AzTrials
AzTrials

Traumatic Brain InjuryCMTNCT06473987

Personalized Cognitive Integrated Motor Training Using Virtual Reality to Improve Gait and Balance

A study testing Personalized cognitive-sensorimotor VR/AR training and Traditional dual-task training in people with Traumatic Brain Injury, run by Kessler Foundation at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

Problems with walking and balance are common after traumatic brain injury (TBI). Walking and balance problems limit independence and increase risk for injuries due to falls. The purpose of this research study is to test the effectiveness of training that combines moving and thinking tasks, referred to as Personalized… Read more about this study

Who is it for?
Ages 18 to 65 years
Conditions the study is for
Traumatic Brain Injury
What is being tested?
Personalized cognitive-sensorimotor VR/AR training and Traditional dual-task training
Could I receive a placebo?
No, everyone receives an active treatment
How many people
135 participants
Where
1 siteUnited States
Study dates
1 Dec 2024to 29 Sep 2028
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Be between 18-65 years of age.
  • Be a person living with TBI for at least 6 months.
  • Be able to follow directions and commands.
  • Be able to speak and understand English well as evaluated by a test I will be given by the researchers.
  • Not have amnesia (as determined by study staff based on a Post Traumatic Amnesia O-log score of > 20 on 2 consecutive days)
  • Have approval from a physician to participate.
Show all 11Show fewer
  • Have no history of injury or problems with my legs in the past 6 months or any medical issue which would interfere with my ability to bear weight on my legs and walk (such as a bone or muscle injury).
  • No double vision (diplopia) or other vision problems (such as nystagmus, as determined by study staff)
  • Have joint passive range of motion within normal functional limits for walking as determined by study staff.
  • Have a walking speed of less than 0.8 m/s as determined by study staff.
  • Be able to stand for 5 minutes.

Who cannot join

  • I have uncontrolled or unstable seizure disorder (such as epilepsy).
  • I have pre-existing condition that makes it difficult for me to exercise (such as diagnosed high blood pressure that is not controlled, heart disease, irregular heart rate or rhythm, or congestive heart failure).
  • I have muscle or nervous system problems other than TBI (such as spinal cord injury, multiple sclerosis, or Parkinson's disease)
  • Have any joint or muscle tightness that would limit my movement while walking.
  • I have any medical issue that prevents me from supporting my weight (such as bone or muscle injuries, pain, or severe muscle spasms).
  • I have been diagnosed with cognitive (thinking) problems prior to TBI.
  • I have severe dizziness (Dizziness Handicap Inventory score greater than 54 (as measured by study staff).
  • I have skin issues that would prevent me from wearing a safety harness.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Kiran K Karunakaran, Ph.D. contact

973-324-3590

kkarunakaran@kesslerfoundation.org

United States1 site, 1 recruiting
  • Kessler Foundation

    West Orange, New Jersey, 07052

    Recruiting

Other trials in United States

About this study

Official title: Personalized Cognitive Integrated Motor Training Using Virtual Reality to Improve Gait and Balance in People with Traumatic Brain Injury

Problems with walking and balance are common after traumatic brain injury (TBI). Walking and balance problems limit independence and increase risk for injuries due to falls. The purpose of this research study is to test the effectiveness of training that combines moving and thinking tasks, referred to as Personalized cognitive integrated sensorimotor virtual reality (VR)/augmented reality (AR) training on walking and balance ability. The study will also help to understand the changes in thinking ability and brain activity as a result of this training after a brain injury.

The study will evaluate the differences between three intervention groups (n=45 each): 1) personalized cognitive integrated sensorimotor VR/AR training (CMT), 2) traditional dual-task training (CTRL), and 3) standard of care (SOC) on gait, balance, community ambulation, and cognitive functions, as well as underlying biomechanical and neurophysiological mechanisms to understand the changes due to CMT.

Read the detailed description

Traumatic brain injury (TBI) affects 2.87 million people annually in the US and is a leading cause of long-term disability. TBI impairs both cognitive and sensorimotor functions, with debilitating consequences on ambulation (gait \& balance), which persist during the chronic stages of recovery. Individuals with TBI-induced gait \& balance dysfunction are at a higher risk of falls leading to another TBI. Gait \& balance control is a complex interplay between various cognitive and motor processes, and disruption of any of these processes can severely affect gait \& balance and result in falls. Research examining TBI-related changes in cognitive demands associated with gait \& balance control has shown increased cognitive demand to perform gait \& balance tasks in individuals with TBI, with increases in cognitive demand for more complex tasks. This strong link between cognitive (attention, processing speed \& executive function) and sensorimotor functions is the basis for the proposed project. The investigators aim to strengthen this inseparable link using a novel cognitive-motor intervention.

The investigators propose a training regimen, cognitive integrated sensorimotor training (CMT), which increases the cognitive-motor effort to perform the tasks. CMT uses virtual and augmented reality (VR/AR) to employ the cognitive system to perform the motor task in order to train the inseparable cognitive and motor components that are critically important for gait \& balance function. Here the cognitive task is "incorporated" into the motor task, as the cognitive task is a relevant prerequisite for successfully completing the sensorimotor task. The investigators hypothesize that CMT will maximize gait \& balance function and reduce falls in adults with TBI.

The study will evaluate the differences between three intervention groups (n=45 each): a) personalized cognitive integrated sensorimotor VR/AR training (CMT), b) traditional dual-task training (CTRL), and c) standard of care (SOC) on gait, balance, community ambulation, and cognitive functions, as well as underlying biomechanical and neurophysiological mechanisms to understand the changes due to CMT.

Being tested
Personalized cognitive-sensorimotor VR/AR training, Traditional dual-task training, Standard of Care
Keywords
Traumatic Brain Injury, Gait, Balance, Cognition, Ambulation
Medical subject headings
Brain Injuries, Traumatic

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Personalized cognitive-sensorimotor VR/AR trainingOther

    Also called cognitive-motor training

    Thinking task integrated walking and balance training program

  • Traditional dual-task trainingOther

    Also called Dual task training

    Walking and balance training similar to standard of care group but will also perform additional thinking tasks during training

  • Standard of CareOther

    Also called conventional training

    Standard walking and balance training

Study groups in NCT06473987
Study groupRoleWhat they receive
Personalized cognitive-sensorimotor VR/AR trainingExperimentalThinking task integrated walking and balance training program
Receives: Other: Personalized cognitive-sensorimotor VR/AR training
Traditional dual-task trainingActive comparatorWalking and balance training similar to standard of care group but will also perform additional thinking tasks during training.
Receives: Other: Traditional dual-task training
Standard of CareActive comparatorStandard walking and balance training
Receives: Other: Standard of Care

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. 10 Meter walk test

    Participants will be asked to walk about 12 meters. The time taken to walk 10 meters will be recorded.

    Measured: 10 weeks

  2. Timed Up and Go (TUG)

    TUG is a clinical test of functional gait abilities and dynamic balance. The participants will be asked to walk a distance of 3 meters from a seated position, turn around, walk back to the chair and sit back in the chair. The time taken to perform the task will be recorded using a stop watch. The TUG will be repeated multiple times. The participant may be asked to hold a plastic cup or count backwards by three from a randomly selected number while walking.

    Measured: 10 weeks

  3. Berg balance Assessment:

    This is a test that measures balance on a 5-point during routine tasks. The participant will be asked to perform 14 tasks involving: sitting, standing, reaching, lifting, and turning.

    Measured: 10 weeks

  4. Digit Span (Wechsler Adult Intelligence Scale [WAIS-IV])

    This test assesses attention and working memory.

    Measured: 10 weeks

  5. Flanker Inhibitory Control and Attention Test

    This test assesses the allocation of limited attentional capacities to deal with an abundance of environmental stimulation. The test measures attention and the ability to inhibit response that may interfere with the ability to achieve goals.

    Measured: 10 weeks

  6. Symbol Digit Modalities Test (SDMT)

    This test assesses processing speed without a motor component

    Measured: 10 weeks

  7. Paced Auditory Serial Addition Test (PASAT)

    This test assesses information processing speed \& ability and working memory

    Measured: 10 weeks

  8. Letter-Number Sequencing (WAIS-IV)

    This test assesses working memory

    Measured: 10 weeks

  9. Delis-Kaplan Executive Function System

    Selected subtests to assess executive function.

    Measured: 10 weeks

  10. Hopkins Verbal Learning Test Revised

    This test assesses acquisition and delayed recall of verbal information.

    Measured: 10 weeks

  11. Temporal and spatial characteristics

    This test assess gait deviations and symmetry

    Measured: 10 weeks

  12. Fall Risk

    The silver index will be measured using the Hunova (Movendo Srl., Italy) to quantify the risk of falls. The Silver Index tasks include static balance while eyes are open or closed, dynamic balance while standing on passive and elastic surfaces, limits of stability, reactive balance during perturbations, 6-meter walk, and sit-to-stand.

    Measured: 10 weeks

  13. Balance

    Root-mean-square of COM and COP displacements will be used to quantify static and dynamic balance during Silver Index tasks. COP will be obtained from Hunova. Whole body COM will be obtained using motion capture.

    Measured: 10 weeks

  14. Neurophysiological- Maximum increase in O2Hb concentration in cortical regions

    The change in the hemoglobin concentration in response to a metabolic event (neuronal) such as walking is known as the hemodynamic response (HDR) of the brain. The maximum increase following a task will be quantified as net cortical responsivity to task using functional near infrared spectroscopy (fNIRS)

    Measured: 10 weeks

  15. Participation Objective, Participation Subjective (POPS)

    POPS assesses perspectives of the respondent regarding participation in home \& community, and societal/normative ("outsider") evaluation. POPS consists of 26 items sorted into 5 categories [a) Domestic Life, b) Major Life Activities, c) Transportation, d) Interpersonal Interactions and Relationships, e) Community, Recreational and Civic Life].

    Measured: 10 weeks

  16. Quality of Life after Brain Injury (QOLIBRI)

    This assesses QoL in people with TBI and is a 37-item scale with six subscales. The first part assesses "satisfaction level" with Health-related Quality of Life (HRQOL) and is composed of 6 overall items and 29 items assigned to 4 subscales: a) thinking, b) feelings and emotion, c) autonomy in daily life, and d) social aspects. The second part is devoted to "bothered" questions and composed of 12 items in 2 subscales: a) negative feelings, and b) restrictions. Responses to the 'satisfaction' items are coded on a 1 to 5 scale, where 1= "not at all satisfied" and 5= "very satisfied". Responses to the 'bothered' items are reverse scored to correspond with the satisfaction items, where 1=" very bothered" and 5= "not at all bothered".

    Measured: 10 weeks

Secondary outcomes (9)
  1. 6 Minute Walk Test

    Participants walk as far as possible for 6 minutes. They walk back and forth around the cones along an unobstructed pathway of 15 meters. They will be permitted to slow down or stop as necessary. The distance covered by the participant for the 6 minutes will be recorded at an interval of every 30 seconds using a measuring wheel and stop watch.

    Measured: 10 weeks

  2. Dynamic Gait Index (DGI)

    DGI is a measurement tool commonly used to assess dynamic balance, gait and risk for falls29. It consists of a total of eight gait assessments which can be scored on a four-point ordinal scale, ranging from 0-3, where '0' indicates the lowest level of function and '3' the highest level of function, allowing for a total possible score of 24.

    Measured: 10 weeks

  3. Walking While Talking Test

    The participants walk 20 ft, turn, and return while reciting the alphabet aloud from a given alphabet (simple) or alternate alphabets (complex).

    Measured: 10 weeks

  4. Area under the curve (AOC)

    AOC of O2Hb for each region of interest will be computed

    Measured: 10 weeks

  5. minimum change in O2Hb

    The minimum change following a task will be quantified using fNIRS.

    Measured: 10 weeks

  6. functional connectivity

    Functional connectivity between channels during rest and walking will be evaluated.

    Measured: 10 weeks

  7. Electromyography

    Electromygraphy (EMG) will be recorded as a complementary measure to fNIRS. Bilateral muscle responses from lower extremities will be recorded via surface EMG.

    Measured: 10 weeks

  8. Community Integration Questionnaire (CIT)

    The questionnaire is used to assess the societal role limitations and community integration of people with TBI. The CIT contains 15 items assessing community integration across three domains: a) Home integration (10 Points), b) Social integration (12 points), and c) Productive activity (7 points). Total scores ranges from 0 to 29 points. High scores represent greater independence and community integration.

    Measured: 10 weeks

  9. Patient Competency Rating Scale (PCRS)

    Instrument to assess the ability to perform a variety of activities, skills, and tasks. PCRS is a 30-item self-report that asks the person with TBI to rank their ability to accomplish common daily activities (ADL, behavioral and emotional functions, cognitive and physical abilities) on a 5-point scale. An informant (relative, caregiver, or therapist) also rates the person with TBI on the same items.

    Measured: 10 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted25 Jun 2024
  2. Study start1 Dec 2024 (estimated)
  3. Primary completion31 Jul 2028 (estimated)
  4. Study completion29 Sep 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
135 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06473987
Sponsor's protocol ID
R-1262-24
Other IDs
TP230307
Acronym
CMT
Status last verified
Sep 2024
First submitted
19 Jun 2024
Last updated
27 Nov 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A study testing Personalized cognitive-sensorimotor VR/AR training and Traditional dual-task training in people with Traumatic Brain Injury, run by Kessler Foundation at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 11 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 27 Nov 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Kiran K Karunakaran, Ph.D. (973-324-3590, kkarunakaran@kesslerfoundation.org), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

10 Meter walk test (time frame: 10 weeks). The study lists 16 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Nov 2024.

Free account

Keep searching with a free account

You’ve used your 3 free searches for this session. Log in or create a free AzTrials account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in