Study of Safety and Effectiveness of PoNS Device to Treat Chronic Balance Deficit Due to Traumatic Brain Injury (TBI)

NCT02429167 | Completed DMC

• 1 other identifier: NHC-TBI-PoNS-RT001
• Study Type: interventional
• Target: 122
• Locations: 2 countries
• Sites: 3

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.

Conditions

Traumatic Brain Injury; Chronic Balance Disorder

Keywords

Traumatic Brain Injury; Neuromodulation; Chronic Balance Disorder

Outcome Measures

Primary Outcomes (1)

• 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.

  5 weeks after the start of the intervention

Secondary Outcomes (1)

• Increase in SOT score from pre-training SOT score at the end of 2 weeks in lab training

  Two weeks after start of the intervention

Other Outcomes (2)

• Frequency of falls

  Daily for 5 weeks

• Frequency of headaches

  5 weeks

Study Arms (2)

PoNS Device

EXPERIMENTAL

Cranial nerve non-invasive neuromodulation via PoNS device. The system delivers 19 V pulses to the tongue (a nominal 5.5 kilo-ohm load).

Device: Cranial nerve non-invasive neuromodulation via PoNS device

Sham PoNS Device

SHAM COMPARATOR

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

Device: Sham PoNS device

Interventions

Cranial nerve non-invasive neuromodulation via PoNS device DEVICE

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.

PoNS Device

Sham PoNS device DEVICE

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.

Sham PoNS Device

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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

You may not qualify if:

• 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.

Sponsors & Collaborators

• Helius Medical Inc: lead

Study Sites (3)

Orlando Health

Orlando, Florida, 32806, United States

Location

Oregon Health and Science University Center for Regenerative Medicine

Portland, Oregon, 97239, United States

Location

The Montreal Neurofeedback Center

Montreal, Quebec, H4A 3L5, Canada

Location

MeSH Terms

Conditions

Brain Injuries, Traumatic

Condition Hierarchy (Ancestors)

Brain Injuries; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Craniocerebral Trauma; Trauma, Nervous System; Wounds and Injuries

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: INDUSTRY
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 20, 2015
• First Posted: April 29, 2015
• Study Start: August 1, 2015
• Primary Completion: August 18, 2017
• Study Completion: August 18, 2017
• Last Updated: February 7, 2020

Record last verified: 2020-01

Locations

US (2); CA (1)