Advertisement

A Shoe Insole Delivering Subsensory Vibratory Noise Improves Balance and Gait in Healthy Elderly People

Published:October 24, 2014DOI:https://doi.org/10.1016/j.apmr.2014.10.004

      Abstract

      Objectives

      To test whether subsensory vibratory noise applied to the sole of the foot using a novel piezoelectric vibratory insole can significantly improve sensation, enhance balance, and reduce gait variability in elderly people, as well as to determine the optimal level of vibratory noise and whether the therapeutic effect would endure and the user's sensory threshold would remain constant during the course of a day.

      Design

      A randomized, single-blind, crossover study of 3 subsensory noise stimulation levels on 3 days.

      Setting

      Balance and gait laboratory.

      Participants

      Healthy community-dwelling elderly volunteers (N=12; age, 65–90y) who could feel the maximum insole vibration.

      Interventions

      A urethane foam insole with the piezoelectric actuators delivering subsensory vibratory noise stimulation to the soles of the feet.

      Main Outcome Measures

      Balance, gait, and timed Up and Go (TUG) test.

      Results

      The vibratory insoles significantly improved performance on the TUG test, reduced the area of postural sway, and reduced the temporal variability of walking at both 70% and 85% of the sensory threshold and during the course of a day. Vibratory sensation thresholds remained relatively stable within and across study days.

      Conclusions

      This study provides proof of concept that the application of the principle of stochastic resonance to the foot sole sensory system using a new low-voltage piezoelectric technology can improve measures of balance and gait that are associated with falls. Effective vibratory noise amplitudes range from 70% to 85% of the sensory threshold and can be set once daily.

      Keywords

      List of abbreviations:

      COP (center of pressure), CV (coefficient of variation), ICC (intraclass correlation coefficient), SR (stochastic resonance), TUG (timed Up and Go)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Centers for Disease Control and Prevention
        National Center for Injury Prevention and Control. Division of Unintentional Injury Prevention. Falls among older adults: an overview.
        Centers for Disease Control and Prevention, Atlanta2008
        • Forrest G.
        • Huss S.
        • Patel V.
        • et al.
        Falls on an inpatient rehabilitation unit: risk assessment and prevention.
        Rehabil Nurs. 2012; 37: 56-61
        • Richardson J.K.
        • Ashton-Miller J.A.
        Peripheral neuropathy: an often-overlooked cause of falls in the elderly.
        Postgrad Med. 1996; 99: 161-172
        • Richardson J.K.
        • Hurvitz E.A.
        Peripheral neuropathy: a true risk factor for falls.
        J Gerontol A Biol Sci Med Sci. 1995; 50: M211-M215
        • Thurman D.J.
        • Stevens J.A.
        • Rao J.K.
        Practice parameter: assessing patients in a neurology practice for risk of falls (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.
        Neurology. 2008; 70: 473-479
        • Collins J.J.
        • Imhoff T.T.
        • Grigg P.
        Noise-enhanced tactile sensation.
        Nature. 1996; 383: 770
        • Sejdic E.
        • Lipsitz L.A.
        Necessity of noise in physiology and medicine.
        Comput Methods Programs Biomed. 2013; 111: 459-470
        • Priplata A.A.
        • Niemi J.B.
        • Harry J.D.
        • Lipsitz L.A.
        • Collins J.J.
        Vibrating insoles and balance control in elderly people.
        Lancet. 2003; 362: 1123-1124
        • Priplata A.A.
        • Patritti B.L.
        • Niemi J.B.
        • et al.
        Noise-enhanced balance control in patients with diabetes and patients with stroke.
        Ann Neurol. 2006; 59: 4-12
        • Galica A.M.
        • Kang H.G.
        • Priplata A.A.
        • et al.
        Subsensory vibrations to the feet reduce gait variability in elderly fallers.
        Gait Posture. 2009; 30: 383-387
        • Podsiadlo D.
        • Richardson S.
        The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.
        J Am Geriatr Soc. 1991; 39: 142-148
        • Herman T.
        • Giladi N.
        • Hausdorff J.M.
        Properties of the ‘timed up and go’ test: more than meets the eye.
        Gerontology. 2011; 57: 203-210
        • Shumway-Cook A.
        • Brauer S.
        • Woollacott M.
        Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go test.
        Phys Ther. 2000; 80: 896-903
        • Golriz S.
        • Hebert J.J.
        • Foreman K.B.
        • Walker B.F.
        The reliability of a portable clinical force plate used for the assessment of static postural control: repeated measures reliability study.
        Chiropr Man Therap. 2012; 20: 14
        • Prieto T.E.
        • Myklebust J.B.
        • Hoffmann R.G.
        • Lovett E.G.
        • Myklebust B.M.
        Measures of postural steadiness: differences between healthy young and elderly adults.
        IEEE Trans Biomed Eng. 1996; 43: 956-966
        • Brach J.S.
        • Perera S.
        • Studenski S.
        • Newman A.B.
        The reliability and validity of measures of gait variability in community-dwelling older adults.
        Arch Phys Med Rehabil. 2008; 89: 2293-2296
        • Wuehr M.
        • Schniepp R.
        • Schlick C.
        • et al.
        Sensory loss and walking speed related factors for gait alterations in patients with peripheral neuropathy.
        Gait Posture. 2014; 39: 852-858
        • Manor B.
        • Wolenski P.
        • Li L.
        Faster walking speeds increase local instability among people with peripheral neuropathy.
        J Biomech. 2008; 41: 2787-2792
        • Dingwell J.B.
        • Cusumano J.P.
        • Sternad D.
        • Cavanagh P.R.
        Slower speeds in patients with diabetic neuropathy lead to improved local dynamic stability of continuous overground walking.
        J Biomech. 2000; 33: 1269-1277
        • Bernard-Demanze L.
        • Vuillerme N.
        • Ferry M.
        • Berger L.
        Can tactile plantar stimulation improve postural control of persons with superficial plantar sensory deficit?.
        Aging Clin Exp Res. 2009; 21: 62-68
        • Lord S.R.
        • Rogers M.W.
        • Howland A.
        • Fitzpatrick R.
        Lateral stability, sensorimotor function and falls in older people.
        J Am Geriatr Soc. 1999; 47: 1077-1081