Balance Assessment, Falls, Plantar Sensation
Conditions
Keywords
Balance, Falls, Plantar sensation
Brief summary
The goals of this observational study are to investigate the following: * If there is a relationship between prior falls, single leg stance time, and plantar cutaneous sensitivity as measured by monofilaments. * Plantar sensitivity across a broad range of ages. * Self-reported physical function related to balance and mobility using the PROMIS® PROWalk™ questionnaire and balance confidence using the Activities-specific Balance Confidence Scale-6 (ABC-6). Participants will answer questions about themselves and their balance and falls. Their plantar (bottom of their feet) sensation will also be tested using monofilaments. And they will stand on a force plate with their eyes open and closed in dual and single leg stances for up to 30 seconds.
Detailed description
Preserving sensory function, particularly in the feet, is essential for preventing falls and maintaining autonomy and health across the human lifespan. Monofilament testing is a widely used clinical tool for assessing foot sensation. In older adults, this test typically involves applying a standardized nylon filament (commonly the 10g monofilament) to specific sites on the plantar surface of the foot. Loss of sensation detected through monofilament testing often indicates peripheral neuropathy, which can be caused by aging, diabetes, or other conditions affecting nerve function. This sensory impairment significantly impacts postural control by reducing the afferent feedback needed for postural adjustments. Thus, monofilament testing serves as a diagnostic tool and a predictor of fall risk, emphasizing the critical role of sensory feedback in maintaining stability and preventing injury in aging populations. In addition to monofilament testing, single leg stance time is a strong indicator of balance, functional, and neurological health, with shorter times signaling higher fall risks, particularly in older adults. The unipedal or single leg (limb) stance test measures static postural control and is a valuable, quick screening tool in clinical settings to identify individuals in need of further evaluation or rehabilitation. Inability to hold a one-leg stand for at least 5 seconds is a red flag for potential balance issues, while a 30-second hold indicates good stability. We will expand on existing research by examining plantar sensitivity across ages and exploring links between fall history, unipedal stance time, and plantar cutaneous sensation. Primary Research Question/Hypothesis What is the relationship between physiological aging and Romberg ratio values during standing balance, and how well can age and somatosensory function explain variation in Romberg ratio values? We hypothesize that older age and reduced somatosensory function will be associated with higher Romberg ratio values (i.e., stronger dependence on vision, suggestive of somatosensory deficits) during standing balance. Secondary Research Question(s)/Hypothesis * To what extent does plantar cutaneous sensitivity at different foot sites relate to Romberg ratio values during standing balance, and which site(s) remain significant predictors after controlling for age? We believe that reduced plantar cutaneous sensitivity (higher monofilament thresholds) at medial foot sites will be associated with higher Romberg ratio values, independent of age. * How are standing Romberg ratio values related to self-reported physical function (PROMIS® PROWalk™) and balance confidence (ABC-6) across different ages? We hypothesize that self-reported physical function and balance confidence will be significant predictors of standing Romberg ratio values, such that lower PROMIS® PROWalk™ scores and lower ABC-6 scores are associated with higher Romberg ratio values, independent of age. * We will continue to evaluate whether the threshold for loss of balance sensation is lower than that for loss of protective sensation (i.e., inability to feel a 10g monofilament at 2 of 5 sites on the plantar surface of the foot). We hypothesize that impaired balance will be associated with reduced or absent plantar cutaneous sensation, regardless of age.
Interventions
OTHERNone AHT
This is an observational study that does not involve any intervention.
Sponsors
RxFunction Inc.
Study design
Observational model
ECOLOGIC_OR_COMMUNITY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Adults, ages 20 and older * Able to provide verbal consent
Exclusion criteria
* Individuals, ages 19 and younger * Inability to provide verbal consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Dual- and Single-Leg Quiet Standing Tests | About 4-5 minutes of a single 20-minute session | The dual- and single-leg quiet standing tests are static balance assessments used to quantify postural sway under eyes-open and eyes-closed conditions. These tests will be performed on a force plate to determine Romberg ratios. The Romberg ratio compares sway when visual input is removed to sway when visual input is available, providing an index of visual dependence and sensory contribution to upright balance. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Anthropometric Information | About 4-5 minutes of a single 20-minute session | We will collect information about the participants: age, sex, race, ethnicity, fall history, diagnosis of prediabetes or diabetes, diagnosis of peripheral neuropathy, etc. No Protected Health Information (PHI) will be collected. |
| PROMIS® Physical Function v2.0 PROWalk | About 2-3 minutes of a single 20-minute session | Nine items were selected from the 165 items comprising the PROMIS Item Bank v2.0 - Physical Function. Specifically, the selected items measure an individual's ability to perform various activities that involve upright mobility (balance, standing, and walking). Participants rate the nine items on a scale of 1 to 5; the raw scores are converted to T-scores for comparison to national norms. |
| Activities-specific Balance Confidence Scale-6 (ABC-6) | 2-3 minutes of a single 20-minute session | Powell and Myers developed the 16-item Activities-specific Balance Confidence (ABC) Scale to detect levels of balance confidence in older adults. Schepens et al. (2009) validated a 6-item version of the ABC, using the six most challenging activities from the 16-item scale. The six tasks are rated on a scale of 0 to 100; a score of 0 indicates no confidence and a score of 100 indicates complete confidence when performing the task. The overall score is calculated by adding the individual items then dividing by the total number of items (6). The higher the score, the greater the person's balance confidence; thus, higher scores indicate that subjects are more confident of their balance. |
| International Physical Activity Questionnaire (IPAQ)-Short Form | About 2-3 minutes of a single 20-minute session | The International Physical Activity Questionnaire (IPAQ) is a standardized self-report instrument used to assess physical activity across populations. It captures time spent walking, performing moderate and vigorous physical activity, and sitting, typically over the previous 7 days. The IPAQ is available in short and long forms; the short form is commonly used for surveillance and prevalence studies. Responses can be scored to estimate total physical activity, often expressed as MET (Metabolic Equivalent of Task)-minutes per week, and to classify activity levels as low, moderate, or high. |
| Monofilament Testing | About 2 minutes of a single 20-minute session | The Centers for Medicare \& Medicaid Services (CMS) identifies the monofilament test as the means of diagnosing loss of protective sensation (https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=171). To conduct the test, a clinician applies pressure with various sizes of monofilament to selected parts of the foot and asks the participant to indicate when he/she feels the filament. Per CMS, inability to feel a 10-gram monofilament on at least two of five test sites on either foot indicates loss of protective sensation (LOPS). |
Countries
United States
Contacts
CONTACTClinical Research Project Manager
CONTACTSenior Clinical Scientist
PRINCIPAL_INVESTIGATORLars Oddsson, PhD
RxFunction Inc.
Outcome results
None listed