THE EFFECTS OF MYLAR TECHNOLOGY ON BALANCE AND SWAY VELOCITY USING NEUROCOM INSTRUMENTATION By: Eberline, Thomas; Hudson, Seth; Johnson, Benjamin; Lieberman, Micah; McDonald, Ian Advisor: Rodger Tepe, PhD A senior research project submitted in partial requirement for the degree Doctor of Chiropractic April 14, 2011 THE EFFECTS OF MYLAR TECHNOLOGY ON BALANCE AND SWAY VELOCITY USING NEUROCOM INSTRUMENTATION By: Eberline, Thomas; Hudson, Seth; Johnson, Benjamin; Lieberman, Micah; McDonald, Ian Abstract Purpose The purpose of this study was to investigate if the Mylar Technology that is embedded in Power Balance bracelets can increase functional sway velocity, and improve balance in participants through a double blind study designed and performed by senior interns at Logan College of Chiropractic‟s research facility. Active balance and stability was measured by the use of the NeuroCom International‟s Balance Master System and two of its tests: Modified Clinical Test of Sensory Interaction and Balance (mCTSIB), Limits of Stability test (LOS). Methods This study was comprised of one group of twenty-five (25) consenting participants; each participant was part of both the control group as well as the experimental group. Participant recruitment was executed through fliers around Logan College of Chiropractic, and through classroom announcements. Participants were required to be of ages 18 to 45 years old and in good health, with no known injuries/ailments at the time of the experiment which would change the results of the study. These ailments included known vestibular problems, known muscle strains, sprains, or tears. Also, participants could not have been on any muscle relaxers throughout the course of the study or any other medication that could hinder motor control or tonicity of one‟s muscles. Participants were also asked to self-report their height and weight. Results The results obtained from the mCTSIB test and the LOS tests yielded no significant increase in performance when the subjected were wearing the Power Balance bracelets as opposed to wearing a sham bracelet. The only increase in performance noted was found with the Directional Control test. There was a 1.5% increase in control of movement in the intended direction versus extraneous movement. All other tests performed showed either a slightly higher or equal performance by the sham group. Conclusion No evidence was obtained which showed an increase in balance or sway velocity while a subject was wearing a Power Balance bracelet. Any positive result apart from this experiment is likely due to some immeasurable attribute such as a placebo effect. However, the data so not support any improvement in performance be it physiologic or placebo induced. Key Words Balance, sway velocity, equilibrium Eberline; Hudson, et al: Mylar Technology and Balance 1 THE EFFECTS OF MYLAR TECHNOLOGY ON BALANCE AND SWAY VELOCITY USING NEUROCOM INSTRUMENTATION Introduction The purpose of this study was to investigate whether the Mylar Technology that is embedded in Power Balance bracelets can improve balance and increase functional sway velocity in participants through a double blind study designed and performed by senior interns at Logan College of Chiropractic‟s research facility. Relationships between overall control and stability when performing the tasks of NeuroCom‟s tests during the control period versus the placebo period of investigation will be the main concentration of data collection. Studies of functional balance, control, and sway velocity and their relationships together have clinical value; especially when analyzed with NeuroCom‟s system. For instance, these interpretations using NeuroCom can aid in diagnosis and treatment of conditions like short leg and upper cross syndromes, as well as more serious conditions such as multiple sclerosis. However, this study is not designed for clinical outcomes, the latter statement on the uses of balance, control and sway velocity must be mentioned to provide the significance of these qualities. This investigation will study active or uncontrolled trends, as well as active or functional balance and the data will be collected with the aid of the NeuroCom Basic Balance Master 8.3.0. The NeuroCom can also be used for assessing balance deficits and as a neurological re-education tool in treating various balance disorders. Eberline; Hudson, et al: Mylar Technology and Balance 2 1 According to Logan College of Chiropractic‟s Research Department , the NeuroCom Balance Master system is described as: “(A system) designed to identify potential fall candidates, determine ankle and knee status, limits of stability, and other factors in balance compromised patients. Test results are compared to age and gender dependent normal ranges to determine the appropriate levels of balance control and stability. Balance training is both a function of proprioception and stabilization exercises, sway velocity conditioning and weight- shifting exercises. The NeuroCom uses a safe, controlled and reproducible Force Plate that measures deflection of axial load forces on four strain gauges. Starting with a completely firm surface and progressing through levels of instability, the patient facilitates activities that distract the patient from concentrating on balance. The device documents and records patient progress through a series of reproducible neuromuscular training protocols and biofeedback graphics. The NeuroCom Balance Master evaluates neuromuscular control by quantifying the ability to maintain dynamic postural stability on both a stable and unstable surface. The surface instability is created by the addition of a foam block to the force platform. The NeuroCom Balance Master is extremely effective, providing instantaneous feedback that makes it easy for patients to relate to and reproduce specified motion patterns. Starting with a completely firm surface, progressing through an unstable surface, maximum stimulation of joint mechanoreceptors is insured.” Methods 1 Assessed February 20, 2011 on the world wide web at: http://www.logan.edu/SubPages.aspx?pID=227&mhID=261&shID=135&splpID=23 Eberline; Hudson, et al: Mylar Technology and Balance 3 Participants This study was approved by the Logan College Institutional Review Board. Twenty-five (25) consenting Logan College of Chiropractic students, both male and female, between the ages of 18 and 45 volunteered to participate in this study. Prospective students were excluded from the study if any of the following applied: currently taking medications of muscle relaxers or any medication that can cause a decrease in motor control or normal spasticity of muscle, past/present vestibular problems, known muscle strains/sprains/ tears, pregnancy, spinal cord injuries, and any lower extremity injury within the last six months. Instruments The measurements of this investigation, as stated, were performed with the use of one primary instrument to keep the correlation of data as precise or controlled as possible. NeuroCom‟s Basic Balance Master 8.3.0 was the primary instrument utilized when participants performed balance and functional control activities. These movements and activities were collected and evaluated by this system‟s computer program. The NeuroCom equipment consists of a balance plate and computer software that assesses the active balance parameters. Measurement capable functional movements that were utilized were collected during a Modified Clinical Test of Sensory Interaction and Balance (CTSIB) and the Limit‟s of Stability (LOS) test. Procedures After the participants signed a consent form and fulfilled the initial requirement to partake in the investigation, the participants were directed to the NeuroCom system. Here, they were put through a series of tests. The first test, a Modified Clinical Test of Sensory Interaction Eberline; Hudson, et al: Mylar Technology and Balance 4 and Balance (CTSIB) was performed on each of the participants. This measured balance (via Center of Gravity calculations) on a stable and unstable surface; with eyes open and closed. The Limits of Stability (LOS) test was second and as the participant, on a completely firm surface, progressed through levels of instability. The individual facilitated activities that distracted them from concentrating on balance. This instability was created by the addition of a foam block to the force platform. The resulting data was compiled by the computer program and saved in specific file formats so further interpretation and analysis could be applied. After confirming proper compilations of data following completion of the two tests, the participants were dismissed. Results Data were collected for all research subjects using the NeuroCom Balance Master System. Figures 1 and 2 provide examples of the data collection for the Modified CTSIB test and the LOS test. The Modified CTSIB test consisted of twelve trials, three with the subject‟s eyes open on a firm surface, three with the subject‟s eyes closed on a firm surface, three with the subject‟s eyes open on foam surface, and three with the subject‟s eyes closed on a foam surface. The values from the twelve trials were then averaged to determine a comprehensive or average score for comparison. The trials were performed in order to determine the effects of the Mylar technology versus a sham study on sway velocity. The LOS test was performed to monitor the patient‟s reaction time, movement velocity, endpoint excursion, maximum excursion, and directional control. These parameters involved in this test are intended to compare the effects of the Mylar Technology on the participant‟s center of gravity to a sham test. Eberline; Hudson, et al: Mylar Technology and Balance 5 Figure 1: example CTSIB data report Modified Clinical Test of Sensory Interaction and Balance (mCTSIB) - Comprehensive Report 1. The COG traces for each trial shown at the top of the report also include numerical values indicating the sway velocity in degrees per second and total duration (in seconds) of the trial. 2. Mean COG Sway Velocity for each condition is shown as a bar graph. 3. Comp or Composite Sway is the mean sway velocity averaged over the thirty (25) trials. 4. COG Alignment reflects the patient's Center of Gravity (COG) position relative to the center of the base of support at the start of each trial of the SOT. Normal individuals maintain their COG near the center of the support base. 5. The shaded area on each graphic represents performance outside of the normative data range. Green bars indicate performance within the normal range; Red bars indicate performance outside the normal range. A numerical value is given at the top of each bar. Eberline; Hudson, et al: Mylar Technology and Balance 6 Figure 2: Example LOS data report Limits of Stability (LOS) - Comprehensive Report 1. The COG traces for each trial are shown at the top left of the report. 2. Reaction Time (RT) is the time in seconds between the command to move and the patient's first movement. 3. Movement Velocity (MVL) is the average speed of COG movement in degrees per second. 4. Endpoint Excursion (EPE) is the distance of the first movement toward the designated target, expressed as a percentage of maximum LOS distance. The endpoint is considered to be the point at which the initial movement toward the target ceases. 5. Maximum Excursion (MXE) is the maximum distance achieved during the trial. 6. Directional Control (DCL) is a comparison of the amount of movement in the intended direction (towards the target) to the amount of extraneous movement (away from the target). 7. The shaded area on each graphic represents performance outside of the normative data range. Green bars indicate performance within the normal range; Red bars Eberline; Hudson, et al: Mylar Technology and Balance 7 indicate performance outside the normal range. A numerical value is given at the top of each bar. Results Review of the data acquired in the Modified CTSIB test shows no significant impact of the Power Balance bracelet on sway velocity. In fact, the average comprehensive score for the sham test was .1 degree/sec higher than the average comprehensive score for the Power Balance test group. Figure 3 demonstrates this comparison. Figure 3: (mCTSIB) Comprehensive Sway analysis All but one of the Limits of Stability tests demonstrated no significant increase in performance with the subject wearing the Power Balance bracelet. These tests included Reaction Time, Movement Velocity, Endpoint Excursion, and Maximal Excursion, see Figures 4, 5, 6, and 8. Directional Control (Figure 7), however, was increased with the Mylar Technology group. The average of the Comprehensive Directional Control values for the sham group was 77.9% and the average of the Comprehensive Directional Control values for the Power Balance group was 79.4%. This is the only significant increase in performance noted with the subjects wearing Eberline; Hudson, et al: Mylar Technology and Balance 8 the Power Balance bracelet. The other tests, Reaction Time, Movement Velocity, Endpoint Excursion, and Maximal Excursion yielded slightly higher or equal performance by the sham group. Thus, according to this research study, there is no significant evidence to support the claim that Mylar Technology improves balance, coordination, and overall performance aside from a plausible mild increase in directional control. However, this result is likely due to outlying numbers found within the values obtained during the test. Figure 4: Movement Velocity (MVL) - average speed of center of gravity movement in degrees/sec Eberline; Hudson, et al: Mylar Technology and Balance 9