Israeli-developed auditory device makes walking easier for MS patients







  A Technion Institute computer science researcher has devised an auditory
feedback system which enables patients with multiple sclerosis (MS) to
improve their gait.

Professor Yoram Baram said that the apparatus, which is an updated version of
a virtual reality visual feedback apparatus he developed a decade ago, can
also help Parkinson's disease patients walk better.

"Our earlier system was based on a visual feedback device - this one is an
auditory feedback device that has a visual element to it," he explained to
ISRAEL21c. "The apparatus we built is the size of a Walkman and is worn on a
belt. It measures body movement, processes it using a computer and then sends
a signal to the ears through earphones."

According to Baram, auditory feedback helps patients walk at a fixed pace
because gait quality is expressed through a series of sounds that a person
hears while walking.

"The user hears a ticking sound which is synchronized to his steps, rather
than hearing a rhythm track and having to respond to it. Now he hears his own
steps. If the patient doesn't have a balanced, steady walk, all he needs to
do is produce his own rhythm as an auditory cue," he said.

The 400,000 Americans suffering from MS, lack a simple, but integral element
that healthy people have to control their walking - sensory feedback from
muscle nerves, which report on muscle control, telling them if they are using
their muscles correctly or not.

"This feedback is damaged in Parkinson and MS patients and the elderly.
Parkinson's results from the production of dopamine in the brain which
affects muscle function,
and MS develops when the patient's immune system attacks the white matter
nerves in the brain," said Baram.

The most common neurological disorder diagnosed in young adults, MS affects
eyesight, mobility, bladder and bowel control, and causes chronic pain and
dizziness.

Together with Prof. Ariel Miller of the Technion's Rappaport Faculty of
Medicine and the Multiple Sclerosis and Brain Research Center at the Carmel
Medical Center in Haifa, Baram examined the influence of the auditory/visual
apparatus on the gait quality of MS patients. Their work was recently
published in the important scientific publication, Journal of the
Neurological Sciences.

In the study, on-line (device on) and residual short-term therapeutic effects
on walking speed and stride length were measured in 14 randomly selected MS
patients with gait disturbances. The results showed an average improvement of
12.84% on-line and 18.75% residually in walking speed. Average improvement in
stride length was 8.30% on-line and 9.93% residually. According to Baram, the
improvement results are particularly noteworthy when compared with the lack
of change in healthy control subjects.

Baram says that the virtual reality visual feedback apparatus developed 10
years ago influences more stride length while the auditory apparatus
influences walking speed. Now that both devices have been integrated, the
patient wears the visual feedback apparatus on his eyes and the earphones are
connected to it.

"Our findings also raise the possibility of understanding the processes that
go on in the brain when processing the sensory information reaching it," he
adds.

Baram recently returned to the Technion after spending a year in the US
conducting research on the device with MS and Parkinson's patients at the
Neuroscience Institute at the University of Cincinnati, as well as at the
Parkinson's Institute at Stanford University in California.

"The device has been tested at all those places and the preliminary results
are very good. We received very positive response from our colleagues at
those institutions," he said.

Baram, who holds a PhD in electrical engineering and computer science from
MIT, once designed a mechanism for the U.S. National Aeronautics and Space
Administration that helped helicopters navigate at low altitudes around
obstacles such as electrical poles and trees. Several years after his work
for NASA he was watching television and heard a man with Parkinson's describe
how he found it easier to walk on a tiled floor since the grid pattern made
the image more stable.

Baram made a connection between his work for NASA and the Parkinson's
patient's description. The design Baram later used for the visual device was
based on the idea that optical images of fixed objects help people stabilize
themselves, whether they are walking or flying a helicopter.

One patient who tested the audio/visual system was Jack Rose, a 77-year-old
Parkinson's patient from outside Cincinnati. He told  The Cincinnati Enquirer
that the grid "makes you feel like you have something to step over," which
makes it easier to take that first step.

At the neurology clinic, Rose and other study subjects walked on a special mat
equipped with sensors that measure how fast they walk and the length of their
steps.

The information was fed into a computer so researchers could track people's
progress.
Rose's data showed his steps were short and close together at the start of the
study session, and longer and faster at the end of it, indicating his
progress from a slow shuffle to an easy, natural stride.

According to Baram, the main reason for developing the auditory element of the
device is because many of the patients are also handicapped by poor eyesight,
for which the audio device compensates.

"Some people don't see very well, and this provides an auditory channel
option. In addition, the rhythmic sound device is less expensive than the
relatively costly visual display," he said, adding that the combined device
would probably cost in the area of $1,000.

Now ensconced back at the Technion, Baram is concentrating on conducting
further testing of the auditory/visual device and looking forward to the day
when MS and Parkinson's patients will be walking steadier.

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