Postural Stability Deficiencies in Asymptomatic Individuals With HIV
Primary Purpose
HIV, Balance, Vestibular Disorder
Status
Completed
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Postural Stability Testing
Sponsored by
About this trial
This is an interventional screening trial for HIV focused on measuring HIV, Balance, Vestibular, Somatosensory, postural stability, center of pressure
Eligibility Criteria
Inclusion Criteria:
- CD4 levels above 300,
- age within the range of 25-57 years
- walks without assistive device
- tolerates standing position for at least 30 minutes
- stable cardiorespiratory system.
Exclusion Criteria:
- diagnosis of AIDS (CD4 levels less than 200)
- diagnosis of Diabetes, Dementia or Arthritis
- severe neuropathy
- severe balance impairments
- severe visual acuity problems that are not treated
- BMI > 40,
- decreased functional strength in the lower extremities
- severe proprioception impairments
- falls during the last 6 months
- back or lower extremities lesion or surgery during the last 6 months
- the use of medications that causes drowsiness 24 hours previous to intervention
- women that are pregnant or think they might be pregnant
Sites / Locations
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Asymptomatic persons with HIV
Arm Description
Outcomes
Primary Outcome Measures
Postural Stability
Postural stability was operationally defined by the center of pressure displacement measured by the MatScan® pressure mat. These sensors detect the displacement as the body sways anterior, posterior or laterally (right or left).
Secondary Outcome Measures
Full Information
NCT ID
NCT03446677
First Posted
February 11, 2018
Last Updated
February 20, 2018
Sponsor
Texas Woman's University
1. Study Identification
Unique Protocol Identification Number
NCT03446677
Brief Title
Postural Stability Deficiencies in Asymptomatic Individuals With HIV
Official Title
Somatosensory Deficiencies Affect Postural Stability in Asymptomatic Individuals With HIV
Study Type
Interventional
2. Study Status
Record Verification Date
February 2018
Overall Recruitment Status
Completed
Study Start Date
July 22, 2014 (Actual)
Primary Completion Date
May 22, 2015 (Actual)
Study Completion Date
July 22, 2015 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Texas Woman's University
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
Persons with HIV can present vestibular system impairments, affecting postural stability. There is scarce literature related to the contribution of the visual and somatosensory systems in maintaining postural stability in persons with HIV. The purpose of this study is to describe the sensory systems used to maintain postural stability and how the sources of sensory information contributes to postural stability in asymptomatic persons with HIV. Postural stability was measured in 20 asymptomatic persons with HIV (11 male, 9 female, aged 43 ± 8 years). Static postural stability was evaluated during eight conditions that perturbed the visual, somatosensory and vestibular inputs. A paired-samples t-test was conducted to compare center of pressure (COP), antero-posterior displacement (APD) and right-left displacement (RLD) on stable and unstable surface and to characterize each balance sensory system. There was a significant difference in the COP and APD of eyes open condition compared to the remaining conditions on stable surface. Furthermore, there was a significant difference in the COP, APD and RLD for the eyes open on a foam surface compared to the remaining conditions on an unstable surface. Postural instability can be detected in asymptomatic persons with HIV under challenging conditions, previous to the evident appearance of balance impairments.
Detailed Description
The institutional review boards (IRB) of the University of Puerto Rico Medical Science Campus, reviewed and approved this study before any data collection was initiated. An informed consent was provided to each subject to access their medical records, HIV status, CD4+ cell count and as a requirement to participate in the study.
The subjects were recruited from La Perla de Gran Precio (Community wellness center that specializes in individuals with HIV) localized in San Juan, Puerto Rico. Each subject was evaluated by interview and review of their medical record for the inclusion and exclusion criteria assessment. Different tests were performed as a screening tool to identify additional limitations or impairments in the different sensory systems. To rule out severe neuropathy, the subject had to be able to detect a Semmes- Weinstein Monofilament of 5.07 or less in more than two areas of the foot.12,13 The visual system was screened using Snellen chart and the subject had to obtain at least 20/40 of visual acuity. To rule out severe balance impairments, the Romberg Test and Fukuda's Stepping Test were used. For Romberg Test, subjects had to maintain standing position for 30 seconds and Fukuda's Stepping Test required that the subject did not rotate more than 30° from the initial position or deviate more than 0.5 meters from the center of the circle. Functional strength of lower extremities was screened using a Five Times Sit to Stand test, where the subject had to complete the test in 10 seconds or less. Severe proprioception impairments were assessed using a Proprioceptive Awareness test, where the subject was asked to replicate the initial position performed by the evaluator in the contralateral ankle joint in three trials. After the screening of the inclusion and exclusion criteria, a total of 20 subjects were able to participate in the study.
Each subject was instructed to stand in a static bipedal posture on the MatScan® pressure mat and performed eight balance tasks. Data of center of pressure, antero-posterior sways and medial-lateral sways were collected in each of the conditions. Each task took 30 seconds to be performed. The first four tasks were performed with the mat on the hard surface of the floor. These four tasks are as follows:1) eyes open looking at a fixed point to evaluate all systems (EO); 2) eyes closed (with head fixed approximately 90˚) to eliminate visual input (EC); 3) eyes open looking at a fixed point and actively moving head upward and downward to alter vestibular inputs (EO+HUD). The subject was instructed to maintain a movement frequency of 60bpm and amplitude of approximately 45 degrees in each direction: neck flexion and extension; 4) eyes closed (with head fixed approximately 90˚) to eliminate visual input and the head actively moves upward and downward to alter vestibular inputs (EC+HUD). The subject is instructed to maintain the movement frequency and amplitude as described in task 3.
The subjects were asked to perform four more tasks while standing on a thick piece of balance foam that was placed on top of the MatScan®, creating an unstable surface. The remaining four tasks (tasks 5-8) are as follows: 5) eyes open looking at a fixed point while standing on the balance foam to alter somatosensory inputs (EO+BF); 6) eyes closed with head fixed approximately 90˚ while standing on the balance foam to alter somatosensory inputs and eliminate visual inputs (EC+BF); 7) eyes open looking at a fixed point and actively moving the head upward and downward while standing on the balance foam to alter somatosensory and vestibular inputs (EO+HUD+BF). The subject was instructed to maintain the movement frequency and amplitude as described in task 3; 8) eyes closed with head fixed approximately 90˚ and actively move head upward and downward while standing on the balance foam to eliminate visual inputs and alter somatosensory and vestibular inputs (EC+HUD+BF). The subject is instructed to maintain the movement frequency and amplitude as described in task 3.
Data of postural stability was obtained using the MatScan® pressure mat (TekScan, Boston, MA). The data collected from the pressure mat was analyzed with Tekscan Sway Analysis Module™ (SAM) software (TekScan, Boston, MA) designed for this purpose. Mean and standard deviation were used to describe data. The statistical software used was SPSS-20 to perform a Paired-Samples t-test and compare the center of pressure, antero-posterior and right-left body sways displacement. P values <0.05 were accepted as statistically significant.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV, Balance, Vestibular Disorder, Somatosensory Disorders, Postural Stability
Keywords
HIV, Balance, Vestibular, Somatosensory, postural stability, center of pressure
7. Study Design
Primary Purpose
Screening
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
20 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Asymptomatic persons with HIV
Arm Type
Experimental
Intervention Type
Other
Intervention Name(s)
Postural Stability Testing
Intervention Description
Each subject was instructed to stand in a static bipedal posture on the MatScan® pressure mat and performed 8 balance tasks. Data of center of pressure, antero-posterior sways and medial-lateral sways were collected in each of the conditions. Each task took 30 seconds to be performed. The first 4 tasks were performed with the mat on the hard surface of the floor. These 4 tasks are as follows: standing with eyes open, standing with eyes closed, standing with eyes open looking and actively moving head upward and downward, and standing with eyes closed and the head actively moving upward and downward. The subjects were asked to perform four more tasks while standing on a thick piece of balance foam that was placed on top of the MatScan®. The remaining 4 tasks are as follows: standing with eyes open, standing with eyes closed, standing with eyes open looking and actively moving the head upward and downward, and standing with eyes closed with head actively moving upward and downward.
Primary Outcome Measure Information:
Title
Postural Stability
Description
Postural stability was operationally defined by the center of pressure displacement measured by the MatScan® pressure mat. These sensors detect the displacement as the body sways anterior, posterior or laterally (right or left).
Time Frame
Baseline
10. Eligibility
Sex
All
Minimum Age & Unit of Time
25 Years
Maximum Age & Unit of Time
57 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
CD4 levels above 300,
age within the range of 25-57 years
walks without assistive device
tolerates standing position for at least 30 minutes
stable cardiorespiratory system.
Exclusion Criteria:
diagnosis of AIDS (CD4 levels less than 200)
diagnosis of Diabetes, Dementia or Arthritis
severe neuropathy
severe balance impairments
severe visual acuity problems that are not treated
BMI > 40,
decreased functional strength in the lower extremities
severe proprioception impairments
falls during the last 6 months
back or lower extremities lesion or surgery during the last 6 months
the use of medications that causes drowsiness 24 hours previous to intervention
women that are pregnant or think they might be pregnant
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Martin G Rosario, Ph.D
Organizational Affiliation
Texas Woman's University
Official's Role
Principal Investigator
12. IPD Sharing Statement
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Links:
URL
http://www.nlm.nih.gov/medlineplus/spanish/ency/article/003396.htm
Description
National Institute of health. (2014). Visual acuity test.
URL
http://vestibular.org/sites/default/files/page_files/Vision%20Challenges.pdf
Description
Vestibular disorders association. (2009). Vision Challenges with Vestibular Disorders.
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Postural Stability Deficiencies in Asymptomatic Individuals With HIV
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