Study of Safety and Effectiveness of PoNS Device to Treat Chronic Balance Deficit Due to Traumatic Brain Injury (TBI)
Primary Purpose
Traumatic Brain Injury, Chronic Balance Disorder
Status
Completed
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Cranial nerve non-invasive neuromodulation via PoNS device
Sham PoNS device
Sponsored by
About this trial
This is an interventional treatment trial for Traumatic Brain Injury focused on measuring Traumatic Brain Injury, Neuromodulation, Chronic Balance Disorder
Eligibility Criteria
Inclusion Criteria:
- Male or female, 18-65 years of age
- Documentation on initial TBI (defined as closed-head, non-penetrating, blunt, whiplash, or explosive blast-induced brain injury) severity (at time of injury): Glasgow Coma Scale (GCS) score 9-15, with loss of consciousness < 24 hours, post-traumatic amnesia ≤7 days, or hospital admission ≤ 7 days post TBI
- If female, subject is not pregnant, not lactating, has a negative pregnancy test prior to receipt of the PoNS™ device, and agrees to use contraception from screening to end of the study
- Balance disorder with SOT composite score at least 16 points below normal resulting from a mild/moderate TBI without any concomitant pathologies
- At least 1 year post injury
- Stable neurologic status
- Prior participation in a focused physical rehabilitation program for TBI and deemed by their treating clinician/themselves to have reached a plateau
- Able to walk continuously on a treadmill for 20 minutes, level grade and at any speed, with support if needed
- Access to a treadmill and commitment to utilize this for the at-home portion of the study
- Able to understand the study procedures and give informed consent
- Willing and able to adhere to the study schedule
- Willing to complete a neuropsychological evaluation prior to inclusion
Exclusion Criteria:
- Medical finding from screening history and physical examination that is clinically significant or would otherwise impact patient safety or data integrity
- Medical finding from prior neuroradiologic study or recent MRI that is significant or that would impact patient safety or data integrity
- Planned use or use of any investigational product, pharmaceutical or device within 30 days preceding receipt of the PoNS device and during the entire study
- Balance or gait deficits due to lower extremity injury or neurological condition other than TBI
- Penetrating brain injury, craniotomy or refractory subdural hematoma
- Oral health problems at the time of recruitment
- Oral surgery within 3 months of screening
- History of oral cancer
- Non-removable metal orthodontic devices that could interfere with PoNS use
- Presence of metallic implant or other MRI-incompatible device
- Blood pressure abnormalities considered clinically significant
- Use of Coumadin or other anticoagulant except aspirin in the last 6 months
- Untreated or undiagnosed diabetes
- Diabetic neuropathy
- Active or recent (within 1 year) treatment for any cancer, excluding basal cell carcinoma.
- Neurological disorders other than those attributed to the primary diagnosis (neurodegenerative diseases such as Multiple Sclerosis, Parkinson's disease, Alzheimer's disease or other dementia, Amyotrophic Lateral Sclerosis)
- History of epileptic or other seizure disorders
- Known ischemic heart disease and/or history or atrial or ventricular arrhythmias with or without syncope
- Any other untreated or unstable acute or chronic, clinically significant medical condition for which the subject is currently undergoing treatment that the study investigator deems unsuitable for inclusion
- Use of a lower extremity biomechanical prosthetic with the exception of a splint for foot drop
- Females who are pregnant, lactating, or planning to become pregnant during the study
- Chronic use of any potentially interfering medication, or use of any medication that would compromise the ability to function or perform the study activities
- Addition of and/or major change in type or dosage of any prescription medication within 3 months prior to receipt of the PoNS device
- Active alcoholism. The study investigator will have the right to exclude subject participation if the subject seems intoxicated at time of screening and/or during any study appointment.
- History of drug abuse will be assessed
- Recent history of smokeless tobacco use
- Any reason that may be a threat to health or safety
- Any finding in the neuropsychological evaluation that makes the subject unsuitable for inclusion
Sites / Locations
- Orlando Health
- Oregon Health and Science University Center for Regenerative Medicine
- The Montreal Neurofeedback Center
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Sham Comparator
Arm Label
PoNS Device
Sham PoNS Device
Arm Description
Cranial nerve non-invasive neuromodulation via PoNS device. The system delivers 19 V pulses to the tongue (a nominal 5.5 kilo-ohm load).
The sham control device appears physically identical but uses a modified stimulus waveform parameter set designed to elicit a mild tactile sensation while minimizing the net energy delivered, thereby providing minimal, if any, cranial nerve non-invasive neuromodulation via PoNS device
Outcomes
Primary Outcome Measures
Response to treatment defined as an 8 point change in the Sensory Organization Test (SOT) from baseline
The SOT is an objective, automated measure of sensory-motor integration that evaluates the functional contribution of the somatosensory, visual, and vestibular components of balance. A composite score is calculated and compared with a database normalized for age and height.
Secondary Outcome Measures
Increase in SOT score from pre-training SOT score at the end of 2 weeks in lab training
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT02429167
Brief Title
Study of Safety and Effectiveness of PoNS Device to Treat Chronic Balance Deficit Due to Traumatic Brain Injury (TBI)
Official Title
Double Blind, Randomized, Sham Controlled Study of Safety and Effectiveness of the Portable Neuromodulation Stimulator (PoNS) Device for Cranial Nerve Noninvasive Neuromodulation Training for Chronic Balance Deficit Due to Mild/Moderate TBI
Study Type
Interventional
2. Study Status
Record Verification Date
January 2020
Overall Recruitment Status
Completed
Study Start Date
August 2015 (undefined)
Primary Completion Date
August 18, 2017 (Actual)
Study Completion Date
August 18, 2017 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Helius Medical Inc
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The purpose of this study is to determine if clinic and home training with a study device will improve a balance deficit. The study device is called Portable Neuromodulation Stimulator (PoNS). The study device will be placed on the tongue to deliver nerve stimulation. The study is testing if use of the study device in conjunction with physical therapy will improve balance and gait in patients suffering from a TBI. The effects of using the device and undergoing therapy will be measured using standardized tests of movement control, gait, headache and other TBI symptoms.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Traumatic Brain Injury, Chronic Balance Disorder
Keywords
Traumatic Brain Injury, Neuromodulation, Chronic Balance Disorder
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
122 (Actual)
8. Arms, Groups, and Interventions
Arm Title
PoNS Device
Arm Type
Experimental
Arm Description
Cranial nerve non-invasive neuromodulation via PoNS device. The system delivers 19 V pulses to the tongue (a nominal 5.5 kilo-ohm load).
Arm Title
Sham PoNS Device
Arm Type
Sham Comparator
Arm Description
The sham control device appears physically identical but uses a modified stimulus waveform parameter set designed to elicit a mild tactile sensation while minimizing the net energy delivered, thereby providing minimal, if any, cranial nerve non-invasive neuromodulation via PoNS device
Intervention Type
Device
Intervention Name(s)
Cranial nerve non-invasive neuromodulation via PoNS device
Intervention Description
The PoNS is a medical device worn around the neck. The controller contains the pulse generator and a user interface. The mouthpiece, held to the top of the tongue, contains 143 circular gold electrodes that deliver a mild, controlled electric stimulation to the subject. While the subject is receiving stimulation, they will perform increasingly difficult balance, posture, gait, and movement control tasks designed to challenge existing abilities. Each training session takes approximately one hour to complete, and is separated by an interval of 2-2.5 hours.
Intervention Type
Device
Intervention Name(s)
Sham PoNS device
Intervention Description
The PoNS is a medical device worn around the neck. The controller contains the pulse generator and a user interface. The mouthpiece, held to the top of the tongue, contains 143 circular gold electrodes that deliver a mild, controlled electric stimulation to the subject. The sham control device is physically identical but uses a modified stimulus waveform parameter set designed to elicit a mild tactile sensation while minimizing the net energy delivered, minimizing any neuromodulatory effect. While the subject is receiving stimulation, they will perform increasingly difficult balance, posture, gait, and movement control tasks designed to challenge existing abilities. Each training session takes approximately one hour to complete, and is separated by an interval of 2-2.5 hours.
Primary Outcome Measure Information:
Title
Response to treatment defined as an 8 point change in the Sensory Organization Test (SOT) from baseline
Description
The SOT is an objective, automated measure of sensory-motor integration that evaluates the functional contribution of the somatosensory, visual, and vestibular components of balance. A composite score is calculated and compared with a database normalized for age and height.
Time Frame
5 weeks after the start of the intervention
Secondary Outcome Measure Information:
Title
Increase in SOT score from pre-training SOT score at the end of 2 weeks in lab training
Time Frame
Two weeks after start of the intervention
Other Pre-specified Outcome Measures:
Title
Frequency of falls
Time Frame
Daily for 5 weeks
Title
Frequency of headaches
Description
Frequency of headaches will be assessed using the headache disability index
Time Frame
5 weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Male or female, 18-65 years of age
Documentation on initial TBI (defined as closed-head, non-penetrating, blunt, whiplash, or explosive blast-induced brain injury) severity (at time of injury): Glasgow Coma Scale (GCS) score 9-15, with loss of consciousness < 24 hours, post-traumatic amnesia ≤7 days, or hospital admission ≤ 7 days post TBI
If female, subject is not pregnant, not lactating, has a negative pregnancy test prior to receipt of the PoNS™ device, and agrees to use contraception from screening to end of the study
Balance disorder with SOT composite score at least 16 points below normal resulting from a mild/moderate TBI without any concomitant pathologies
At least 1 year post injury
Stable neurologic status
Prior participation in a focused physical rehabilitation program for TBI and deemed by their treating clinician/themselves to have reached a plateau
Able to walk continuously on a treadmill for 20 minutes, level grade and at any speed, with support if needed
Access to a treadmill and commitment to utilize this for the at-home portion of the study
Able to understand the study procedures and give informed consent
Willing and able to adhere to the study schedule
Willing to complete a neuropsychological evaluation prior to inclusion
Exclusion Criteria:
Medical finding from screening history and physical examination that is clinically significant or would otherwise impact patient safety or data integrity
Medical finding from prior neuroradiologic study or recent MRI that is significant or that would impact patient safety or data integrity
Planned use or use of any investigational product, pharmaceutical or device within 30 days preceding receipt of the PoNS device and during the entire study
Balance or gait deficits due to lower extremity injury or neurological condition other than TBI
Penetrating brain injury, craniotomy or refractory subdural hematoma
Oral health problems at the time of recruitment
Oral surgery within 3 months of screening
History of oral cancer
Non-removable metal orthodontic devices that could interfere with PoNS use
Presence of metallic implant or other MRI-incompatible device
Blood pressure abnormalities considered clinically significant
Use of Coumadin or other anticoagulant except aspirin in the last 6 months
Untreated or undiagnosed diabetes
Diabetic neuropathy
Active or recent (within 1 year) treatment for any cancer, excluding basal cell carcinoma.
Neurological disorders other than those attributed to the primary diagnosis (neurodegenerative diseases such as Multiple Sclerosis, Parkinson's disease, Alzheimer's disease or other dementia, Amyotrophic Lateral Sclerosis)
History of epileptic or other seizure disorders
Known ischemic heart disease and/or history or atrial or ventricular arrhythmias with or without syncope
Any other untreated or unstable acute or chronic, clinically significant medical condition for which the subject is currently undergoing treatment that the study investigator deems unsuitable for inclusion
Use of a lower extremity biomechanical prosthetic with the exception of a splint for foot drop
Females who are pregnant, lactating, or planning to become pregnant during the study
Chronic use of any potentially interfering medication, or use of any medication that would compromise the ability to function or perform the study activities
Addition of and/or major change in type or dosage of any prescription medication within 3 months prior to receipt of the PoNS device
Active alcoholism. The study investigator will have the right to exclude subject participation if the subject seems intoxicated at time of screening and/or during any study appointment.
History of drug abuse will be assessed
Recent history of smokeless tobacco use
Any reason that may be a threat to health or safety
Any finding in the neuropsychological evaluation that makes the subject unsuitable for inclusion
Facility Information:
Facility Name
Orlando Health
City
Orlando
State/Province
Florida
ZIP/Postal Code
32806
Country
United States
Facility Name
Oregon Health and Science University Center for Regenerative Medicine
City
Portland
State/Province
Oregon
ZIP/Postal Code
97239
Country
United States
Facility Name
The Montreal Neurofeedback Center
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H4A 3L5
Country
Canada
12. IPD Sharing Statement
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Study of Safety and Effectiveness of PoNS Device to Treat Chronic Balance Deficit Due to Traumatic Brain Injury (TBI)
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