitive Assessment (MOCA score full version \> 23, or short version (verbal only, excluding visual \& naming exercises) \> 15 (the Montreal Cognitive Assessment is a validated rapid screening test of language, memory, attention, visual/spatial, reasoning, orientation skills). The short version will only be delivered, if during the initial screening call, the clinician is concerned that the participant will be unable to fulfil the criteria for eligibility)
• • Depression subscale on Hospital Anxiety and Depression Scale \< 10/21 (14-item questionnaire)
• • No significant visual impairment (as self-reported by participants)
• • Willing to comply with study procedures, proposed training and testing regime
• • With capacity to consent
• • No acute musculoskeletal or other injuries that would prevent participation in a structured exercise program
• • Is not currently, and has not in the past 8-weeks received any falls/balance/vestibular and/or cognitive rehabilitation.
• • Does not any implanted medical devices or a cardiac pacemaker.
• • Does not have any other co-existing neurological conditions (ie. Multiple sclerosis, Parkinson's disease, neuropathy etc.)
• • Does not have any language or communication deficits impairing their ability to communicate and/or express their thoughts.
• • Has at least one functional hand for grip function and computer use.
• • Fulfilling all of the criteria from one of the below sub-groups
• STROKE COHORT who will fulfil the additional criteria:
• • Individuals with diagnosis of focal ischaemic or haemorrhagic stroke, as confirmed by a clinical letter.
• • Onset \>3 months prior to study.
• • At risk of falls (i.e. Functional Gait Assessment FGA score \<22/30; FGA is a validated quick balance task assessment) AND/OR having experienced a fall(s) in the last 12 months
• MCI COHORT who will fulfil the additional criteria:
• • Individuals with new or existing formal diagnosis of MCI, according to the International Classification of Disease 10 (ICD10) \[14\], as confirmed by a clinical letter.
• • At risk of falls (FGA \<22/30) AND/OR having experienced a fall(s) in the last 12 months.
• • VESTIBULAR COHORT who will fulfill the additional criteria
• * Individuals with a diagnosis of a vestibular disorder (peripheral and/or mixed peripheral and central):
• • Peripheral vestibular disorder in which the balance problem lies in the vestibular/balance system within the inner ear.
• • Mixed vestibular disorder in which the balance problem lies in the vestibular/balance system within the inner ear (peripheral) and involving the nerves or neuronal network in the brain/brainstem responsible for balance (central).
• • Chronic dizziness and/or unsteadiness (\>3 months duration) that started at the time or after the vestibular disorder diagnosis.
• • Dizziness handicap inventory (DHI \>34) AND/OR At risk of falls (FGA \<22/30)
• LONG COVID-19 COHORT who will fulfill the additional criteria:
• • Individuals with laboratory confirmed diagnosis of Covid (\>6 months prior to study onset), as confirmed by a clinical letter.
• • Who have been diagnosed with long Covid, as confirmed by a clinical letter.
• • Who have chronic dizziness and/or unsteadiness which started after the Covid illness (self-report by the patient; duration \>3 months).
• • Dizziness handicap inventory (DHI \>34) AND/OR At risk of falls (FGA \<22/30)
• Exclusion Criteria:
• • Outside of the stated age bracket
• • Unable to walk independently (even with use of a walking stick)
• • MOCA score \<23
• • Score of 10 or higher on depression subscale of HADS
• • Unwilling to comply with study procedures, proposed training and testing regime
• • No capacity to consent
• • Significant visual impairment or homonymous hemianopia (stroke cohort only) (self-reported)
• • Orthostatic hypotension or uncontrolled hypertension
• • Other neurological problem (e.g. Parkingson's disease, Multiple Sclerosis etc.)
• • Language and communication deficits impairing ability to express thoughts (e.g. Aphasia)
• • Has participated in a clinical drug trial in the past 6 months.
• • Acute musculoskeletal injury that prevents participation in a structured exercise programme (e.g. lower limb fracture).
• • Has an implanted medical device or cardiac pacemaker.
• • Diagnosis of unstable Meniere's or with more than 4 migraines/month at the time of participating in the study
• • Not fulfilling the inclusion criteria for one of the sub-groups (such as criteria for Stroke group, or MCI group, or chronic vestibular disorder group, or long-Covid group), as outlined above.
• • Unable to provide a clinical letter confirming diagnosis.
• • For those with stroke, no visual spatial neglect.